Acute Epidermal Necrolysis (Ritter von Rittershain-Lyell)

Ten new consecutive cases of toxic epidermal necrolysis (TEN) have been studied clinically, bacteriologically, histopathologically, and histochemically and compared with dermatitis exfoliativa neonatorum (DEN) Ritter von Rittershain's disease) both from reports in the literature and personal study of histologic material from patients with that disease. The clinical picture and the histopathology in the two conditions are identical and also diagnostic. In the hematoxylin and eosin-stained sections there is a reversal of the tinctorial properties of the stratum corneum and stratum Malpighi, with transepidermal, or subepidermal separation, and minimal dermal inflammatory change. The pathodynamics of the process and the significance of certain phage types of staphylococcus hemolyticus and drug reactions in what is obviously a reaction pattern of multifactoral etiology are discussed. Appropriate therapy is outlined, and a new name is proposed for the single united syndrome.