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In-hospital mortality for epidermal necrolysis (EN) has been well-characterized, but less is known about the long-term complications. Marxer et al. (2020) report mortality rates of 7.4% during the initial hospitalization, 4.8% within 90 days, and 7.6% after 91 days. Compared with that of matched controls, long-term mortality was not increased, highlighting the importance of understanding the long-term sequelae of EN survivors.

Objective To describe the history of toxic epidermal necrolysis, before and after the original report by the British dermatologist Alan Lyell in 1956. Methods Subjective expert choice of key advances in the comprehension of the nosology, classification, causality, and mechanisms of epidermal necrolysis (EN) over more than a century. Results Epidermolysis had been reported long before Lyell's paper, but most cases had likely been staphylococcal scalded skin syndrome in children. Concerning non- Staphylococcus EN, confusion with erythema multiforme dissipated and its relation to Stevens–Johnson syndrome was clarified. Tremendous advances were made in understanding the causes and mechanisms, with increased acceleration in the last 10 years. Conclusion The next decade should be devoted to improve the prevention and management of a disease that is the most terrible form of drug hypersensitivity.

Toxic epidermal necrolysis is an extremely severe drug reaction, manifesting itself by widespread apoptosis of keratinocytes, generally considered to result from Fas/CD95-FasLigand interaction, but of unknown primary mechanism. We looked at the role of cells present in the skin blisters as probable effectors of this immune reaction. In a patient suffering from cotrimoxazole-induced toxic epidermal necrolysis, blister fluid cells were phenotyped by FACS and tested without prior restimulation for cytotoxicity on autologous and allogeneic cells in the presence of the drug. Blister fluid lymphocytes were predominantly CD8+, DR+, CLA+, CD56+ T lymphocytes, perforin positive and expressing preferentially two Vbeta chains of the T cell receptor repertoire. These lymphocytes were cytotoxic only in the presence of the drug towards autologous EBV transformed lymphocytes and towards allogeneic cells sharing HLA-Cw4. Cytotoxicity occurred in the presence of either cotrimoxazole, sulfamethoxazole, or the nitroso metabolite of sulfamethoxazole, but not with the hydroxylamine metabolite of sulfamethoxazole. The lysis was blocked by an anti-MHC class I monoclonal antibody. It was abolished by EGTA and CMA, but neither by anti-fas, brefeldin A, nor by anti-TRAIL receptor monoclonal antibodies, strongly suggesting perforin/granzyme-mediated cytotoxicity, without implication of Fas or TRAIL at this stage. This is direct evidence that T lymphocytes present within the lesions of toxic epidermal necrolysis may exhibit, without any re-stimulation, a drug-specific cytotoxicity against autologous cells. Harboring the markers of classical CTL and MHC class I restriction these lymphocytes reacted against the parent drug and one of its reactive metabolites. These results challenge several current concepts and could support new therapeutic approaches.

Toxic epidermal necrolysis (TEN) is a rare but life-threatening adverse drug reaction. Implicated drugs are sulfonamides, anticonvulsants, allopurinol, and pyrazolone derivatives. Recently, advances in pathogenesis have been made in two directions. It is now known that (1) most patients with TEN have an abnormal metabolism to the culprit drug; and (2) the mechanism leading to epidermal necrolysis seems to be a cell-mediated cytotoxic reaction. The treatment remains symptomatic.

oxic Epidermal Necrolysis (TEN) is a rare lifethreatening disorder characterised by extensivenecrolysis and detachment of full thickness epidermis,generally induced by drugs [1]. First described in 1939,the condition was named as TEN by Lyell in 1956.Separation of the dermal-epidermal junction causesNikolsky’s sign and gives skin the typical “wet dressing”appearance. The condition is self-limiting, with significantmorbidity rate (10-70%) and numerous sequelae maydevelop due to scarring [2]. Controversy persists aboutits definition, aetiopathogenesis and treatment [3].Corticosteroids have been the mainstay of therapy.Cyclosporin introduced into the treatment of TEN in1986 has been recently used in India.

Introduction. Recent studies indicate that the initial assessment of burn extent is often inaccurate. Since resuscitation and management is predicated on total body surface area (TBSA) burned, inaccurate assessment adversely affects treatment decisions and outcomes. With the rising popularity of personal digital assistants (PDAs) among physicians, we felt a freely available program which utilized a PDA to guide initial evaluation and management would be useful to referring community hospitals. Methods. Using Code Warrior and Visual Build, an application was developed in C for Palm OS handheld computers. This program has no copy protection and is “beamable” among compatible devices to facilitate its availability. Color and grayscale versions are available to allow newer devices to take advantage of high-resolution color screens while still allowing older palm devices to use the application. This application comprises two sections. The first section is interactive. A questionnaire is provided along with a Lund and Browder chart. The bedside clinician answers pertinent questions regarding age, weight, time of burn and mechanism of burn, and colors in the Lund and Browder chart with a stylus. The application then provides %TBSA burned, appropriate resuscitation volume, guidelines for treatment in the case of a specialized burn such as chemical or electrical, and whether the patient meets American Burn Association criteria for transfer to a burn center. If transfer is warranted, the clinician can enter their zip code and get a listing of nearby burn centers with contact numbers. Guidelines for transport preparation are then provided. In addition to the interactive component, the second section provides a searchable mini-textbook which covers key burn topics including inhalation injury, pediatric burns, topic epidermal necrolysis, frostbite, and local wound care. Comments. This application provides a user-friendly method to rapidly assess and treat burn patients with the bedside use of a PDA. We believe that utilization of this application should improve initial burn resuscitation and ensure prompt burn center referral when indicated.

A case of acute (toxic) epidermal necrolysis is reported in the dental literature for the first time. This severe, life-threatening mucocutaneous syndrome resembles severely scalded skin. Sloughing vesiculobullous oral lesions are a frequent component. Staphylococcus aureus and drug reactions may cause separate entities presenting clinically as acute epidermal necrolysis. This case of drug-induced epidermal necrolysis in a child was successfully treated with methicillin and hydrocortisone.