Toxic epidermal necrolysis: a study of 22 cases

Toxic epidermal necrolysis leads to extensive exfoliative epidermal slough, fever, systemic toxic reactions, conjunctivitis and severe mucous membrane involvement. As it evolves many other organs can be affected. Whether or not toxic epidermal necrolysis is the most severe form of erythema multiform is still a subject of discussion. The pathophysiological events involved are not well understood. Indirect evidence suggests a hypersensitivity reaction, but the search for potential immunological mechanisms has resulted in little data to support this hypothesis. Drug reactions remain the most common associated factor. Twenty-two patients, 3-84 years old, have been included in this retrospective study. In 15 patients, clinical evidence points to drugs as the most important cause of toxic epidermal necrolysis. Recent infections were implicated in three patients and ulcerative colitis and lymphoma in one case each. Symptomatic therapy included fluid replacement, nutritional support and local treatment. Steroids were administered in 13 patients, followed by plasmapheresis in three. The mortality rate was approximately 27%. Elderly patients and patients with extensive lesions were at greater risk. Results of immunofluorescence and immunoblot analysis were of no significant interest.