Toxic Epidermal Necrolysis - UNM Biology Department Home Page
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Transcript Toxic Epidermal Necrolysis - UNM Biology Department Home Page
By Angela Cordova
TEN:
Very rare and potentially fatal
skin disorder.
First described by Alan Lyell in
1956 as “an eruption resembling
scalding of the skin”.
Usually triggered by
immunological reaction
Similar symptoms to burn
patients.
Caused by immune reaction to:
Drugs taken for the first time (most commonly)
▪ Antibiotics (penicillin), Anti-seizure agents, Butazones, and Sulfonamides
Certain types of infections
▪ S. aureus, E.coli
Some vaccinations
▪ Polio
Some viruses
New substance in system leads to:
Onset of conjunctival burning, itching, tenderness, fever,
cough, sore throat, headache, aches and pains
Followed by rapid onset of rash and blisters involving most
of skin and mucous membranes.
▪ Affects mouth, eyes, and, and genitalia more severely.
Large bullae develop and sheets of skin begin to slough
off.
▪ In severe cases there is danger to damage to larynx, bronchi, and esophagus
from ulcerations.
Excruciating pain due to rash, blisters, and shedding of
skin.
▪ Includes eyelashes, fingernails, and toenails.
SKIN STARTS SLOUGHING
SKIN COMPLETELY GONE
Affects:
People of all ages.
▪ Many times older people due to the increasing amount of meds
taken.
Both genders
▪ Women more than men.
People with immuno-compromised systems.
▪ HIV, AIDS, etc.
It is believed that most patients have an
abnormal metabolism of drug involved and it
leads to a cell-mediated cytotoxic reaction.
▪ Toxic drug metabolites accumulate in skin.
▪ Attacks keratinocytes that express a foreign antigen.
▪ Believe there is an over expression of tumor necrosis
factor a-(TNF) in epidermis.
▪ Leads to apoptosis of epidermis and stimulates
cytotoxic T-lymphocytes.
▪ Mimics a hypersensitivity reaction.
Final diagnosis is done by:
▪ Taking tissue samples from the nose, pharynx, and
unruptured blisters of those suspected patients.
▪ Samples are then cultured and organism responsible is
identified.
Mortality rates are between 10-70% for this
condition.
Factors include:
▪
▪
▪
▪
▪
▪
Dehydration
The initiation of treatment
Aggressiveness of treatment
Level of care
Amount of surface area involved
Cancer/hematologic malignancy
•
Life-threatening
sepsis.
• Severe infection
•
Keratoconjuctivitis
• Leads to impaired
vision and then
blindness
Treatment is similar to that of severe burns
▪ All suspicious meds are discontinued immediately.
▪ Maintain fluid and electrolyte balance to prevent
dehydration.
▪ Hydrotherapy to remove skin.
▪ Protection of raw skin by topical agents.
▪ Systemic antibiotic treatment with corticosteriods, used
with extreme caution.
Cohen, Victor, Jellinek, Samantha, P., Toxic
Epidermal Necrolysis, Medicine from
web.MD, www.emedicine.com, May 2,
2007.
Smeltzer, Suzanne C., Bare, Brenda, Textbook
0f Medical Surgical Nursing, Lippincott
Williams and Wilkins, 2004