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Diseases > Toxic Epidermal Necrolysis

Toxic epidermal necrolysis (TEN) is a life-threatening skin disorder that can be caused by an allergic reaction to drugs. Bextra and Celebrex, also known by their generic names of valdecoxib and celecoxib, are capable of eliciting this dangerous condition. Antibiotics, anticonvulsants and over-the-counter pain relievers, such as Motrin and Children's Motrin, have also been associated with this debilitating disorder. Toxic epidermal necrolysis is characterized by blistering and peeling of the skin.

Toxic epidermal necrolysis is a type of immune complex mediated hypersensitivity (allergic reaction) in its most severe form. Stevens Johnson Syndrome, or SJS, is a lesser form and erythema multiforme is the least severe form of this hypersensitivity. Like TEN, SJS causes large areas of the skin to become detached and lesions to develop in the mucous membranes.

Symptoms of TEN include peeling of the skin in sheets, leaving large raw areas of open flesh. The loss and damage of skin, similar to what occurs in burn victims, allows fluids and important minerals to ooze from the damaged areas. These areas can easily become infected. The most common symptoms include:

Painful red areas (rashes) that spread quickly
Skin peels without blistering
Considerable pain and discomfort
Fever
Spread to the mucous membranes in the eyes, mouth and genitals

Stevens Johnson Syndrome and toxic epidermal necrolylsis have similar symptoms and clinical paths. A classification system, based primarily on the level of detached skin and the morphology of the lesions, has been used to distinguish SJS and TEN. SJS is characterized by skin detachments across less than 10% of the body surface with widespread rash or flat atypical lesions. The overlap between TEN and SJS occurs when there is 10 to 30% of the body surface with detached skin and with widespread rash or flat atypical lesions. TEN with spots occurs when there is greater than 30% of the body surface area with detached skin and the widespread presence of flat atypical lesions. TEN without spots occurs when there is greater than 30% of the body surface area with detached skin, but there are no surface lesions. Erythema multiforme is the less severe type of the disorder and is classified when there is less than 10% of body surface where skin is detached and localized lesions are present.

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Toxic Epidermal Necrolysis
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