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Toxic Epidermal Necrolysis
Stevens Johnson Syndrome and Toxic Epidermal Necrolysis are life-threatening
Although infrequent, these conditions kill or severely disable previously
healthy people. (Roujeau,
Both diseases are characterized by rapidly expanding
rashes, often with atypical (flat, irregular) target lesion, and involvement
of the mucous membranes (mouth, eyes, and genital areas)
Indian J Dermatol Venereol Leprol. 2005 Nov-Dec;71(6):398-400. Related
Efficacy of low dose intravenous immunoglobulins in children with toxic
epidermal necrolysis: An open uncontrolled study.
Mangla K, Rastogi S, Goyal P, Solanki RB, Rawal RC.
Department of Dermatology, V. S. Hospital, Ahmedabad, India. email@example.com.
BACKGROUND: High dose intravenous immunoglobulins (IVIG) have emerged
as a promising new therapy for treating the rare but potentially fatal
drug reaction toxic epidermal necrolysis (TEN). Experimental in vitro
studies support the view that IVIG can block the fas-fas ligand mediated
apoptosis in TEN. METHODS: Ten pediatric patients of TEN were treated
with IVIG (0.05 - 0.1 gm/kg/day) along with antibiotics and supportive
care. RESULTS: Patients with 67% of mean body surface area of involvement
showed an average of 2.1 days for arrest of progression of lesions
and 8.1 days for complete reepithelization. There was no mortality.
CONCLUSIONS: Low dose IVIG appears to be a safe and effective treatment
for TEN in children. Randomized trials are needed to further evaluate
the efficacy of IVIG and compare it with other therapeutic modalities.
PMID: 16394480 [PubMed - in process]
Indian J Dermatol Venereol Leprol. 2005 Jan-Feb;71(1):23-5. Related
A study of mortality in dermatology.
Nair PS, Moorthy PK, Yogiragan K.
Departments of Dermatology and Venereology, Medical College Hospital,
Trivandrum - 695 011, India. firstname.lastname@example.org.
BACKGROUND AND AIMS: Certain dermatological conditions are life-threatening
and can cause mortality. The aim of this study is to find out the dermatological
diseases leading to death in our indoor patients. METHODS: A record-based
retrospective descriptive study of dermatology cases who died during
the period of 1995 to 2001. RESULTS: The total number of cases analyzed
was thirty-seven. There were 24 males and 13 females. The maximum number
of deaths occurred in the age group 61-70. Vesiculobullous disorders
were the commonest cause of death, found in 18 cases (48.6%), followed
by drug reactions in 5 (13.5%), malignancies in 5 (13.5%) and collagen
vascular disease in 2 cases ((5.40%). Pemphigus was the commonest fatal
vesiculobullous disorder (13 cases - 35.13%), and toxic epidermal necrolysis
the commonest drug reaction (3 cases - 8.10%). CONCLUSION: Area of
skin involvement, electrolyte imbalance and septicemia were important
factors leading to death in pemphigus and toxic epidermal necrolysis.
We advocate that such patients should be managed in burns unit or ICU
PMID: 16394356 [PubMed - in process]
classification of cases of toxic epidermal necrolysis, Stevens-Johnson
syndrome, and erythema multiforme
B. Rzany, R. S. Stern, N. H. Shear, L. Naldi and J. C. Roujeau
of Dermatology, Henri-Mondor Hospital, University of Paris XII,
AND DESIGN. To conduct a prospective case-control study about causative
factors of severe bullous erythema multiforme, Stevens-Johnson syndrome,
and toxic epidermal necrolysis, we needed to define criteria for classifying
the cases and standardize the collection of data so that cases could
be reliably diagnosed according to this classification. Based on review
of case histories and photographs of patients, a group of experts proposed
a classification based on the pattern of erythema multiforme-like lesions
(categorized as typical targets, raised or flat atypical targets, and
purpuric macules) and on the extent of epidermal detachment. An atlas illustrating
this classification that included photographs and schematic drawings
was developed. We compared the evaluations of 28 cases by four nonphysicians
relying on the atlas with the evaluations of the same cases by
five experts not using the atlas to determine the usefulness of this atlas
for classifying cases according to our nosologic schema. RESULTS.
The following consensus classification in five categories
was proposed: bullous erythema multiforme, detachment
below 10% of the body surface area plus localized "typical
targets" or "raised atypical targets"; Stevens-Johnson syndrome,
detachment below 10% of the body surface area plus widespread erythematous
or purpuric macules or flat atypical targets; overlap Stevens-Johnson
syndrome-toxic epidermal necrolysis, detachment between 10% and
30% of the body surface area plus widespread purpuric macules or
flat atypical targets; toxic epidermal necrolysis with
spots, detachment above 30% of the body surface area plus
widespread purpuric macules or flat atypical targets;
and toxic epidermal necrolysis without spots, detachment above
10% of the body surface area with large epidermal sheets and without any
purpuric macule or target. Using the atlas, the nonexperts showed excellent
agreement with the experts. CONCLUSION. This study suggests that an
illustrated atlas is a useful tool for standardizing the diagnosis
of acute severe bullous disorders that are attributed
to drugs or infectious agents. Whether the five categories
proposed represent distinct etiopathologic entities will
require further epidemiologic and laboratory investigations.
Toxic Epidermal Necrolysis is rare but extremely dangerous
to otherwise healthy people
Toxic Epidermal Necrolysis in Children
Toxic Epidermal Necrolysis in Elderly
Toxic Epidermal Necrolysis in Adults