Pediatric Toxic Epidermal Necrolysis

What is toxic epidermal necrolysis?

Toxic epidermal necrolysis is a life-threatening skin disorder characterized by blistering and peeling of the skin. This condition can be caused by a reaction to certain drugs, including antibiotics or anticonvulsives, but about one-third of all 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 damaged areas, and the exposed areas can become infected.

The following are the most common symptoms of toxic epidermal necrolysis. However, each child may experience symptoms differently.

  • Peeling skin without blisters
  • 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 a physician for the correct diagnosis.

What is the treatment for toxic epidermal necrolysis?

This disease progresses fast, usually within 3 days. Treatment usually includes hospitalization, often in the burn unit. If a medication is causing the skin reaction, it is immediately discontinued.

Specific treatment for toxic epidermal necrolysis will be determined based on:

  • The child's age, overall health, and medical history
  • Extent of the disease
  • The child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Child or parent’s opinion or preference

Treatment may include one or more of the following:

  • Isolation to prevent infection
  • Protective bandages
  • Intravenous fluid and electrolytes
  • Antibiotics
  • Intravenous immunoglobulin G (IVIG)
Children's Team

Children's Team





The Division of Dermatology at Children's National Health System continues to expand services as more families seek our expertise in the diagnosis and treatment of disorders of the skin, hair, and nails.