A decade of TEN: An update on toxic epidermal necrolysis

Toxic epidermal necrolysis (TEN) was first described by Lyell in 1956 (1). It is a rare condition, with 1.2 cases per million per year (2), and is characterized by a diffuse erythematous rash that progresses to desquamation of a large body surface area. Although TEN is in the clinical continuum of erythema multiforme (EM) and Stevens Johnson syndrome (SJS), biopsy shows complete separation of epidermis to dermis, similar to a deep partial thickness burn. It is a very serious condition with a mortality of 20% to 30%, even with modern treatment (2-6). The pathophysiology is not well understood, but it does have a strong immunological basis (7-11) and is often considered an adverse drug reaction. Antibiotics, anticonvulsants and nonsteriodal anti-inflammatory drugs are the most commonly implicated causative agents (6,12). Age and total body surface area (TBSA) desquamated are the strongest prognosticators at the onset of TEN (5). The purpose of this study is to identify trends predictive of morbidity and mortality in TEN and to determine the relationship between treatment and clinical course.