View source for Toxic epidermal necrolysis overview

__NOTOC__
{{Toxic epidermal necrolysis}}
{{CMG}}; {{AE}}

==Overview==
'''Toxic Epidermal Necrolysis''' is a life-threatening [[dermatology|dermatological]] condition that is frequently induced by a reaction to medications. It is characterized by the detachment of the top layer of skin (the [[epidermis]]) from the lower layers of the skin (the [[dermis]]) all over the body. There is broad agreement in the medical literature that TEN can be considered a more severe form of [[Stevens-Johnson syndrome]] and debate whether it falls on a spectrum of disease that includes [[erythema multiforme]].<ref>{{cite journal |author=Carrozzo M, Togliatto M, Gandolfo S |title=[Erythema multiforme. A heterogeneous pathologic phenotype] |journal=Minerva Stomatol |volume=48 |issue=5 |pages=217-26 |year=1999 |pmid=10434539}}</ref><ref>{{cite journal |author=Farthing P, Bagan J, Scully C |title=Mucosal disease series. Number IV. Erythema multiforme |journal=Oral Dis |volume=11 |issue=5 |pages=261-7 |year=2005 |pmid=16120111}}</ref>

==Historical Perspective==

==Classification==

==Pathophysiology==
Microscopically, TEN causes [[cell death]] throughout the epidermis.  [[Keratinocytes]], which are the cells found lower in the dermis,  specialize in holding the skin cells together, undergo [[necrosis]] (uncontrolled cell death).

==Causes==
Toxic epidermal necrolysis is a rare and usually severe adverse reaction to certain drugs. History of medication use exists in over 95% of patients with TEN. The drugs most often implicated in TEN are antibiotics such as sulfonamides, [[nonsteroidal anti-inflammatory drugs]], [[allopurinol]], [[antiretroviral drugs]], [[corticosteroids]] and [[anticonvulsant]]s such as [[phenobarbital]], [[phenytoin]], [[carbamazepine]], and [[valproic acid]].  The condition might also result from immunizations,  infection with agents such as ''[[Mycoplasma pneumoniae]]'' or  [[herpes virus]] and [[Organ transplant|transplant]]s of [[bone marrow]] or organs.

==Differentiating Xyz from Other Diseases==

==Epidemiology and Demographics==
The [[incidence (epidemiology)|incidence]] is between 0.4 and 1.2 cases per 100,000 each year.

==Risk Factors==

==Screening==

==Natural History, Complications, and Prognosis==
The mortality for toxic epidermal necrolysis is 30-40%.<ref name=garra>Garra, GP (2007). "[http://www.emedicine.com/EMERG/topic599.htm Toxic Epidermal Necrolysis]". Emedicine.com. Retrieved on December 13, 2007.</ref>  Loss of the skin leaves patients vulnerable to infections from fungi and bacteria, and can result in [[septicemia]], the leading cause of death in the disease.<ref name=garra/> Death is caused either by [[infection]] or by [[respiratory distress]] which is either due to [[pneumonia]] or damage to the linings of the airway. Microscopic analysis of tissue (especially the degree of dermal mononuclear inflammation and the degree of inflammation in general) can play a role in determining the prognosis of individual cases.<ref>{{cite journal |author=Quinn AM et al |title=Uncovering histological criteria with prognostic significance in toxic epidermal necrolysis |journal=Arch Dermatol |volume=141 |issue=6 |pages=683-7 |year=2005 |pmid=15967913}}</ref>

==Diagnosis==
===Diagnostic Study of Choice===

===History and Symptoms===

===Physical Examination===

===Laboratory Findings===
Sometimes, however, examination of affected tissue under the microscope may be needed to distinguish it between other entities such as [[staphylococcal scalded skin syndrome]]. Typical histological criteria of TEN include mild infiltrate of lymphocytes which may obscure the dermoepidermal junction and prominent cell death with basal vacuolar change and individual cell necrosis.<ref>{{cite journal |author=Pereira FA, Mudgil AV, Rosmarin DM |title=Toxic Epidermal Necrolysis |journal=J Am Acad Dermatol |volume=56 |issue=2 |pages=181-200 |year=2007 |pmid=17224365}}</ref>

===Electrocardiogram===

===X-ray===

===Echocardiography and Ultrasound===

===CT scan===

===MRI===

===Other Imaging Findings===

===Other Diagnostic Studies===

==Treatment==
===Medical Therapy===

=== Interventions ===

===Surgery===

===Primary Prevention===

===Secondary Prevention===

==References==
{{reflist|2}}

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
[[Category: (name of the system)]]