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Emergency Toxic Epidermal Necrolysis (TEN) Management

Rapid recognition, drug withdrawal and burn-unit-style supportive care for life-threatening epidermal detachment.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Emergency Toxic Epidermal Necrolysis (TEN) Management?

Toxic epidermal necrolysis (TEN) is a severe cutaneous adverse reaction characterised by extensive epidermal detachment >30% body surface area, mucosal involvement and high mortality.

Drug-induced cytotoxic T-cell response causes keratinocyte apoptosis. Common triggers are allopurinol, antiepileptics, sulphonamides, antibiotics and NSAIDs.

Stevens-Johnson syndrome (<10%), SJS-TEN overlap (10–30%) and TEN (>30%) form a continuum. SCORTEN at admission predicts mortality and guides intensity of care.

Symptoms

Painful erythematous rash
Widespread blistering and skin sloughing
Positive Nikolsky sign
Mucosal erosion (oral, ocular, genital)
Fever and severe systemic illness
Tachycardia and hypotension
Recent drug exposure (1–4 weeks)

Risk Factors

HLA-B*15:02 carriage with carbamazepine
HLA-B*58:01 with allopurinol
HIV infection
Active malignancy
Autoimmune disease
Recent radiation therapy
Polypharmacy in elderly

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • New widespread painful rash with mucosal involvement
  • Skin sloughing or blistering
  • Recent introduction of high-risk drug
  • Eye involvement or vision change
  • Hemodynamic instability
  • Inability to swallow due to oral lesions

Treatment Methods

01
Immediate withdrawal of suspected drug
02
Transfer to burn unit or ICU
03
Aggressive fluid and electrolyte replacement
04
Wound care with non-adherent dressings
05
Ophthalmology consultation for ocular involvement
06
Cyclosporine or IVIG in selected centres
07
Pain control, nutritional support and infection surveillance

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Acil Servis Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.