Toxic epidermal necrolysis (TEN) : a clinical review

Background: Toxic epidermal necrolysis (TEN) is a severe life-threatening condition associatedwith a low incidence but high mortality rate ranging from 25-50%. TEN is characterized by itswidespread skin necrosis with frequent mucous membrane involvement. The pathophysiology ofTEN has yet to be fully understood, however the current understanding involves a limited scope.Objective: Realizing the importance of recognizing and treating such a condition for thepracticing clinician in the world of medicine and dermatology, we have performed acomprehensive review to enhance the understanding of its presentation and treatment.Methods: A search was conducted using PubMed, Science Direct, and Google Scholar searchengines at the Mulford Library of the University of Toledo from inception to September 2012.All articles used in the composition of this project were review articles and clinical humanstudies written in English. The search parameters included the terms ‘toxic epidermal necrolysis’,Lyell’s syndrome’ or ‘toxic epidermal necrolysis’ combined with ‘IVIG’ or ‘intravenousimmunoglobulin’. Publication date parameters were set to include all years between 1990 and2012.Results: Serious complications such as respiratory failure and infections are among the fearedoutcomes therefore treatment is done in a specialized burn unit with a multidisciplinary team involved. We have found that steroid use should be completely avoided and that performing skin biopsy is crucial to the diagnosis and helps to rule out any other diagnoses.Conclusion: The value of current therapies such as intravenous immunoglobulins (IVIGs) revealsvery promising results trending toward improved mortality and prognosis however quantitative analysis of this treatment is lacking and yet to be determined by further research.