Toxic epidermal necrolysis

A commonly held misconception is that no emergencies exist in dermatology. I started my dermatology rotation thinking that most of my time would be spent in outpatient clinics, with cases of psoriasis or eczema. Important as these conditions may be, they are hardly ever life threatening. The first patient I saw proved me wrong. The patient had toxic epidermal necrolysis (TEN), a rare but life threatening adverse drug reaction.

Adverse reactions to drugs complicate 5-15% of drug treatments and account for 3-6% of all hospital admissions.12 Cutaneous reactions are the most common type of adverse drug reaction reported.w2 Most cutaneous drug reactions are of morbilliform type, which is a symmetric, erythematous rash with multiple macules and papules that resemble the rash associated with measles, and which usually disappears after a few days with no serious sequelae.3 Morbilliform eruptions can, however, precede some rare and more serious cutaneous reactions, such as serum sickness, hypersensitivity syndrome, and TEN.3

The first description of TEN was given by Adam Llye in 1956.4 He saw that patients with TEN presented in a similar manner to that of scalded skin syndrome, with a widespread extensive epidermal necrolysis, with scalding and bullous detachment of the skin.36 With an incidence of 0.4-1.2 in every million population a year,6 TEN is a relatively rare condition, but given its associated morbidity and mortality it is one that all medical professionals should be aware of.