TEN

Question 1

TEN - presentation, examination finding

Answer 1

scalded appearance to skin over extensive area
systemically unwell
Nikolsky’s sign - epidermis separates on mild lateral pressure

Question 2

drugs that can induce TEN

Answer 2

anticonvulsants - phenytoin + carbamazepine
allopurinol
penicillin / antibiotics
NSAIDs

Question 3

How long after ingestion of a drug can TEN occur?

Answer 3

2 months - mainly anticonvulsants that take this long

Question 4

Oxygen sats cut off for treatment

Answer 4

94-98% is the aim - give O2 if below this

Question 5

TEN - management

Answer 5

conservative:
ICU
stop precipitant
v greasy ointment + non adhesive dressing

1° - IV immunoglobulin
other - ciclosporin / cyclophosphamide, plasmapheresis, steroids

Question 6

TEN - outcomes

Answer 6

septic shock + multi-organ failure

long term:
scarring
psychological + not wanting meds
inability to sweat
eye complications
chronic erosion mouth + genitals

Question 7

What scoring system is used for TEN?

Answer 7

SCORTEN - for mortality prediction

Question 8

Risk of patch testing

Answer 8

Patch testing can trigger sensitivity (not necessarily TEN, more for allergies)
TEN Can’t happen first time trying a drug
But cross-sensitivity can mean reaction to a new drug is due to sensitisation to a different drug had previously (?)