Derm: Toxic Epidermal Necrolysis: Free MSRA Podcast

⚕️ FREE MSRA PODCAST – Toxic Epidermal Necrolysis🎧 A clear, high-yield breakdown of this life-threatening blistering skin emergency – perfect for exam prep and rapid clinical recognition.🧠 Key Learning Points📌 Definition• Toxic Epidermal Necrolysis (TEN) is a rare, severe mucocutaneous reaction, typically to medications, characterised by widespread epidermal necrosis and detachment affecting >30% of the body surface area.• It’s the most extreme form of the SJS/TEN spectrum.📌 Causes & Risk Factors• Drugs are the most common trigger (90%+):– Antibiotics (esp. sulphonamides)– Anticonvulsants (e.g. carbamazepine, lamotrigine)– NSAIDs (oxicam class)– Allopurinol• Other triggers:– Mycoplasma pneumoniae, HSV– HLA-B*1502 allele (esp. in East Asian populations)– HIV, SLE, malignancy– Recent vaccination or transplant📌 Pathophysiology• A delayed hypersensitivity reaction (Type IV)• Immune activation → cytotoxic T cells release granulysin and perforin, destroying keratinocytes• Results in full-thickness epidermal necrosis📌 Symptoms• Prodrome: flu-like illness (fever, sore throat, conjunctivitis)• Mucosal involvement early (eyes, mouth, genitals)• Rapidly spreading erythematous macules, then blisters and sloughing• Positive Nikolsky’s sign – skin peels with lateral pressure💡 Mnemonic: "Fever + Fragile skin + Facial mucosa"📌 Differential Diagnosis• Stevens-Johnson syndrome (SJS) – less skin involved• Staphylococcal scalded skin syndrome (SSSS)• Bullous pemphigoid / pemphigus vulgaris• Burns• Erythroderma, Toxic shock syndrome, Erythema multiforme📌 Diagnosis• Clinical diagnosis based on history and skin signs• Skin biopsy: shows full-thickness epidermal necrosis• Bloods: FBC, U&Es, LFTs, CRP – assess severity• Cultures: screen for secondary infection• Rule out SSSS and autoimmune blistering with biopsy + DIF🧠 No specific blood test confirms TEN📌 Management• Stop causative drug immediately• Admit to burns/ICU unit• Supportive care:– Fluid/electrolyte replacement– Nutritional support (often NG feeds)– Temperature regulation– Skin care: non-adhesive dressings, barrier nursing– Pain relief• Controversial pharmacological therapies:– IVIG, cyclosporin, TNF-α inhibitors (limited evidence)– Steroids: debated• Multidisciplinary care: dermatology, critical care, ophthalmology📌 Complications• Sepsis, pneumonia, renal failure, DIC• Ocular complications (dry eye, scarring, blindness)• Esophageal strictures, urogenital stenosis, joint contractures• Psychological trauma, chronic pain📌 Prognosis• High mortality (up to 30–50%)• SCORTEN score predicts mortality:– Score ≥5 → ~90% mortality• Prognosis depends on:– BSA involvement– Age, comorbidities– Speed of recognition and referral• Lifelong avoidance of causative drug is essential📎 More MSRA Resources for Toxic Epidermal Necrolysis📝 Revision Notes:https://www.passthemsra.com/topic/toxic-epidermal-necrolysis-revision-notes/🧠 Flashcards:https://www.passthemsra.com/topic/toxic-epidermal-necrolysis-flashcards/💬 Accordion Q&A Notes:https://www.passthemsra.com/topic/toxic-epidermal-necrolysis-accordion-qa-notes/🚀 Rapid Quiz:https://www.passthemsra.com/topic/toxic-epidermal-necrolysis-rapid-quiz/🧪 Topic Quiz:https://www.passthemsra.com/quizzes/toxic-epidermal-necrolysis/🎓 Full Course:https://www.passthemsra.com/courses/dermatology-for-the-msra/🎓 This episode is part of the Dermatology for the MSRA courseExplore full revision guides, flashcards, quizzes, and more at:👉 https://www.passthemsra.com#MSRA #ToxicEpidermalNecrolysis #TEN #StevensJohnsonSyndrome #MSRATextbook #MSRARevision #MSRAQuiz #MSRAFlashcards #MSRAAccordions #MSRAPodcast #MSRAQandA #MSRAResources #MultiSpecialityRecruitmentAssessment #DermatologyForMSRA