1. STEVENS JOHNSON SYNDROME SUPPORT NETWORK A type of hypersensitivity (allergic) reaction that occurs in response to medications, infections, Category Health Conditions and Diseases Erythema Multiforme......Stevens Johnson Syndrome and toxic epidermal necrolysis Syndrome SupportGroup Providing Support and Information. Stevens Johnson http://www.interlog.com/~zzzz/

Stevens Johnson Syndrome Toxic Epidermal Necrolysis Syndrome Support Network SJS/TENS sjssuport@interlog.com TORONTO ONTARIO CANADA The Stevens Johnson Syndrome and Toxic Epidermal Necrolysis Syndrome Support Network is dedicated to providing people with emotional support, providing information and to building a network of contacts for people to access. If you have something to add to this site, or if you have any suggestions for this site, I would love to hear them PLEASE BE SURE TO JOIN OUR STEVENS JOHNSON SYNDROME TOXIC EPIDERMAL NECROLYSIS SYNDROME MAILING LIST. WE NOW HAVE 133 PEOPLE ON THE LIST! To Join please enter your e-mail address in the box below and press "Join group" Subscribe to Stevens Johnson Syndrome tens archive Hosted by eGroups.com PRESS BUTTON FOR MORE INFORMATION LAST UPDATE Oct. Oct. 23, 1999

2. EMedicine - Toxic Epidermal Necrolysis : Article By Robert Fan, MD Background toxic epidermal necrolysis (TEN) is a severe mucocutaneous exfoliative disease with an uncertain http://www.emedicine.com/emerg/topic599.htm

(advertisement) Home Specialties CME PDA ... Patient Education Articles Images CME Patient Education Advanced Search Link to this site Back to: eMedicine Specialties Emergency Medicine Infectious Diseases Toxic Epidermal Necrolysis Last Updated: August 10, 2001 Rate this Article Email to a Colleague Synonyms and related keywords: TEN, mucocutaneous exfoliative disease, staphylococcal scalded skin syndrome, SSSS AUTHOR INFORMATION Section 1 of 9 Author Information Introduction Clinical Differentials ... Bibliography Author: Robert Fan, MD , Attending Staff, Department of Emergency Medicine, Kaiser Permanente Medical Center at Hayward Coauthor(s): Peter Viccellio, MD , Vice-Chair, Professor, Department of Emergency Medicine, State University of New York at Stony Brook Editor(s): Theodore Gaeta, DO, MPH , Residency Director, Clinical Associate Professor of Emergency Medicine in Medicine, Department of Emergency Medicine, New York Methodist Hospital; Francisco Talavera, PharmD, PhD , Senior Pharmacy Editor, Pharmacy, eMedicine; Mark L Plaster, MD, JD

3. BCOM Otolaryngology - Erythema Mutliforme See an article on erythema multiforme and toxic epidermal necrolysis, a similar condition to SJS. toxic epidermal necrolysis (TEN) is distinguished by larger body surface area involvement, and the development of bullae. http://www.bcm.tmc.edu/oto/grand/22092.html

Grand Rounds Archives The information contained within the Grand Rounds Archive is intended for use by doctors and other health care professionals. These documents were prepared by resident physicians for presentation and discussion at a conference held at The Baylor College of Medicine in Houston, Texas. No guarantees are made with respect to accuracy or timeliness of this material. This material should not be used as a basis for treatment decisions, and is not a substitute for professional consultation and/or peer-reviewed medical literature. ERYTHEMA MULTIFORME AND TOXIC EPIDERMAL NECROLYSIS Michael G. Stewart, MD February 20, 1992 Clinical Features The diagnostic criteria for erythema multiforme (EM) is individual "target" skin lesions less than 3 cm in diameter, less than 20% of body surface area involved, with minimal mucous membrane involvement, and biopsy compatible with EM. The cutaneous lesions are typically symmetric, and involve the extremities, with the dorsal hands and extensor aspects most commonly involved. Many authors use the designation erythema multiforme minor and major, with EM minor meaning skin lesions only, and EM major being synonymous with Stevens-Johnson syndrome.

4. Postgraduate Medicine: Pearls In Dermatology peels off in sheets, leaving widespread denuded areas. toxic epidermal necrolysis (TEN) most often occurs in adults. http://www.postgradmed.com/issues/2000/04_00/brodell.htm

PEARLS IN DERMATOLOGY Toxic epidermal necrolysis A widespread, life-threatening blistering reaction Paul Watanakunakorn, MD; Robert T. Brodell, MD VOL 107 / NO 4 / APRIL 2000 / POSTGRADUATE MEDICINE A n 18-year-old woman had a 3-day history of skin tenderness over her entire body and blistering involving 40% of her body surface area, including face, trunk, upper arms, and thighs. Mucosal tissues, including lips, throat, conjunctivae, and labia, were tender and eroded (figure 1). One week before onset of symptoms, she had been treated with trimethoprim-sulfamethoxazole (TMP-SMZ) for a urinary tract infection. A diagnosis of toxic epidermal necrolysis induced by TMP-SMZ was made. The patient was admitted to a burn unit and carefully handled to prevent further tissue sloughing. Treatment consisted of administration of fluids to achieve balance, nutritional support, oral prednisone (60 mg per day for 4 days), and local application of mupirocin ointment. The patient's condition stabilized over 2 weeks, and she was discharged. Figure 1. Denuded skin with flaccid blisters over the cheeks, neck, and chest of 18-year-old patient with toxic epidermal necrolysis. Lips are eroded and erythematous. Dermal-epidermal separation (below the pigmented layer of epidermis) is evidenced by lighter shade of exposed dermis on chest in contrast to darker tan of surrounding skin.

5. Dermatology - Toxic Epidermal Necrolysis toxic epidermal necrolysis What is toxic epidermal necrolysis? toxic epidermal necrolysis is a lifethreatening skin disorder characterized by a blistering and peeling of the skin. http://www.musckids.com/health_library/derm/necrolys.htm

6. Stevens Johnson Syndrome Foundation Nonprofit organization dedicated to providing information and support to persons afflicted with Stevens Johnson Syndrome and toxic epidermal necrolysis. http://hometown.aol.com/sjsupport/index.html

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7. Toxic Epidermal Necrolysis - Dermatology Health Guide Dermatology. toxic epidermal necrolysis. What is toxic epidermalnecrolysis? What are the symptoms of toxic epidermal necrolysis? http://www.umm.edu/dermatology-info/toxic.htm

Dermatology Health Guide Anatomy of the Skin Skin Tests Describing a Skin Condition ... Glossary Related Resources Within UMM Dept. of Dermatology Dermatology Toxic Epidermal Necrolysis What is toxic epidermal necrolysis? Toxic epidermal necrolysis is a life-threatening skin disorder characterized by a blistering and peeling of the top layer of skin. This disorder can be caused by a drug reaction most often penicillin or another disease. About one-third of all diagnosed cases of toxic epidermal necrolysis are a result of unknown causes. What are the symptoms of toxic epidermal necrolysis? Toxic epidermal necrolysis can cause the skin to peel off in sheets, leaving large areas that look scalded. The loss of skin causes fluids and salts to ooze from the raw, damaged areas which can easily become infected. The following are the most common symptoms of toxic epidermal necrolysis. However, each person may experience symptoms differently: a painful, red area that spreads quickly the top layer of skin may peel without blistering scalded-looking raw areas of flesh discomfort fever condition spread to eyes, mouth, and genitals

8. Erythema Multiforme, Stevens-Johnson Syndrome, And Toxic Epidermal Necrolysis Erythema Multiforme, StevensJohnson Syndrome, and Toxic EpidermalNecrolysis. Kate M. Petersen, Pharm.D. toxic epidermal necrolysis. http://hsc.virginia.edu/cmc/pedpharm/v4n11.htm

Pediatric Pharmacotherapy A Monthly Review for Health Care Professionals of the Children's Medical Center Volume 4 Number 11, November 1998 Erythema Multiforme, Stevens-Johnson Syndrome, and Toxic Epidermal Necrolysis Kate M. Petersen, Pharm.D. Introduction Erythema multiforme Stevens Johnson Syndrome Toxic epidermal necrolysis ... References Pharmacology Literature Reviews Adverse Effects from Anesthetics Frequency of Adverse Drug Reactions Grapefruit Juice with Carbemazepine Formulary Update Erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis are mucocutaneous disorders that are thought to be related, constituting a spectrum of reactions. Erythema multiforme (EM) has the most benign presentation, and is followed in severity by Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). Additionally, EM is generally a postinfectious process, while SJS and TEN are drug-induced reactions. As a result, SJS and TEN will therefore be discussed in greater detail than EM in this newsletter article. Erythema multiforme EM, first described in 1860 by von Hebra

9. Gale Encyclopedia Of Medicine: Toxic Epidermal Necrolysis toxic epidermal necrolysis (TEN) begins with fever, cough, and other nonspecific symptoms, and is soon followed by http://www.findarticles.com/cf_dls/g2601/0013/2601001375/p1/article.jhtml

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10. Dermatology - Toxic Epidermal Necrolysis toxic epidermal necrolysis What is toxic epidermal necrolysis? Toxic Whatare the symptoms of toxic epidermal necrolysis? Toxic http://www.muschealth.com/derm/toxic.htm

Toxic Epidermal Necrolysis What is toxic epidermal necrolysis? Toxic epidermal necrolysis is a life-threatening skin disorder characterized by a blistering and peeling of the skin. This disorder can be caused by a drug reaction - frequently antibiotics or anticonvulsives. About one-third of all diagnosed cases of toxic epidermal necrolysis do not have an identifiable cause. What are the symptoms of toxic epidermal necrolysis? Toxic epidermal necrolysis causes the skin to peel in sheets, leaving large, raw areas exposed. The loss of skin allows fluids and salts to ooze from the raw, damaged areas and can easily become infected. The following are the other most common symptoms of toxic epidermal necrolysis. However, each individual may experience symptoms differently. Symptoms may include: a painful, red area that spreads quickly the skin may peel without blistering raw areas of skin discomfort fever condition spread to eyes, mouth, and genitals The symptoms of toxic epidermal necrolysis may resemble other skin conditions. Always consult your physician for a diagnosis.

11. Toxic Epidermal Necrolysis - Lucile Packard Children's Hospital Dermatology. toxic epidermal necrolysis What is toxic epidermal necrolysis? Whatare the symptoms of toxic epidermal necrolysis? http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/derm/necrolys.html

Dermatology Dermatologists Burns Dermatology Dermatology Toxic Epidermal Necrolysis What is toxic epidermal necrolysis? Toxic epidermal necrolysis is a life-threatening skin disorder characterized by a blistering and peeling of the skin. This disorder can be caused by a drug reaction - frequently antibiotics or anticonvulsives. About one-third of all diagnosed cases of toxic epidermal necrolysis do not have an identifiable cause. What are the symptoms of toxic epidermal necrolysis? Toxic epidermal necrolysis causes the skin to peel in sheets, leaving large, raw areas. The loss of skin allows fluids and salts to ooze from the raw, damaged areas and can easily become infected. The following are the most common symptoms of toxic epidermal necrolysis. However, each child may experience symptoms differently. Symptoms may include: a painful, red area that spreads quickly the skin may peel without blistering raw areas of skin discomfort fever condition spread to eyes, mouth, and genitals

12. Interventions For Toxic Epidermal Necrolysis (Cochrane Review) Interventions for toxic epidermal necrolysis (Cochrane Review). More researchis required to understand the mechanisms of toxic epidermal necrolysis. http://www.cochrane.org/cochrane/revabstr/ab001435.htm

Abstract from The Cochrane Library , Issue 1, 2003 Click here to order the full review Interventions for toxic epidermal necrolysis (Cochrane Review) Majumdar S, Mockenhaupt M, Roujeau J-C, Townshend A ABSTRACT A substantive amendment to this systematic review was last made on 21 August 2002. Cochrane reviews are regularly checked and updated if necessary. Background: Toxic epidermal necrolysis is a rare condition where a drug reaction induces skin loss, similar to that seen in extensive burns. It is associated with high morbidity and mortality and there is no clear agreement on effective treatment. Objectives: To assess the effects of all interventions for the treatment of toxic epidermal necrolysis. Search strategy: We searched the Cochrane Skin Group Specialised Register (March 2001), the Cochrane Controlled Trials Register (March 2001), MEDLINE (1966 to December 2001), EMBASE (1980 to December 2001), DARE (4th Quarter 2001) and CINAHL (1982 to October 2001). Selection criteria: Randomised controlled trials of therapeutic and supportive interventions that included participants clinically diagnosed with toxic epidermal necrolysis were included. Data collection and analysis: Two independent reviewers carried out study selection and assessment of methodological quality.

13. EMedicine - Toxic Epidermal Necrolysis : Article Excerpt By: Robert Fan, MD Excerpt from toxic epidermal necrolysis. Synonyms, Key Words, and Related Terms TEN, mucocutaneous exfoliative disease, http://www.emedicine.com/emerg/byname/toxic-epidermal-necrolysis.htm

(advertisement) Excerpt from Toxic Epidermal Necrolysis Synonyms, Key Words, and Related Terms: TEN, mucocutaneous exfoliative disease, staphylococcal scalded skin syndrome, SSSS Please click here to view the full topic text: Toxic Epidermal Necrolysis Background: Toxic epidermal necrolysis (TEN) is a severe mucocutaneous exfoliative disease with an uncertain pathogenesis and a high mortality rate. It can usually be distinguished from the morphologically similar, but more benign, staphylococcal scalded skin syndrome (SSSS) according to historical and epidemiologic factors. While controversy exists regarding the classification of TEN as a separate entity or a severe form of erythema multiforme (eg, Stevens-Johnson syndrome), the clinical distinction is of little significance in the ED, because the etiology and immediate treatment of these potentially life-threatening diseases are similar. Pathophysiology: The primary manifestation of TEN is the appearance of an erythematous confluent morbilliform eruption that rapidly evolves into exfoliation of the skin at the dermal-epidermal junction, resulting in large sheets of necrotic epidermis and the underlying shiny, denuded dermal surface. This process seems to be immune-complex mediated. Frequency: In the US: TEN occurs in 0.22-1.23 cases per 100,000 population.

14. Member Sign In Patients with toxic epidermal necrolysis (TEN) are frequently admitted for careat the burn center of Doctor´s Hospital in Augusta, Ga. Focus On http://www.medscape.com/viewarticle/444920

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15. Member Sign In toxic epidermal necrolysis (TEN) is a severe cutaneous adverse drugreaction that can result in morbidity or death. Focus On http://www.medscape.com/viewarticle/441933

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16. Toxic Epidermal Necrolysis MAIN SEARCH INDEX toxic epidermal necrolysis. Advances in toxic epidermal necrolysis. Seminars in Cutaneous Medicine and Surgery 15 (Dec. 1996) 258266. http://www.hendrickhealth.org/healthy/001376.htm

MAIN SEARCH INDEX Toxic epidermal necrolysis Definition Description Causes and symptoms Diagnosis ... Resources Definition Toxic epidermal necrolysis is a rare condition that causes large portions of the epidermis, the skin's outermost layer, to detach from the layers of skin below. A reaction to a medication is the primary cause. Description Toxic epidermal necrolysis (TEN) begins with fever cough , and other nonspecific symptoms, and is soon followed by purplish, bloody-looking lesions on the skin and mucous membranes. These early lesions, typically found on the head, neck, and upper chest, soon merge and blister. Sheets of epidermis then begin to detach from the skin layers below. In time, the entire surface of the skin may be involved, with detachment of 100% of the epidermis. Causes and symptoms The main cause of TEN is a severe drug reaction. Some investigators believe there may be additional infectious causes. A severe reaction in transplant patients, called graft-vs.-host disease , can also produce TEN. One study reported more than 100 different drugs as causes of TEN. The drugs most commonly implicated, however, include antibacterial sulfonamides such as sulfadiazine

17. Toxic Epidermal Necrolysis toxic epidermal necrolysis. Definition. Advances in toxic epidermal necrolysis. Seminars in Cutaneous Medicine and Surgery 15 (Dec. 1996) 258266. http://www.healthatoz.com/healthatoz/Atoz/ency/toxic_epidermal_necrolysis.html

Encyclopedia Index T Home Encyclopedia Encyclopedia Index T Toxic epidermal necrolysis Definition Toxic epidermal necrolysis is a rare condition that causes large portions of the epidermis, the skin's outermost layer, to detach from the layers of skin below. A reaction to a medication is the primary cause. Description Toxic epidermal necrolysis (TEN) begins with fever cough , and other nonspecific symptoms, and is soon followed by purplish, bloody-looking lesions on the skin and mucous membranes. These early lesions, typically found on the head, neck, and upper chest, soon merge and blister. Sheets of epidermis then begin to detach from the skin layers below. In time, the entire surface of the skin may be involved, with detachment of 100% of the epidermis. Causes and symptoms The main cause of TEN is a severe drug reaction. Some investigators believe there may be additional infectious causes. A severe reaction in transplant patients, called graft-vs.-host disease , can also produce TEN. One study reported more than 100 different drugs as causes of TEN. The drugs most commonly implicated, however, include antibacterial sulfonamides such as sulfadiazine

18. Cyclophosphamide In The Treatment Of Toxic Epidermal Necrolysis Cyclophosphamide in the Treatment of toxic epidermal necrolysis NIKOLAOS G. FRANGOGIANNIS,MD, ILLYA BORIDY, MD, MOBEEN MAZHAR, MD, RAJY MATHEWS, MD, SUBROTO http://www.sma.org/smj/96oct15.htm

Cyclophosphamide in the Treatment of Toxic Epidermal Necrolysis NIKOLAOS G. FRANGOGIANNIS, MD, ILLYA BORIDY, MD, MOBEEN MAZHAR, MD, RAJY MATHEWS, MD, SUBROTO GANGOPADHYAY, MD, and THOMAS CATE, MD, Houston, Tex ABSTRACT: A patient with non-small cell lung carcinoma and recent radiotherapy for brain metastases developed toxic epidermal necrolysis (TEN) shortly after therapy with phenytoin was initiated for a seizure. Exfoliation progressed to involve 90% of her body surface despite treatment with high-dose corticosteroids for 5 days, but sloughing and systemic toxicity ceased within 2 days of initiating therapy with intravenous cyclophosphamide (300 mg/day). Reepithelialization rapidly followed. This experience and the reports of others suggest that intravenous cyclophosphamide is helpful in the treatment of TEN. Toxic epidermal necrolysis (TEN) is a life-threatening reaction characterized by necrosis and detachment of the epidermis in its whole thickness and associated with severe constitutional symptoms and complications. Mortality rates are high (around 30%), and no generally accepted treatment of the underlying disorder has been defined.

19. Arch Dermatol -- Page Not Found 139;8586, January 2003, Treatment of toxic epidermal necrolysis The UncertaintyPersists but the Fog Is Dispersing, Klaus Wolff, MD, FRCP; Gerhard Tappeiner http://archderm.ama-assn.org/issues/current/ffull/ded20011.html

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20. Example Site - T Toxic Epidermal Necrolysis Keywords A B C D E F H I K L M P R S T U Z G j n o Q V W X Y. Toxic epidermalnecrolysis toxic epidermal necrolysis See StevensJohnson Syndrome. http://www.totalskincare.com/library/totalskincare_t_toxic-epidermal-necrolysis.

Keywords: A B C D ... S T U V W X ... Y-Z Toxic epidermal necrolysis Toxic epidermal necrolysis See Stevens-Johnson Syndrome. Tanning Tansy Tetracycline Thunder God Vine ... Topical Vitamin C Toxic epidermal necrolysis Trichloroacetic Acid Peels Tummy Tuck Tyrosine

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