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Toxic epidermal necrolysis: causes, symptoms, diagnosis, treatment
Last reviewed: 05.07.2025
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Toxic epidermal necrolysis is an acute bullous lesion of the skin and mucous membranes (Lyell's syndrome, Ritter's disease, mild bullous rash, epidermolysis, necrotic polymorphic, toxic-allergic epidermal necrolysis, etc.). There is no fundamental difference between drug bullous dermatitis, Lyell's syndrome and Stevens-Johnson disease, there are only qualitative differences in the degree of expression of changes in the skin and mucous membranes. It is assumed that all three forms are varieties of multiform exudative erythema with vesicular lesions4 of the skin and mucous membranes.
What causes toxic epidermal necrolysis?
Most often, the disease develops after taking sulfonamides and antibiotics. The disease can also be caused by other drugs: amidopyrine, phenolphthalein, aspirin, aminazine, phenylbugazone, as well as vaccines and serums. Of great importance is previous sensitization, connection with the underlying disease, a frequent combination of viral infection with drug sensitization is noted.
The pathogenesis of the disease is unknown. An autoimmune mechanism is suggested. After the prodromal period, characterized by the appearance of erythema, the erythema zone around the mouth and eyes quickly expands, blisters with serous and serous-hemorrhagic contents, erosions, and severe toxemia appear. The mucous membrane of the oral cavity, trachea, larynx, and stomach ulcerates, and this aggravates the course of the disease. Mortality reaches 30-40%.
Eye lesions
The skin of the eyelids and periorbital area may be affected in the same way as the skin of other parts of the body. Conjunctivitis is usually mild, with mucopurulent discharge, and is observed in almost all patients. Conjunctival damage may lead to impaired eyelid mobility, corneal ulceration with subsequent formation of coarse corneal vascularized scars, and significant vision loss.
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Treatment of toxic epidermal necrolysis
Powerful desensitizing therapy, glucocorticoids in moderate doses (especially in the erythematous stage), detoxification therapy, cardiovascular agents, vitamins, and in some cases blood transfusions are used.
In case of eye lesions, it is necessary to treat the eyelids with the removal of drying crusts. Particular attention is paid to protecting the cornea from drying out and timely treatment of trichiasis. In the acute period, ointments with corticosteroids, antibacterial drugs are prescribed, and subsequently - eye drops with polyglucin, polyacrylamend. Local antibacterial therapy is necessary in case of corneal ulceration.