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Toxic epidermal necrolysis: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Toxic epidermal necrolysis - acute bullous lesions of the skin and mucous membranes (Lyell's syndrome, Ritter's disease, ungainful bullous rash, epidermolysis, necrotic polymorphic, toxic-allergic epidermal necrolysis, etc.). Between drug bullet dermatitis, Lyell's syndrome and Stevens-Johnson's disease, there is no fundamental difference, there are only qualitative differences in the severity of changes in the skin and mucous membranes. It is assumed that all three forms are varieties of multiforme exudative erythema with bladder lesions4 of the skin and mucous membranes.
What causes toxic epidermal necrolysis?
The most common disease develops after taking sulfonamides and antibiotics. The disease can cause other drugs: amidopirin, phenolphthalein, aspirin, aminazine, phenylbugazone, as well as vaccines, serums. Of great importance is the previous sensitization, the connection with the underlying disease, there is a frequent combination of a viral infection with drug sensitization.
The pathogenesis of the disease is unknown. Assume an autoimmune mechanism. After the prodromal period, characterized by the appearance of erythema, the erythema zone rapidly expands around the mouth and eyes, bubbles appear with serous and serous-hemorrhagic contents, erosion, pronounced toxemia. Ulcer the mucous membrane of the mouth, trachea, larynx, stomach, and this burdens the course of the disease. The lethality reaches 30-40%.
Eye lesions
The skin of the eyelids and the periorbital area can be affected in the same way as the skin of other parts of the body. Conjunctivitis is usually mild, with muco-purulent discharge, is noted in almost all patients. Affecting the conjunctiva can lead to impaired mobility of the eyelids, ulceration of the cornea, followed by the formation of coarse corneal vascularized scars and a significant decrease in vision.
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Treatment of toxic epidermal necrolysis
Apply powerful desensitizing therapy, glucocorticoids in moderate doses (especially in the eritrematous stage), detoxification therapy, cardiovascular drugs, vitamins, in some cases, blood transfusion.
When eye lesions require treatment of the eyelids with the removal of drying crusts. Particular attention is paid to protecting the cornea from drying and timely treatment of trichiasis. In an acute period, ointments with corticosteroids are prescribed, antibacterial preparations, followed by eye drops with polyglucin, polyacrylamine. Local antibacterial therapy is necessary in case of ulceration of the cornea.