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Toxic epidermal necrolysis (Lyell syndrome).
J C Roujeau1, O Chosidow, P Saiag
1Department of Dermatology, Hôpital Henri Mondor, Université Paris XII.
Journal of the American Academy of Dermatology
|December 1, 1990
Summary
Toxic epidermal necrolysis (TEN) is a severe drug reaction causing widespread skin and organ damage. Early recognition and burn unit care improve outcomes, while corticosteroids should be avoided.
Area of Science:
- Dermatology
- Toxicology
- Immunology
Background:
- Toxic epidermal necrolysis (TEN) is a rare but severe dermatologic emergency.
- Its exact pathophysiology remains poorly understood, though drug-induced hypersensitivity is suspected.
- TEN shares similarities with erythema multiforme, but its classification is debated.
Purpose of the Study:
- To review the epidemiology, clinical presentation, and management of toxic epidermal necrolysis.
- To highlight the critical role of drug triggers in TEN.
- To discuss the severe systemic complications and prognostic factors.
Main Methods:
- Review of clinical evidence and literature on toxic epidermal necrolysis.
- Analysis of drug associations and implicated medications.
- Discussion of organ involvement, complications, and therapeutic strategies.
Main Results:
- Drugs, including sulfonamides, anticonvulsants, NSAIDs, and antibiotics, are the primary cause of TEN.
- Systemic involvement can affect multiple organs, with sepsis being a major cause of mortality.
- Mortality rates range from 20-30%, higher in elderly patients and those with extensive lesions.
Conclusions:
- Aggressive supportive care, similar to burn management, is crucial for TEN survival.
- Survivors may experience long-term sequelae, particularly ocular lesions.
- Corticosteroids have shown detrimental effects and should be avoided in TEN management.