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, May 2,  Smeltzer, Suzanne C., Bare, Brenda, Textbook 0f Medical Surgical Nursing, Lippincott Williams and Wilkins, 2004