44 - Epidermal Necrolysis (SJS and TEN) Flashcards
Highest incidence of EN in
Adults after 65 years of age
Y/N: Men and women are equally affected by EN.
N - women more frequently affected
Prognosis score for EN
SCORTEN
Most important etiologic factor in EN
Drugs
High-risk drugs in EN
Antibacterial sulfonamides Aromatic antiepileptic drugs Allopurinol Oxicam NSAIDs Lamotrigibe Nevirapine
Risk of EN seems to be confined to the first _____ weeks of treatment
8
Extreme phenotype of LE that has to be considered as a differential diagnosis of EN
Erosive LE
Cytotoxic T cells kill keratinocytes directly and indirectly through the recruitment of other cells that release soluble death mediators, the principal being
Granulysin
Probably also IL-15
Medications taken to treat the prodromal symptoms of EM are often accused to have caused the reaction
Protopathic bias
Dislodgement of the epidermis by lateral pressure on erythematous zones
Nikolsky sign
Represents a little less than 1% of the BSA
One hand (palms and fingers)
Low serum bicarbonate levels usually result from _____ and more rarely from _____
Respiratory alkalosis related to the specific involvement of bronchi
Metabolic acidosis
Often considered to be an unfavorable prognostic factor but is too rare to have a significant impact on SCORTEN
Neutropenia
Biopsy should preferentially not be taken from
Legs below the knee
Could be superimposed by stasis dermatitis
Absence of _____ involvement or its restriction to a single site must always raise the suspicion of an alternative diagnosis to EN
Mucous membrane
Hallmarks of generalized bullous fixed drug eruption
Prior events
Rapid onset after drug intake
Very large, well-demarcated blisters
During the acute phase, the most common complication of EN is
Sepsis
Main causes of mortality in EN
Infections
Most frequent pathogens of infections in EN
S. aureus
Pseudomonas spp
Most frequent sequelae of the skin in EN
Hypo- and hyperpigmentation
The epidermal detachment progresses for
5-7 days
The plateau phase corresponds to
Progressive reepithelialization
In case of doubt, all not life-sustaining drugs should be stopped when initiated and administered within the previous
8 weeks
Y/N: Volumes of infusions are usually more than for burns of similar extent of skin detachment.
No - interstitial edema is absent in EN vs burns
Environmental temperature should be raised to
28-30 deg C
Prophylactic _____ are not indicated
Antibiotics
Prophylactic _____ should be provided during hospitalization
Anticoagulation
Only feasible in populations where a strong association has been established between a simple genetic marker and the risk of EN
Primary prevention
HLA-_____ in EN induced by carbamazepine in persons of Southeast Asian ancestry
B*1502
Important for patients who experienced EN and are reluctant to take any medication
Secondary prevention
