Toxic epidermal necrolysis

Diagnosis: Toxic epidermal necrolysis

Toxic epidermal necrolysis

Clinical Presentation

Toxic epidermal necrolysis

Clinical History

Submitted by Ellie Goulding MD. Originally posted January 23, 2017.

Treatment

See case discussion.

Differential Diagnosis

• Stevens-Johnson syndrome • Staphylococcal scalded skin syndrome • Acute GVHD • Drug reaction with eosinophilia and systemic symptoms (DRESS) • Paraneoplastic pemphigus • Generalized bullous FDE • Pemphigus vulgaris

Key Learnings

• Most severe cutaneous drug reaction — >30% BSA epidermal detachment • Mortality 25-35% — SCORTEN predicts prognosis • Same drug culprits as SJS: allopurinol, carbamazepine, sulfonamides, phenytoin, lamotrigine • Positive Nikolsky sign — full-thickness epidermal necrosis • Resembles a large superficial burn — transfer to burn center is standard • Mucosal involvement in >90% (oral, ocular, genital, respiratory) • Long-term complications: ocular scarring, cutaneous scarring, dyspigmentation

Tags: toxic, epidermal, necrolysis, ellie goulding md