Toxic Epidermal Necrolysis, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
By Kenneth Kee
()
About this ebook
This book describes Toxic Epidermal Necrolysis, Diagnosis and Treatment and Related Diseases
Toxic epidermal necrolysis (TEN) is a very rare, sudden onset, often life-threatening reactions to medicines that occur in the skin and the linings of mouth, gastrointestinal tract, genitalia and eyes.
The affected patient has a fever and there may be enlargement of the lymph nodes and inflammation in the liver and other organ systems.
Widespread full-thickness epidermal necrosis forms, causing erythema, and sloughing of the skin and mucosa, affecting internal and external surfaces
The skin has an appearance similar to a burn.
It normally involves the trunk, face and one or more mucous membranes.
Steven Johnson Syndrome (SJS) and TEN are related disorders which can be distinguished by the degree of skin involvement.
Less of the epidermis peels off in SJS, while TEN may be defined as affecting >30% of the total body surface area
SJS is a less serious presentation affecting mainly the lips, eyes and genital mucosa.
People with 10-30% skin loss are categorized as “overlap”.
TEN is more often observed in people who have a specific genetic make-up (genotype) that leads to slow metabolizing of certain classes of drugs, or those who have HIV or are immune suppressed.
There is the belief that an immune complex-mediated hypersensitivity reaction happens because of the presence of toxic drug metabolites which collect in the skin.
This reaction leads to the damage of keratinocytes.
Specifically, cytotoxic T lymphocytes produce keratinocyte damage and subsequent necrosis, mediated by granzyme B.
Cytotoxic molecules such as FasL and granulysin have been indicated as causing the widespread keratinocyte apoptosis.
More than 200 medicines have been linked with TEN, mostly:
1.Sulfonamides.
2.Ampicillin.
3.Quinolones
4.Cefalosporins.
5.Anticonvulsants - phenobarbital, phenytoin, carbamazepine, lamotrigine and valproate.
6.Allopurinol.
Symptoms:
There is a prodromal stage normally persisting 2-3 days with fever, symptoms the same as upper respiratory tract infection, conjunctivitis, pharyngitis, pruritus, malaise, arthralgia and myalgia.
Mucous membrane affliction happens early in 90% of cases and often goes before other symptoms
The conjunctivae, buccal, nasal, pharyngeal, tracheobronchial, perineal, vaginal, urethral and anal mucosae may all be affected.
Skin lesions first occur in the pre-sternal region and the face, palms, and soles of the feet.
A gentle touch or rub can slough the skin off and it is very painful (Nikolsky's sign)
Diagnosis:
There is no specific laboratory test required to diagnose TEN.
Rapid histological examination such as direct immunofluorescence analysis of a lesion skin biopsy is first in the diagnostic work-up of TEN, as it helps to exclude diseases similar to TEN
Treatment
The first step is to stop the medicine causing TEN.
Following this, the treatment for TEN and SJS is mostly supportive care until the top layer of skin regenerates.
Affected individuals are often sent to a burns or intensive care unit and treated as if they have suffered from very severe burns.
1.Fluid and electrolyte replacement
2.Infection control with antibiotics
3.Pain relief
4.Skin care such as the use of topical antiseptics and regular wound dressings
5.Special wound nursing care
6.Eye, mouth and lung care
7.Urinary catheterization
8.Oral hygiene
Some cases have benefited from the use of immunoglobulins, immunosuppressive agents, systemic steroids or other biologic agents.
Debridement of necrotic areas of skin may be needed.
The exposed dermis needs protecting with skin grafting to prevent fluid and protein loss and infection.
TABLE OF CONTENT
Introduction
Chapter 1 Toxic Epidermal Necrolysis
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagno
Kenneth Kee
Dr. Kenneth Kee is a well-known medical doctor from Singapore who has been practicing medicine since 1972.He graduated from the University of Singapore and furthered his studies with a Master of Science in Health Management in 1991, followed by a Ph.D. in Healthcare Administration in 1993.Dr. Kee established Kee Clinic in 1974, located in the Holland Drive area of Singapore. The clinic has been a prominent feature of the community, offering general medical services for 5 decades.Dr Kee also served his country Singapore as a national service police Inspector at night from 1975 to 1985 while working at his clinic during the day.He had served as a police guard to the Woodland Petroleum Tanks at night during the Indonesian Confrontation period, took part in police rounds at night in the Beach Road area and taught First aid and emergency resuscitation to Police recruits.He received the Singapore Police Bicentennial 2020 Medallion on 1st March 2024 as recognition for his work in the Singapore Police.Even as he grew older, Dr. Kee continued to work actively in his clinic, although he eventually reduced his consultation hours.Beyond his medical career, Dr. Kee is also an author.He started writing about medical conditions in 2007, using blogs and other online platforms to share his knowledge with a broader audience.Over time, he published various books, many of which provide simple and accessible guides to different health conditions.His works include "A Family Doctor's Tale," "My Personal Singapore History," and numerous medical guides, available through platforms like Amazon.His books often combine his personal experiences as a family doctor with insights into Singapore's healthcare system and history.Dr. Kee has written extensively on health topics, contributing to both medical literature and general knowledge resources.Dr. Kenneth Kee has written numerous books, primarily focused on health education and personal experiences as a family doctor. Some of his notable titles include:"A Family Doctor's Tale"This book is a blend of Dr. Kee’s personal experiences and his reflections on being a family doctor in Singapore. It’s a great choice if you're looking for a narrative that combines both medical knowledge and human stories.“Specialized Medical Conditions”Books like **"Congestive Heart Failure: Diagnosis and Treatment"** focus on specific conditions, offering in-depth information about diagnosis, treatment options, and patient management.“Healthcare Management”Some of his works touch on broader aspects of healthcare, discussing patient care, medical ethics, and the role of the family doctor in the healthcare system“Medical Case Studies”“Case Notes from a Family Doctor": This book provides insights into real-life medical cases that Dr. Kee has encountered in his practice, offering readers a behind-the-scenes look at diagnostic processes and patient care.“Health Education”His writings aim to educate the public on maintaining health and preventing diseases, covering topics like healthy living, nutrition, and fitness“Life and death of different Cell”“Life and death of Red Blood Cell” This book describes the beginning of a red blood cell (named Red Bull) from its origin from the bone marrow and its journey around the body before its death in the spleen. Other stories told are Sperm cell, Ovum, Cancer cell etc."Singapore's Medical and Social History"**"My Personal Singapore History":** This book reflects on Singapore's development from a medical perspective, interwoven with personal stories and observations about healthcare in the country.His works are known for simplifying complex medical information, making it accessible to the general public.Dr. Kenneth Kee's books cover a wide range of health and medical topics.He is known for writing in a clear and straightforward manner, making complex medical information accessible to the general public.His works are known for simplifying complex medical information, making it accessible to the general public.If you are looking for a good starting point, "A Family Doctor's Tale" offers a well-rounded introduction to Dr. Kee’s experiences and insights.It is engaging and provides a mix of personal stories and medical knowledge, making it a good entry into his work.One of the best health tips, supported by both medical professionals like Dr. Kenneth Kee and health research, is to focus on preventive care.This means taking steps to maintain your health before problems arise.There are books on Psychological conditions (PTSD) and disorders (Depression, dementia etc) and children books on Time travelMany of his books are available on platforms like Amazon and Smashwords.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"
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Toxic Epidermal Necrolysis, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions - Kenneth Kee
Toxic Epidermal Necrolysis,
A
Simple
Guide
To
The Condition,
Diagnosis,
Treatment
And
Related Conditions
By
Dr Kenneth Kee
M.B.,B.S. (Singapore)
Ph.D (Healthcare Administration)
Copyright Kenneth Kee 2018 Smashwords Edition
Published by Kenneth Kee at Smashwords.com
Dedication
This book is dedicated
To my wife Dorothy
And my children
Carolyn, Grace
And Kelvin
This book describes Toxic Epidermal Necrolysis, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.
(What The patient Need to Treat Toxic Epidermal Necrolysis)
This eBook is licensed for your personal enjoyment only. This eBook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader.
If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.
Thank you for respecting the hard work of this author.
Introduction
I have been writing medical articles for my blog: http://kennethkee.blogspot.com (A Simple Guide to Medical Disorder) for the benefit of my patients since 2007.
My purpose in writing these simple guides was for the health education of my patients.
Health Education was also my dissertation for my Ph.D (Healthcare Administration).
I then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog: http://afamilydoctorstale.blogspot.com.
This autobiolographical account A Family Doctor’s Tale
was combined with my early A Simple Guide to Medical Disorders
into a new Wordpress Blog A Family Doctor’s Tale
on http://kenkee481.wordpress.com.
From which many free articles from the blog was taken and put together into 800 eBooks.
Some people have complained that the simple guides are too simple.
For their information they are made simple in order to educate the patients.
The later books go into more details of medical disorders.
The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.
Since 2013, I have tried to improve my spelling and writing.
As I tried to bring the patient the latest information about a disorder or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.
Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.
I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.
I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.
I apologize if these repetitions are irritating to some readers.
Chapter 1
Toxic epidermal necrolysis
What is Toxic epidermal necrolysis (TEN)?
Toxic epidermal necrolysis (TEN) is a very rare, sudden onset, often life-threatening reactions to medicines that occur in the skin and the linings of mouth, gastrointestinal tract, genitalia and eyes.
The affected patient has a fever and there may be enlargement of the lymph nodes and inflammation in the liver and other organ systems.
Toxic epidermal necrolysis (TEN) is a possibly life-threatening, idiosyncratic mucocutaneous reaction, normally happening after introduction of a new medicine.
Widespread full-thickness epidermal necrosis forms, causing erythema, and sloughing of the skin and mucosa, affecting internal and external surfaces
The skin has an appearance similar to a burn.
It normally involves the trunk, face and one or more mucous membranes.
It is considered by some as being part of a group of disease which involves, in order of severity, erythema multiforme, Stevens-Johnson syndrome (SJS) and TEN.
This relationship remains debatable.
Erythema multiforme is linked with infections such as herpes simplex virus and Mycoplasma pneumoniae while SJS and TEN are necrolytic bullous skin reactions to certain drugs.
It may be that erythema multiforme should not be categorized as part of the same disease spectrum
Many however accept that it differs from SJS (Steven Johnson Syndrome) and TEN.
Another classification method is based on the fact that SJS and TEN are related disorders which can be distinguished by the degree of skin involvement.
Less of the epidermis peels off in SJS, while TEN may be defined as affecting >30% of the total body surface area
Steven