Toxic Epidermal Necrolysis - TENS

Question 1

What happen in TENs?

Answer 1

• full thickness epidermal loss
• massive keratinocyte apoptosis
• drug is commonest causes
• rapid
• high mortality

Question 2

What drugs most likely cause TEN?

Answer 2

ALLOPURINOL
ABX:
- chloramphenicol
- macrolides
- penicillin
- quinolones
- sulphonamides
ANTICONVULSANTS:
- carbamazepine
- lamotrigine
- phenytoin
- phenobarbitone
- valproate
NSAIDS

Question 3

Predicting mortality in TEN?

Management?

Answer 3

Use SCORTEN

• > 10% epidermal detachement
• > 40yrs old
• Hx of malignancy
• HR >120
• urea >10
• glucose >14
• bicarb <20

Points = mortality %
1 = 3.2%
2 = 12.1%
3 = 35.3
4 = 59.3
5 = >90

Success need team approach:

• ITU / derm / opt
• remove cause
• supportive
• silicone coated mesh dressing / exudry suit
• drug use controversial. Dont use steroids as infection risk.
• maybe IV immunoglobulins (stops apoptosis, few downsides)