Full-thickness epidermal necrosis and subepidermal bullae

Introduction Toxic necrotizing epidermolysis type drug rash skin manifests as full-thickness of the epidermis and formation of subepidermal bullae.

Cause

Most drugs have the potential to cause drug eruptions, including Chinese herbal medicines, but most of them are caused by more antigenicity. Mostly sulfonamides, salicylates, phenylbutazone, aminopyrine and other antipyretic analgesics, phenolphthalein, penicillin, tetracycline, barbital, phenytoin and so on. In addition, for patients with congenital allergic diseases and patients with diseases of vital organs, the risk of drug eruption is relatively high.

Toxic necrotizing epidermolysis drug eruption (TEN) is the most severe drug eruption, which is usually seen in the emergency department.

an examination

Related inspection

Blood routine temperature measurement

Initiate a drug

Sulfonamides, salicylates, phenylbutazone, aminopyrine and other antipyretic analgesics, phenolphthalein, penicillin, tetracycline, barbital, phenytoin and so on.

2. Clinical manifestations

Acute onset, accompanied by high fever, irritability, lethargy, convulsions, coma and other obvious symptoms of systemic poisoning. The skin manifests as full-thickness of the epidermis and formation of subepidermal bullae. At the beginning, it was a large piece of bright red patches, followed by purple-brown. In 1 to 2 days, bullae appeared on the spots and expanded, and the sub-synthesis was several tens of centimeters in size, showing most parallel strips of crepe. The bullae are easily rubbed and there is a large smash, similar to a second degree burn. Nilolsky sign (10), at the same time, mouth, eye, nose, upper respiratory tract, genital area, esophageal mucosa, can be widely affected. A large erosion surface appears after the mucosa falls off. The pain is extreme. The body temperature often lasts at 40 ° C, and does not retreat for 2 to 3 weeks. Heart, kidney, liver, and brain are also often affected. The prognosis is serious, and the mortality rate is 25% to 50%. More often due to secondary infection, liver and kidney dysfunction, water and electrolyte disorders and death.

Differential diagnosis

Need to be differentiated from toxic shock syndrome.

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