SAQ 187 – Paediatric Dermatology – toxic epidermal necrolysis

Question 3. toxic epidermal necrolysis.

a. Diagnosis

• Toxic epidermal necrolysis.

b. Causes

• Medication, such as sulfonamides, carbamazepine, phenobarbital, lamotrigine, aspirin, or NSAIDs.
• Infection, such as HIV, Mycoplasma, or CMV.
• Vaccination.
• Contrast medium, chemical exposure, herbal medicine, or food.
• Systemic disease such as SLE.
• Malignancy such as leukaemia or lymphoma.

c. Disposition

• Urgent transfer to a tertiary paediatric centre with intensive-care and burns capability.
• Arrange early ophthalmology and gynaecology review where relevant.

d. Justification

• Prompt transfer to a burns or intensive-care unit improves prognosis.
• The condition requires major-burn-style care and rapidly evolving ocular or genital complications need specialist input.

e. Management

• Withdraw or treat the inciting agent.
• Apply non-adherent dressings.
• Provide analgesia.
• Manage fluids as for burns.
• Prevent infection with sterile handling and antiseptic solutions; routine prophylactic antibiotics are not recommended.
• Provide eye lubrication and care.