Is toxic epidermal necrolysis (TEN) contagious?

Toxic Epidermal Necrolysis Is Not Contagious

Toxic epidermal necrolysis (TEN) is not contagious and cannot be transmitted from person to person as it is an immune-mediated reaction, typically triggered by medications or infections rather than a communicable disease. 1

Understanding TEN: Causes and Mechanism

TEN is part of a spectrum of severe mucocutaneous reactions characterized by widespread epithelial keratinocyte apoptosis and necrosis. The spectrum includes:

• Stevens-Johnson Syndrome (SJS): <10% body surface area involvement
• SJS/TEN overlap: 10-30% body surface area involvement
• TEN: >30% body surface area involvement 1, 2

Primary Triggers:

• In adults: Primarily medication-induced (90% of cases)

  • Common culprits: anticonvulsants, antibiotics (particularly sulfonamides), allopurinol, and NSAIDs 2

• In children: Infections are more common triggers (up to 50% of cases)

  • Herpes simplex virus and Mycoplasma pneumoniae are frequent infectious causes 1, 2

Pathophysiology:

TEN occurs when drug-induced cytotoxic T lymphocytes trigger widespread keratinocyte apoptosis. Current evidence suggests granulysin is the key mediator of this process, not an infectious agent that could be transmitted between individuals 1.

Clinical Presentation

TEN presents with:

• Prodromal symptoms: fever, malaise, upper respiratory tract symptoms
• Painful cutaneous lesions that progress rapidly
• Widespread epidermal detachment with exposed dermis
• Mucosal involvement (eyes, mouth, genitalia)
• Positive Nikolsky sign (epidermis separates from dermis with gentle lateral pressure) 1

Why TEN Is Not Contagious

1. Immune-mediated reaction: TEN is an adverse immune reaction to a specific trigger, not an infectious process 1

2. No person-to-person transmission: Unlike infectious skin conditions, TEN cannot be transmitted through direct contact, respiratory droplets, or any other means 1

3. No isolation precautions needed: While patients with TEN require specialized care, they do not need isolation to prevent disease transmission to others (though they may need protective isolation to prevent them from acquiring infections due to compromised skin barrier) 1

Important Considerations in TEN Management

While not contagious, TEN patients require:

• Immediate discontinuation of suspected triggering medications
• Specialized care, often in burn units or intensive care settings
• Protection from secondary infections due to compromised skin barrier
• Supportive care including fluid management and nutritional support
• Careful monitoring for complications affecting multiple organ systems 1

Common Misconceptions

• Confusion with SSSS: Staphylococcal Scalded Skin Syndrome (SSSS) can mimic TEN clinically but is caused by circulating bacterial toxins. Unlike TEN, SSSS is associated with Staphylococcus aureus infection 1

• Mistaking wound exudate as infectious: While denuded skin in TEN exudes serum and can become secondarily infected, the underlying condition itself is not infectious 1

Long-term Considerations

Patients who survive TEN may experience:

• Skin pigmentation changes
• Scarring
• Nail deformities
• Ocular complications
• Respiratory and urogenital problems 1

These sequelae are consequences of the immune-mediated damage, not ongoing infection, and pose no contagion risk to others.