Toxic epidermal necrolysis: the scalded skin syndrome

Toxic epidermal necrolysis is a condition that may occur in all age groups and resembles skin scalding. It presents as a generalized, markedly tender erythema and rapidly progresses to bullous desquamation of the superficial epidermal layers and systemic toxicity.The condition was first described in 1956. A review of the recent literature suggests that the incidence of the syndrome is increasing or it is being recognized more frequently. Its etiology has not been established, but it may represent unusual hypersensitivity to drug, bacterial, viral or immunization factors. The mortality rate in reported cases is approximately 30% and young children and debilitated adults are at greatest risk.Recently, two children with this condition were successfully treated at the Montreal Children's Hospital, using protective isolation, intensive nursing care, intravenous antibiotics and hydrocortisone hemisuccinate. Early use of corticosteroids may inhibit the progression of epidermal necrolysis and improve the prognosis.