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Toxic epidermal necrolysis is skin deterioration resulting from reaction to certain drugs. Although it is rare, with an estimated incidence of two or fewer cases per million people per year, toxic epidermal necrolysis is associated with a high death rate. Because of the low incidence of the disease, it is difficult to obtain information about causative agents, diagnostic criteria, and clinical prognosis. The usefulness of case report literature concerning toxic epidermal necrolysis was evaluated by survey of English-language reports, published from January 1966 to April 1987, stored in the MEDLINE database. Of the 345 articles identified using the key words epidermal necrolysis, 59 were available for review; they represented 73 cases of drug-related toxic epidermal necrolysis. These cases accounted for only five percent of the total number of cases occurring between January 1966 and April 1987. In 62 percent of the 73 cases, the purpose of the published study was to show a relation between the development of toxic epidermal necrolysis and a drug. The drugs most commonly associated with the disease were allopurinol, the nonsteroidal anti-inflammatory agents, phenytoin (dilantin), and the sulfonamide antibiotics. The contribution these few case reports is limited in providing an estimate of risk for drug-related toxic epidermal necrolysis. Specific diagnostic criteria are required for more uniform reporting of signs, symptoms, and therapy of this disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN), are very serious and sometimes fatal diseases of the skin and mucous membranes characterized by fluid-filled blisters. Many believe they are different versions of a single disease, because both disorders are caused by adverse reaction to the same group of drugs and the same causes of infection. The best treatment has not yet been established. Recently it has been suggested that the use of systemic steroids not only may not be beneficial, but may actually increase the risk of complications. Overwhelming infection, as a complication, is the prime cause of deaths with these diseases. Other serious complications include severe blood loss and gastrointestinal bleeding, as well as eye problems which can cause permanent loss of vision. A retrospective study analyzed the results of treatment given 21 children hospitalized with either of these diseases. The treatment was provided on the regular pediatric floor, and when necessary the pediatric intensive care unit. Initial treatment included careful skin care, early identification and treatment of infection, maintenance of proper fluid balance, good nutrition and relief of symptoms. Daily eye examinations were done and, because of possible complications later, long-term ophthalmologic follow-up was recommended. Antibiotics were used only when infection was proved or strongly suspected and not as preventative medication. No patients received steroids and there were no deaths. The most serious long-term complications involved the eyes; there were five cases of symblepharon, in which the eyelid and eyeball adhere to each other, two cases of dry eye syndrome, and one case of inflammation of the cornea. The authors believe that treatment of these conditions should not include systemic steroid treatment, and if steroids are already being given, they should be discontinued unless necessary for treatment of other conditions.

A 43-year-old woman presented to the emergency department with a 4-day history of worsening erythema, swelling, and pruritus that developed on the face and progressed to the abdomen, back, and [...]

HISTORY An 80-year-old woman was seen for rash. She lived in a nursing home because of multiple medical problems, among them end-sage coronary artery disease, status post aortic valve replacement [...]