DR Medhat MRCP

• Treatment :
No specific therapies are of proven penifits even corticosteroids are controversial
General supportive measures (main line of treatment) :
- Fluid replacement if the patient is dehydrated.
- Daily RFT & electrolyes monitoring.
- Adequate nutrition (oral or NGT feeding if required)(monitor s.albumin).
- Frequent application of skin bland emollients & topical antiseptics .
DC any suspected drug cause & treat any suspected infection cause.
Involve ophthalmologist if the eye is affected.
Toxic Epidermal Necrolysis (TEN)
- A potentially life-threatening skin disorder that is mostly seen secondary to a drug
reaction (same drugs causing SJS `see before`)
- In this condition the skin develops a scalded appearance over an extensive area.
- Some authors consider TEN to be the severe end of a spectrum of skin disorders which
includes erythema multiforme and Stevens-Johnson syndrome
• Features
Systemically unwell e.g. Pyrexia, tachycardia.
Diffuse erythema (> 10% of skin surface) & tenderness with epidermal
detachment revealing raw red dermis.
Mucosal involvement as in SJS.
Positive Nikolsky's sign: the epidermis separates with mild lateral pressure
• Management :
I.V Immunoglobulins (the 1 st line of treatment now).
Stop precipitating factor.
Supportive care often in intensive care unit
Other treatment options include:
o Immunosuppressive agents (Cyclosporin and cyclophosphamide)
o Plasmapheresis
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