Pediatric Toxic Epidermal Necrolysis

Toxic epidermal necrolysis is a life-threatening skin disorder. It causes skin tissue to die, resulting in skin blistering and peeling. It is most often caused by a medicine reaction. A milder form of the disorder is known as Stevens-Johnson syndrome.

The condition is most often triggered in the first eight weeks of using a new medicine. It may be caused by medicines for:

• Infections (antibiotics)
• Gout
• Seizures
• HIV

In rare cases, the condition may be caused by:

• A vaccine
• Herbal medicine
• Contact with chemicals
• Infections with Mycoplasma pneumoniae or cytomegalovirus

A child is at risk if they have:

• HIV/AIDS
• Weak immune system
• Family history of toxic epidermal necrolysis or Stevens-Johnson syndrome

Symptoms can be a bit different for each child. They can include:

• Skin peeling in sheets with or without blistering, leaving large, raw areas
• A painful, red skin area that spreads quickly
• High fever and flu-like symptoms one to three days before skin peeling
• Pain when exposed to light (photosensitivity)
• Extreme tiredness (fatigue), muscle pain and joint pain
• Trouble swallowing

The condition may spread to the eyes, mouth or throat and it may spread to the genitals, urethra or anus. The loss of skin allows fluids and salts to ooze from the raw, damaged areas. These areas can easily become infected.

Toxic epidermal necrolysis can be life-threatening. If your child has these symptoms, take them to the closest emergency room for assessment.

Your healthcare provider will ask about your child’s symptoms and health history. They may also ask what medicines your child has had recently. They will give your child a physical exam. Your child may also have tests, such as:

• Skin biopsy. A tiny sample of skin is taken and examined under a microscope.
• Cultures. These are simple tests to check for infection. Cultures may be done of the blood, skin and mucous membranes.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is. If a medicine is causing the skin reaction, your child will stop taking it right away. The disease progresses fast, often within three days. Your child will need to be treated in the hospital. They may be in the burn unit of the hospital. This is because the treatment is a lot like treating a child with burns. Or your child may be treated in the intensive care unit (ICU). Treatment may include:

• Isolation to prevent infection
• Protective bandages
• IV (intravenous) fluid and electrolytes
• Antibiotics
• IV immunoglobulin G 
• IV steroids
• Feeding by nasogastric tube, if needed
• Eye exam by an eye care provider who specializes in diseases of the eyes (ophthalmologist) and prompt eye care with cleaning of eyelids and daily lubrication

Complications can include:

• Skin color changes
• Growth of many moles that don’t look normal (nevi)
• Abnormal growth of fingernails and toenails
• Hair loss
• Skin scarring, from a moderate to severe infection
• Eye changes
• Oral changes such as periodontal disease
• Lung damage
• Dehydration
• Infection
• Death

There is no known way to prevent the condition. But a child who has had the disease must stay away from all possible triggers. A future episode of the condition may be fatal. Your child needs to stay away from not only the medicine that triggered the disease, but medicines in the same class. Talk with your child’s healthcare provider about which medicines your child needs to stay away from.

Get medical care right away if your child has any skin problems after taking a new medicine.