Prompt withdrawal of the culprit drug is essential in managing toxic epidermal necrolysis (TEN). Wound care including sterile handling and antibiotics according to culture results are also important. Systemic steroids are contraindicated due to risk of infection and poor wound healing. Cyclosporine may provide a survival benefit but requires further study. A tumor necrosis factor inhibitor such as a single dose of etanercept can halt skin detachment and induce rapid healing in some cases.

1. TOXIC EPIDERMAL
NECROLYSIS (TEN)
management
AHMED ABDULGHANY

2. “
”
Prompt withdrawal of the culprit
drug is the cornerstone of
management
Including: Allopurinol, Aromatic anticonvulsants, Antibiotics, Lamotrigine and oxicam NSAIDs

3.  Wound care: the extent of epidermal detachment should be evaluated.
 Fluid and electrolyte replacement together with nutritional assessment.
 Ocular care
 Prevention of infection: sterile handling is essential, antiseptic solution are
recommended.
 Repeated cultures from blood, urine and wounds are recommended.
 Antibiotics are given according to cultures results.

4. Systemic steroids
 Results from EuroSCAR and RegiSCAR studies done on more than 500
patients from France and Germany DON’T support the use of systemic
steroids for the treatment of SJS/TEN.
 In addition, since steroids are associated with increased risk of sepsis and
catabolism and poor wound healing, their use in such cases is
contraindicated.
Halebian PH. et al., Improved burn center survival of
patients with toxic epidermal necrolysis managed without
corticosteroids Ann Surg. 1986 Nov;204(5):503-12

5. Intravenous immunoglobulins
 Data surrounding the use of IVIG in SJS/TEN patients are conflicting
especially after the acceptance that granulysin, a cytotoxic protein found
in cytotoxic T-cells is the main mediator in the pathogenesis of TEN.

6. Cyclosporine
 A survival benefit for patients treated with cyclosporine (dosed at 3 – 5
mg/kg/day) was noted in RegiSCAR cohort study, however further studies
are required to confirm its rule in SJS/TEN.
Sekula P. et al,. Comprehensive survival analysis of a cohort
of patients with Stevens-Johnson syndrome and toxic
epidermal necrolysis J Invest Dermatol. 2013
May;133(5):1197-204

7. Tumor necrosis factor inhibitor (Anti-TNF)
 A single infusion of 5 mg/kg of anti-TNF halted the progression of skin
detachment and induced rapid re-epithelialization.
 Etanercept 50 mg single subcutaneous injection has been successful in
some cases.
 Plasma exchange may be benifitial
Paradisi A. et al., Etanercept therapy for toxic epidermal
necrolysis J Am Acad Dermatol. 2014 Aug;71(2):278-83

8. THANK YOU