Toxic Epidermal Necrolysis (TEN) is a dangerous condition that causes the skin to peel off as if it has been burned! Let's learn about it.

Imagine that you have just started taking a new medication for some illness. After about a week or two, you feel unwell, as if you are about to catch a cold. Your body aches, you feel feverish, you shiver... Then suddenly, your body starts to break out in red spots that gradually turn into watery blisters, and your skin starts to peel off as if you have been burned. This is a very scary, painful, and potentially life-threatening condition. Today we are talking about this dangerous condition, which is Toxic Epidermal Necrolysis (TEN) .

Simply put, what is Toxic Epidermal Necrolysis (TEN)?

Toxic Epidermal Necrolysis, or TEN for short, is a very painful and potentially life-threatening skin condition. It causes blistering and peeling of large areas of your body, usually at least 30% of your body. This peeling can also occur in areas with mucous membranes, such as the mouth, eyes, and genitals.

This dangerous condition often occurs as a severe reaction to certain medications we take. When the skin is damaged this badly, there is a high risk of dehydration and serious infections.

Who is most at risk of developing this condition?

People with weakened immune systems are more likely to develop Stevens-Johnson syndrome (SJS) or TEN. There can be several reasons why the immune system is weakened.

• People infected with human immunodeficiency virus (HIV).
• People with certain cancers, such as lymphoma.

In addition, genetic factors can also play a role. Some people's bodies cannot break down and metabolize certain drugs normally. This is something that comes from their genes. In such cases, those drugs can accumulate in the body and cause severe reactions such as SJS or TEN. Also, due to changes (mutations) in certain genes, some people may be more likely to react to certain drugs.

Although TEN can affect anyone of any age, it is more common in older people. However, it is important to remember that it is a very rare condition . Worldwide, SJS and TEN combined only affect one to two million people per year.

What are the main causes of TEN?

In many cases, doctors believe that certain medications are the main cause of TEN. Let's take a look at which medications are at higher risk.

In addition to these medications, very rarely, certain infections or vaccines can also cause TEN. But this is very rare. Sometimes, the cause of TEN cannot be found.

What are the symptoms of TEN?

TEN symptoms usually start to appear within a few weeks of starting a new medication. It starts with cold-like symptoms.

• Body pain
• Cough
• Fever and chills
• Headache
• Eye redness and inflammation

After these initial symptoms, painful red spots (rash) begin to appear on the skin. These spots gradually enlarge, turn into water-filled blisters, and eventually the skin begins to peel off. The wounds that form when the skin peels off are called erosions . These are extremely painful, open wounds that look like severe burns.

These lesions first appear on the face and chest, and can then spread to other parts of the body.

• Eyes: The inside of the eyelid (conjunctiva) and the outer part of the black eye (cornea) can be damaged.
• Mucous membranes: Lesions can occur inside the mouth, nose, throat, and respiratory tract.
• Urethral tract, anus, and genitals: These areas can also be seriously injured.

These injuries make even simple tasks like eating, swallowing, breathing, closing your eyes, and urinating extremely painful and difficult.

Serious complications that can occur due to TEN

TEN is not a condition to be taken lightly. It can lead to serious, life-threatening complications.

• Infections: When the skin breaks, there is a greater chance that germs will enter the body. If these germs enter the bloodstream, a very dangerous condition called sepsis can occur.
• Multiple organ failure: Severe inflammation and infection in the body can cause internal organs such as the kidneys, liver, and lungs to fail.
• Pneumonia: There is an increased risk of lung infections due to injuries to the respiratory tract.

Because of the potential for such severe complications, a person with TEN symptoms should be hospitalized and treated immediately .

How do doctors diagnose this disease?

A qualified doctor can usually diagnose TEN by examining your skin and asking about your symptoms. Sometimes, a skin biopsy may be needed to confirm the diagnosis.

This involves taking a very small piece of skin from a skin lesion under anesthesia and examining it under a microscope. This test can clearly see whether there are dead skin cells (necrotic cells) and whether the upper layer of skin (epidermis) has separated from the lower layer.

What are the treatments for this?

In the hospital, the patient is often admitted to an intensive care unit (ICU) or burn center, as these patients require specialized care similar to that given to a burn patient.

Treatment methods can be divided into two main parts.

Long-term effects after recovery

Survivors of TEN may experience some long-term effects. Even if the skin heals completely, other problems may arise.

• Skin, hair and nails: abnormal nail growth or shedding, skin spots (black or white), hair loss in some areas (alopecia areata), dry and itchy skin, excessive sweating.
• Eyes: Long-term inflammation or redness of the eyes, dry eyes, eyelid abnormalities, sensitivity to light, blurred vision or, rarely, blindness.
• Mouth, nose and respiratory system: Bronchitis, lung diseases such as COPD, dry mouth, gum disease, loss of taste and smell, lung damage.
• Urinary and reproductive system: Long-term injury or inflammation of the urethra, vagina, or penis, difficulty urinating, vaginal dryness in women.

It is very important to talk to your doctor about these long-term effects and seek the necessary treatment.