The outcome of toxic epidermal necrolysis syndrome : revisited

Abstract EN

Background / Aim : Toxic epidermal necrosis syndrome (TEN) is an uncommon acute life-threatening blistering disease characterized by involvement of the skin, multiple mucous membranes and internal organs.

It is most commonly precipitated by the administration of medication like anticonvulsants.

Different variables have been identified as risk factors.

The aim of the study was to highlight some variables determining the clinical outcome.

Patients & Methods: This retrospective study included 9 cases diagnosed as toxic epidermal necrosis's syndrome in the period from 2001 to 2005.

The case records of all patients were studied in detail regarding the drugs implicated as the cause, the pre-referral period, the body surface area affected the presence or absence of sepsis, the management and the clinical outcome.

The study group was classified according to outcome into survivors and non survivors.

Statistical comparison was done with t and x2 tests, with P value less than 0.05 considered significant.

Results : survivors were 5patients and non survivors were 4 patients.

Anticonvulsants were implicated as the cause of TEN in 4 cases, no steroidal anti-inflammatory drugs in 4 cases, and antibiotics in one case.

The average time from the onset of symptoms to admission to the burn unit was 2.80+ 0.98 days for survivors and 7.13+ 1.43 days for no survivors (P = 0.012).

The average body surface area affected was 28.00+ 4.35 % for survivors versus 34.75 + 14.06 % for no survivors (P 0.338).

Sepsis was present in 5 cases (4died and one survived).

Conclusion : pre-referral of patients with toxic epidermal necrosis's syndrome to the burn center affects significantly the clinical outcome, so early referral is recommended.