[Toxic epidermal necrosis. Review of the theme and presentation of 20 cases]

Twenty cases of toxic epidermal necrolysis were studied. 14 male and 6 female. The peak incidence by age was in the first two decades. All of them were related to drugs. Twelve of the cases had received antibiotics and, therefore an infection existed. The remaining 8 cases did not receive antibiotics and had no concomitant infection. We emphasise the clinical observation that in 11 cases the first symptom was an increase in cutaneous sensitivity, and then a rise in temperature, malaise, and extensive cutaneous sloughing resembling extensive burns. As for complications, only in 4 patients could we demonstrate disseminated intravascular coagulation (haematological tests were carried out in only 14 patients). The commonest complication observed was glomerular nephritis. Blood counts, blood chemistry and urine tests were altered more in relation to complications than to TEN. Protein electrophoresis, conversely, showed an increase of gamma globulin in 53.3% of cases, and inverted A/G ratio in 80%. S. aureus was cultured in 12 cases (not all of them children). E.S.R. was increased in 18 cases. Pathological findings with those already described: "in toto" epidermal necrolysis, intra and subepidermal blisters, and occasional inflamatory reaction at the level of the papillae, and the non-uniform presence of melanin in basal cells and Lyell cells. Prognosis was excellent, since we only had one death and one case of blindness due to bilateral ocular perforation. This could be due to the general medical care of the patient, nursing them with D.I.C., which in certain cases substituted by heparin with excellent results. Antibiotics were used in those infected.