Toxic Epidermal Necrolysis
Toxic epidermal necrolysis (TEN) is a life-threatening skin disorder that can be caused by an allergic reaction to drugs. Bextra and Celebrex, also known by their generic names of valdecoxib and celecoxib, are capable of eliciting this dangerous condition. Antibiotics, anticonvulsants and over-the-counter pain relievers, such as Motrin and Children's Motrin, have also been associated with this debilitating disorder. Toxic epidermal necrolysis is characterized by blistering and peeling of the skin.
Toxic epidermal necrolysis is a type of immune complex mediated hypersensitivity (allergic reaction) in its most severe form. Stevens Johnson Syndrome, or SJS, is a lesser form and erythema multiforme is the least severe form of this hypersensitivity. Like TEN, SJS causes large areas of the skin to become detached and lesions to develop in the mucous membranes.
Symptoms of TEN include peeling of the skin in sheets, leaving large raw areas of open flesh. The loss and damage of skin, similar to what occurs in burn victims, allows fluids and important minerals to ooze from the damaged areas. These areas can easily become infected. The most common symptoms include:
- Painful red areas (rashes) that spread quickly
- Skin peels without blistering
- Considerable pain and discomfort
- Spread to the mucous membranes in the eyes, mouth and genitals
Stevens Johnson Syndrome and toxic epidermal necrolylsis have similar symptoms and clinical paths. A classification system, based primarily on the level of detached skin and the morphology of the lesions, has been used to distinguish SJS and TEN. SJS is characterized by skin detachments across less than 10% of the body surface with widespread rash or flat atypical lesions. The overlap between TEN and SJS occurs when there is 10 to 30% of the body surface with detached skin and with widespread rash or flat atypical lesions. TEN with spots occurs when there is greater than 30% of the body surface area with detached skin and the widespread presence of flat atypical lesions. TEN without spots occurs when there is greater than 30% of the body surface area with detached skin, but there are no surface lesions. Erythema multiforme is the less severe type of the disorder and is classified when there is less than 10% of body surface where skin is detached and localized lesions are present.
Toxic Epidermal Necrolysis Clinical Course and Treatment
Toxic epidermal necrolysis spreads rapidly, usually within 3- to 5-days. Since the treatment of the disease is similar to that of burn victims, hospitalization in a burn unit is typically required. Treatment includes isolation of the affected areas to prevent infection, protective bandages, intravenous fluids and electrolytes and antibiotics. Since TEN can be caused by a reaction to a drug, all drug treatments within the previous 1 to 2 weeks of first symptoms should be evaluated. Any drug treatment that could be the cause of TEN, such as Bextra or Celebrex, should be stopped immediately.
Frequency and Mortality of Toxic Epidermal Necrolysis
Toxic epidermal necrolysis occurs worldwide at a rate of 0.4- to 1.2-cases per million population. TEN has a mortality rate of up to 40%. The loss of skin leaves TEN patients open to bacterial and fungal infection; these are the primary causes of death. Lesions of mucous membranes in the mouth and digestive tract make patients intolerant of drinking or eating. Lesions and scarring in the respiratory system leads to difficulty in breathing or may require the use of breathing aids. Corneal ulcers can lead to blindness and patients may require corneal transplants after the lesions have subsided.
Toxic Epidermal Necrolysis Legal Remedies
If you or a loved one has been afflicted with toxic epidermal necrolysis, then it is possible that the condition was caused by an allergic reaction to a drug. Drug manufacturers have a responsibility to notify physicians and patients of any potential harmful side effects of drugs.
If they fail to carry out this responsibility, drug manufacturers can and should be held financially liable for any harm caused to patients as a result of taking their drugs. Please contact a knowledgeable personal injury lawyer if you suspect that you or your loved one's toxic epidermal necrolysis was caused by an allergic drug reaction. Because victims of this perilous condition often require legal help in various areas of their lives, many necrolysis injury law firms have excellent working relationships with a skilled car accident attorney, DUI lawyer, family attorney and divorce lawyer.
Last Revision: June 29, 2009