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VOLUME 1 , ISSUE 3 ( September-December, 2023 ) > List of Articles

CASE SERIES

Dermatological Emergency in Emergency Medicine: A Case Series

Goutham Deivassigamany, Nithyaraj Ramanathan, Kirubasankaran Ezhilan

Keywords : Emergency medicine, Muco-cutaneous disease, Pulse therapy, Toxic epidermal necrolysis, Severity-of-illness score for TEN

Citation Information : Deivassigamany G, Ramanathan N, Ezhilan K. Dermatological Emergency in Emergency Medicine: A Case Series. 2023; 1 (3):71-76.

DOI: 10.5005/njem-11015-0020

License: CC BY-NC 4.0

Published Online: 25-01-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Toxic epidermal necrolysis (TEN), is an acute, potentially life-threatening mucocutaneous disease often induced by drugs due to an inappropriate immune reaction. It is characterized by the widespread detachment and exfoliation of the epidermis and mucous membrane, leaving large areas of raw, exposed tissue. It is a medical emergency and requires immediate treatment. The condition might result in sepsis, a deadly complication if not treated promptly. It involves >30% of the total body surface area (TBSA), which helps to differentiate it from Stevens-Johnson syndrome (SJS) which involves 10% of TBSA. It usually occurs within a few weeks of treatment initiation, and requires a detailed medication history that plays a pivotal role in the diagnosis. The severity-of-illness score for TEN (SCORTEN) is used to estimate the prognosis. In this report, we report three cases of drug-induced severe TEN who were presented to the emergency room (ER). The presence of the characteristic skin lesions led to the diagnosis of TEN in these cases. Their TBSA was >30%, with a positive Nikolsky sign. Two of the cases had a SCORTEN of 2, and one had a SCORTEN of 6 with a significant history. Treatment was initiated with the withdrawal of the potential agent and pulse therapy with conservative treatment.


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