Tuesday, April 24, 2012

Toxic Epidermal Necrolysis, healing phase

TEN is a potentially fatal disease that involves the complete sloughing of the epidermis, nearly always as a result of a drug exposure.  It is the most extreme part of the spectrum of erythema multiforme.  Separation of the epidermis happens at the dermal-epidermal level, and the damage can also extend to internal organs, such as the gut and the liver.  The ddx would include a phototoxic reaction, except it is not limited to photoexposed areas; also psoriatic erythroderma would have to be considered.  If you look at the overall process, you get the feeling of skin having just peeled and separated right off the dermis, even at this late stage of healing. These are not the lesions of an immunobullous process, which are more discrete. Also, PRP would have islands of sparing and I would have shown you his palms.  

For those of you who answered the question for extra credit on the treatment of acute paronychia, the answer was indeed incision, drainage and local heat, with possibility of antibiotics (although those are secondary). Good job.

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