TEN

Diagnosis

Toxic epidermal necrolysis, or TEN, is diagnosed when a person with Stevens-Johnson syndrome develops a much more severe form of the condition that involves more than 30% of the body surface area. The diagnosis is based on the extent of skin involvement, the appearance of symptoms and how quickly the condition progresses.

Treatment

If your healthcare professional suspects that a medication triggered TEN, stopping that drug immediately is essential. Most people with TEN need to be treated in a hospital, often in a burn unit or intensive care unit, because the condition affects large areas of skin and can lead to serious complications. The recovery process may take several months.

Supportive care is the main focus of treatment while the skin heals. This includes measures that keep you stable and reduce discomfort.
Supportive care may involve:

• Fluid replacement and nutrition. Extensive skin loss can cause major fluid and electrolyte loss, so it is important to replace them. Fluids and nutrition may be provided through a tube that goes from the nose to the stomach.
• Wound care. The healthcare team may gently clean affected areas and apply specialized dressings containing petroleum jelly or medication. Monitoring for infection is ongoing, and antibiotics may be given if needed.
• Breathing help. Tests and procedures may be necessary to check and protect the airway. Severe cases may require intubation or mechanical ventilation.
• Pain control. Pain-relief medicines are used to make you more comfortable. If the mouth is affected, a numbing mouthwash such as one containing lidocaine may be recommended.
• Eye care. Artificial tears without preservatives may help with mild eye symptoms. Corticosteroid eye drops may be used to control inflammation, and an ophthalmologist may be part of your care team.

Medications that affect the whole body may also be used in some cases. These can include cyclosporine, etanercept or intravenous immunoglobulin. Research is ongoing to better understand whether these systemic treatments provide meaningful benefits.