Dermatologist Allen Lyell was thought to be the first person to discover a breakout appearing to be a scalding of the skin when he observed four boys. In 1965, he named the condition Toxic epidermal necrolysis (TEN; Harr & French, 2010). TEN, a life threatening disorder that can occur at any age, is a disease that mostly develops from a drug reaction to antibiotics, anticonvulsants, nonsteroidal anti-inflammatory drugs, psychotropics, and antigout medications (Law & Leung, 2014; Tiwari, Panik, Bhattacharya, Ahirwar, & Chandy, 2013). Although most cases are caused by drug reactions, Kim et al. (2012) have found that there are nondrug related sources, for instance, upper respiratory infections and influenza. Thong (2013) found that genetic factors-which have emerged from Asian ancestry-can cause a higher risk of TEN. In addition, Harr and French (2010) reported that mycoplasma pneumoniae induces TEN. There are also situations in which TEN is idiopathic (Harr & French, 2010). .
TEN is very rare, with mortality rates of 25% to 35% (Porth, 2011). As a dermatological disorder, it affects the skin and the mucous membrane (Ellender, Peters, Albritton, Garcia, & Kaye, 2014). The mucous membrane becomes tender, and erythema and bullae arise from the epidermis. This disease is characterized by the separation of the epidermis and the dermis. Ultimately epidermis is stripped away from the dermis. Punctual diagnosis and management is needed for this condition (Tiwari, et al., 2013).
B. Typical Presentation/Course .
Harr and French (2010) stated that TEN can occur in two phases, acute and late. The acute phase generally develops within the first 8 to 12 days (Law & Leung, 2014). The first symptoms include fever, irritation of the eyes, and a difficulty swallowing. It is expected to have an ocular involvement that presents with erythema, ocular discharge, and crusts (Harr & French, 2010). The eyes, and the tissue lining the eyes, become swollen as well.
With the advancements of technology over the past years, physicians, especially those who practice in intensive care setting, are faced with patients who are not going to recover, however they are not going to die. This is due to modern treatments and technology. However there are certain ethics t...
