From the Guidelines
Toxic epidermal necrolysis (TEN) can occur without oral or mucosal lesions, although this is a rare presentation. The majority of TEN cases present with mucosal involvement, but atypical cases without mucosal lesions have been documented in the medical literature 1. These cases may present diagnostic challenges for clinicians, but the absence of mucosal lesions does not rule out TEN, especially if other characteristic features are present, such as widespread epidermal detachment and preceding medication exposure. The pathophysiology of TEN remains the same, regardless of mucosal involvement, and is characterized by a severe, immune-mediated drug reaction causing keratinocyte apoptosis and epidermal detachment. Clinicians should maintain a high index of suspicion for TEN even without mucosal lesions when other clinical features suggest this diagnosis, as prompt recognition and management are crucial for improving outcomes. Key features that may suggest TEN in the absence of mucosal lesions include:
- Widespread epidermal detachment
- Positive Nikolsky sign
- Preceding medication exposure
- Systemic symptoms such as fever and malaise It is essential to note that the management of TEN, regardless of the presence or absence of mucosal lesions, involves prompt withdrawal of the offending medication, supportive care, and close monitoring for complications 1. Early recognition and management of TEN are critical to reducing morbidity and mortality, and clinicians should not hesitate to seek specialist advice if they suspect TEN, even in the absence of mucosal lesions.
From the Research
Definition and Characteristics of Toxic Epidermal Necrolysis
Toxic epidermal necrolysis (TEN) is a severe mucocutaneous adverse drug reaction characterized by mucosal and epidermal necrosis and sloughing 2. It is commonly caused by an immunologic reaction to medications and can lead to many long-term complications.
Occurrence of TEN without Oral or Mucosal Lesions
While TEN is typically associated with mucosal and epidermal lesions, there is limited information in the provided studies on whether it can occur without oral or mucosal lesions. The studies primarily focus on the treatment and management of TEN, including the use of intravenous immunoglobulins (IVIG) and systemic corticosteroids 3, 4, 5, 6.
Key Points about TEN
- TEN is a rare and severe mucocutaneous disorder 2
- It is characterized by mucosal and epidermal necrosis and sloughing 2
- TEN is commonly caused by an immunologic reaction to medications 2
- The disorder can lead to many long-term complications 2
- Treatment options include IVIG and systemic corticosteroids 3, 4, 5, 6
Treatment and Management of TEN
The provided studies discuss the use of IVIG and systemic corticosteroids in the treatment and management of TEN. For example, a study published in 2022 found that the combined use of systemic corticosteroids and IVIG seems to be a safe treatment option for patients with TEN 3. Another study published in 2006 reviewed the use of IVIG in the treatment of TEN, highlighting its potential to interfere with the interaction of Fas and FasL 4.
Limitations of the Studies
The provided studies do not directly address the question of whether TEN can occur without oral or mucosal lesions. Therefore, it is not possible to provide a definitive answer based on the available evidence.