Toxic Epidermal Necrolysis Definition, Reason, Symptoms, Treatment & Prevention
Understanding
Toxic Epidermal Necrolysis (NET) is a very severe type of skin disorder. This condition is characterized by extensive skin tissue damage, which can lead to severe infection and death. Not only on the skin, NET can also attack internal organs and cause respiratory problems, digestive tract bleeding, urinary tract disorders, and so on.
NET cases are more common in women. NET can be experienced at any age, but the most common cases are in the 40–60 year age group. This health disorder is a form of disorder similar to Steven-Johnson Syndrome (SSJ).
NET originators are generally similar to SSJ. The difference is the skin damage that occurs. In NET the damage caused is heavier than SSJ.
Symptom
Symptoms of Toxic Epidermal Necrolysis (TEN) generally begin to occur several hours to several days after taking certain drugs.
In the early stages, the symptoms are similar to those of the common cold, in the form of fever, cough, runny nose, muscle aches, joint pain, loss of appetite, nausea, and vomiting. It can also be accompanied by complaints of itching on the skin and eyes that look red. These complaints may last 1–21 days.
Shortly after these symptoms appear, lesions will generally appear in the mouth such as canker sores which feel very painful or feel like they are burning. In addition, the eyes, which initially only look red, begin to feel dry and vision may begin to blur due to disturbances in the cornea of the eye.
After that, symptoms appear on the skin. Starting with skin that feels sore or painful, reddish, and warm when touched. Shortly thereafter, reddish spots will appear on the skin similar to measles. These spots will turn into elastic filled with fluid. If the elastic breaks it will be seen that the top layer of skin is separated from the layers of skin below it.
If not treated quickly and appropriately, complications from NET often occur which can lead to death. The most common complications are:
- Sepsis, which is a severe infection that occurs throughout the body. This condition causes a large number of germs to circulate in the blood and can cause a sudden drop in blood pressure, a too-fast or too-slow heart rate, and shock.
- Organ failure can be in the form of failure of the kidneys, liver, brain, heart, and lungs in performing their respective functions.
- Acute respiratory distress syndrome (ARDS), which is a condition of shortness of breath that results in insufficient oxygen needs, so that cells in the body lack oxygen, and these cells can slowly die
The risk of complications and death is higher in the following conditions:
- The patient is over 40 years old
- Heart rate above 120 beats per minute
- The body surface area that experiences NET is more than 10 percent
- High blood sugar
- Suffering from cancer
Reason
The most common cause of Toxic Epidermal Necrolysis (TEN) is an allergic reaction to a drug. All types of drugs have the potential to cause NET. But among all the drugs, the ones that most often trigger NET are antibiotics (especially the penicillin, sulfa, chloramphenicol, and quinolone groups), anti-inflammatory drugs (eg paracetamol, ibuprofen, and mefenamic acid), allopurinol, corticosteroids, anti-epileptic drugs ( eg phenobarbital, phenytoin and valproic acid), and anti-retroviral drugs (eg nevirapine and abacavir).
Apart from being caused by an allergic drug reaction, TEN can also be triggered by the following:
- Infections, especially bacterial infections mycoplasma pneumonia, herpes virus, and hepatitis A virus
- Immunization
- Organ or bone marrow transplant
However, that does not mean that all people who use these drugs, get immunized, undergo a transplant, or experience an infection, are definitely at risk of experiencing NET. Until now, the specific things that underlie the occurrence of NET in a person are not clearly known. As is the case with allergic reactions to certain substances that are different for each person, until now the mechanisms and causes of NET are not clearly known.
Diagnosis
If the doctor suspects that there is Toxic Epidermal Necrolysis (TEN), then the doctor will do a thorough physical examination and complete interviews, especially regarding the history of previous drug consumption. Furthermore, blood tests and X-ray examinations are needed to assess complications that occur due to NET.
On blood tests, you will generally find levels of white blood cells that are lower than they should be due to a severe infection. In addition, platelets (platelets) can also be at low levels due to bleeding. A chest X-ray is necessary if the patient is short of breath. This step is to ensure if complications occur in the lungs.
Treatment
Treatment of Toxic Epidermal Necrolysis (NET) must be carried out quickly, precisely, and carried out in a hospital that has complete medical facilities. The later it is treated, the greater the possibility of complications and death.
An important initial treatment is to give large amounts of fluids through an IV to ensure that the patient is not dehydrated and to prevent shock. Generally, patients will be treated in an isolation room, so they don’t easily catch infections from other patients being treated.
The part of the skin that is experiencing NET usually needs to be smeared with a saline solution (physiological saline solution) every hour, then followed by applying moisturizer on top. This is important to prevent excessive evaporation of water from the skin. If the dead skin tissue is large enough, it is not uncommon for surgery to remove dead skin to prevent the dead skin from becoming a nesting place for disease germs.
To treat canker sores in the mouth, the patient will be asked to rinse his mouth with a solution of chlorhexidine four times a day. If the pain due to canker sores is unbearable, pain medication that is used by smearing it will be given.
It is no less important is the administration of antibiotics to prevent severe infections. The antibiotics that the doctor will give are broad-spectrum antibiotics that can kill various types of bacteria.
NET treatment generally takes a long time, it can be for two weeks, it can also be up to months. In addition, please note that not all cases of NET can heal completely.
Sometimes there are sequelae on the skin. It can be a change in skin pigment (skin that has experienced NET can be lighter or darker in color than the surrounding skin), nails do not grow, scars appear, skin becomes dry, the mouth and vaginal areas are prone to irritation, and dry eyes.
Prevention
Not all cases of Toxic Epidermal Necrolysis (TEN) can be prevented. However, if someone already knows he has a history of allergies to a particular substance or drug, then try to avoid exposure to that substance. This will really help lower the risk of experiencing NET.