Clinical features

There is a characteristic prodromal period lasting between 1-14 days where patients may present with influenza-like symptoms, such as fever, malaise, rhinitis, cough, pharyngitis, and arthalgia. This is followed by widespread erythemas which develop into flaccid blisters and bullae

• these bullae are combined together to form large bullae and later large sheets of epidermis are sloughed off giving the scalded appearance to the skin
• Nikolsky's sign can be seen in TEN (sloughing off of the epithelium during a mild shearing force even when the skin appears normal)

Mucous membrane involvement which is present 1-3 days before the skin lesions can be seen in the oropharynx, eyes, genital tract, and in the anus.

The internal mucosa of the gastrointestinal and respiratory tract may be involved too.

Severe occular involvement is one of the common and perhaps the most serious complication of TEN

• conjunctivitis, vesiculation, corneal ulceration and scarring, uveitis, synchiae, and pseudomembrane formation can be seen which will eventually lead to blindness

Sloughing of epidermal skin in TEN will result in "acute skin failure".

• the normal protective functions are compromised leading to electrolyte and fluid loss, reduced thermoregulation and an increased susceptibility to infection (1).

Reference:

• 1. Gupta S, Devkaran A. Toxic epidermal necrolysis. Student BMJ 2008;16:168-170