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Toxic epidermal necrolysis (TEN)
Diagnosis
Healthcare providers typically diagnose toxic epidermal necrolysis (TEN) by evaluating your skin and symptoms. When individuals with SJS exhibit a severe illness impacting more than 30% of their bodies, TEN is identified. Occasionally, confirmation of the diagnosis may necessitate a skin biopsy. A pathologist, a healthcare professional specializing in examining human tissues, analyzes a sample of your skin under a microscope to confirm the diagnosis.
Treatment
It will be necessary for you to stop taking the medication if your healthcare provider considers it may have contributed to your TEN. Afterwards, you will probably be admitted to a hospital and treated there, perhaps in an ICU or burn center. It may take several months for everything to recover completely.
The primary goal of TEN treatment is to maximize your comfort level as your skin heals. During your stay in the hospital, you will get supportive care. It could consist of:
- Fluid replacement and nutrition: Replacing fluids and electrolytes is important since skin loss can cause the body to lose fluids. A nasal tube (nasogastric tube) that is inserted in the nose to the stomach may be used to provide nutrition and fluids.
- Wound care: The healthcare provider may gently wash the affected area and apply bandages that are infused with medicine or petroleum jelly (Vaseline). Additionally, your healthcare provider keeps an eye out for infections and may administers antibiotics as necessary.
- Breathing support: To assess your airway and maintain its clarity, you may require tests and procedures. You may require artificial breathing assistance (ventilation) or intubation if your condition is severe.
- Pain management: Painkillers will be administered to you to ease your pain. You may be prescribed mouthwash that contains lidocaine or another numbing ingredient if you have oral pain.
- Eye care: Applying preservative-free artificial tears at least four times a day may help with mild problems with the eyes. To reduce inflammation in the eyes, corticosteroid-containing eye drops may be applied.
- Other treatments: For the treatment of TEN, a patient may also be prescribed systemic medicines:
- Immune globulin: Immunoglobulin is administered intravenously (IV). It is a sterile fluid derived from donor plasma, which is the liquid portion of blood. It has components or antibodies that support your body’s defense against infections.
- Immunosuppressants: When the immune system isn’t functioning properly, these medications weaken it. They prevent tissue-attacking cells in your body.
- Plasmapheresis: By removing blood from your body, this process also extracts plasma from blood cells. Materials that trigger a negative immunological reaction are extracted from the plasma by a machine. The “clean” blood or a plasma replacement is then given back to your body by the machine.
