Toxic Epidermal Necrolysis (TEN)

Toxic epidermal necrolysis (TEN) is a rare, severe skin reaction (related to Stevens-Johnson syndrome) involving widespread skin loss and mucous membrane involvement. It is a medical emergency, usually triggered by medications.

Table of Contents

Quick Facts

  • ICD-10: L51.2
  • Severity: Life-threatening
  • Triggers: Medications, infections

Emergency Warning

Painful spreading rash with skin sloughing, blistering, or mucous membrane involvement (mouth, eyes, genitals) is a medical emergency. Seek immediate care.

Features

  • Flu-like prodrome 1–3 days before rash
  • Painful red or purple skin that spreads quickly
  • Extensive blistering and skin peeling (>30% body surface in TEN; SJS is <10%)
  • Severe involvement of mouth, eyes, and genitals
  • Fever, dehydration, electrolyte abnormalities

Common Triggers

  • Medications (allopurinol, anticonvulsants, sulfa antibiotics, NSAIDs, nevirapine)
  • Infections (rarely)

Treatment

  • Immediate hospitalization (burn unit or ICU)
  • Stop the suspected medication immediately
  • Fluid and electrolyte management
  • Wound care, often like burn care
  • Eye care to prevent long-term damage
  • Pain control
  • Specific therapies (cyclosporine, IVIG) in selected cases

Related Conditions

Stevens-Johnson Syndrome

Same spectrum

 Angioedema

Different drug reaction
Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about a medical condition. If you are experiencing a medical emergency, call your local emergency number immediately.

References

  • American Academy of Dermatology. SJS/TEN Patient Information.