Complex dermatological diseases that could be life-threatening are not very common. However, they are. One of these is epidermal toxic necrolysis. This pathology is a rare skin disease that can lead to death.
What is pathology?
Toxic epidermal necrolysis is a severe allergic pathology, the result of which is the exfoliation of the upper layer of the skin. He subsequently dies, and the body is subjected to powerful intoxication. Without qualified treatment, a person may experience sepsis and death.
Bullous transformation and death can be exposed not only to the skin, but also to the mucous membranes. The disease is very insidious. The fact is that even the internal mucous membranes can be affected, which often leads to gastric bleeding, respiratory failure and other disorders of the body.
Most often developsepidermal toxic necrolysis after the use of certain drugs. However, there may be other reasons. The appearance and course of the disease is almost impossible to predict.
Reason for development
The most common cause of the development of pathology is the use of certain types of drugs:
- Sulfanilamides.
- Macrolides: "Erythromycin".
- Penicillins.
- Anticonvulsants: Lamotrigine, Carbamazepine, Phenobarbital.
- Quinolones: "Trovafloxacin".
- Anti-inflammatory nonsteroidal drugs: Indomethacin, Ibuprofen, Piroxicam.
The incidence is extremely low, at only 1 case per 1,000,000 people per year. Women are more often affected. Age also matters, since most cases of the development of pathology are noted after 55 years.
In addition to taking drugs, staphylococcal infection can also cause necrolysis.
Features of the development of the disease
Epidermal toxic necrolysis develops quite quickly. In the case of illness, the immune system cannot correctly recognize and neutralize the toxic substance, in our case, the drug. An allergic reaction is very strong.
In this case, the immune system attacks the skin, as it considers them a foreign body. In this case, the regulation of the breakdown of protein substances is disturbed. Toxins begin to accumulate in the skin,which lead to general intoxication of the body. If therapy is not started in time, the person will die.
Varieties and Localization
Toxic epidermal necrolysis (we have already considered the symptoms of the pathology) can be classified as follows:
- Idiopathic. It occurs on its own, and its cause may not be established.
- Caused by the influence of certain drugs.
- Caused by a staphylococcal infection. This type of pathology is diagnosed mainly in children. In this case, the possibility of death is excluded.
- Associated with other diseases.
Lesions can be found on such places: buttocks, shoulders, chest, abdomen and back, oral mucosa.
Symptoms of the disease
Toxic epidermal necrolysis (Lyell's syndrome) is usually characterized by the following symptoms:
- General disturbance of the state of the body, which manifests itself in loss of appetite, headaches, increased basal body temperature. A frequent sign of pathology is increased thirst.
- Pain and discomfort in the mucous membranes. At the same time, their sensitivity is significantly increased. For example, while eating when swallowing, the patient feels pain.
- Appearance of red spots, rashes and blisters on the skin and mucous membranes. In most cases, about 30% of the body is affected, although this figure may besignificantly larger.
- Exfoliation of the epidermis. In this case, the skin begins to wrinkle even with a slight touch. If the affected area of the skin is removed, a bleeding wound will appear under it.
- Kidney failure.
- Infectious process. The fact is that the skin cannot function normally and protect a person from the effects of pathogenic microorganisms. The situation may end in sepsis.
- In the later stages of the pathology, dehydration, tachycardia, and hypotension can be observed.
- Muscle pain.
- Fever and cough.
- Anorexia.
- Nausea and vomiting.
It should be noted that mucosal lesions appear faster than skin disorders. If in the initial stages of toxic epidermal necrolysis, the photo of which is not for the faint of heart, is faintly noticeable, then later it can be seen very well.
Diagnostic features
If you suspect toxic epidermal necrolysis, you need to see a doctor immediately. He must make a differential and very thorough diagnosis, which includes:
- Fixing the complaints of the victim. Attention is drawn to every rash, sensation of pain.
- Collecting a patient history. That is, the doctor must find out if he has any allergies that contributed to the development of such a complex reaction. It is desirable to find out if the patient's relatives have similar problems.
- External examination of the patient. In this case, the dermatologist pays attention to the shadeskin, the presence of rashes and blisters on the mucous membrane. The patient may not respond adequately to the surrounding reality.
- Common blood test. It will make it possible to determine whether the level of leukocytes is increased, whether there are immature blood cells, and the acceleration of erythrocyte sedimentation. If these parameters go beyond the norm, then the situation indicates the presence of an inflammatory process.
- Blood biochemical analysis. If the result is an increased level of bilirubin or too little protein, then the patient may have kidney problems.
- Urine analysis is general. This study is also necessary to determine the functionality of the kidneys. If there is blood in the urine, then the problem is global.
- Measurement of heart activity, blood pressure indicators.
Diagnosis is also necessary in order to distinguish toxic epidermal necrolysis from other diseases: pemphigus, scarlet fever, erythema, bullous impetigo, lichen planus.
Features of treatment
The presented disease must be treated. Otherwise, the patient can expect sepsis and death. If the patient has the above symptoms, then it must be quickly delivered to the hospital. If the course of the disease is severe, then the victim is placed in intensive care, where the medical staff can provide him with proper care.
The ward into which the patient enters must besterile, which will exclude the possibility of attaching other infections. Treatment of pathology involves the elimination of the factor that provoked the disease.
As for drug therapy, then corticosteroids and antihistamines will come to the rescue. In addition, infusion therapy should be organized. Antibiotics should only be used if the patient has a secondary infection.
Toxic epidermal necrolysis (what it is, you already know) should also be treated with local remedies that will help restore normal skin regeneration: anesthetics (pain medications), ointments, antiseptics.
In addition, you will need to adhere to these principles of therapy:
- It is necessary to cleanse the body of previously taken drugs as quickly as possible. Enemas are used for this.
- It is advisable to take drugs that help restore normal water-s alt metabolism, such as Regidron.
- The doctor will prescribe medications to protect the liver, in particular Gepabene.
- Taking substances that reduce blood clotting.
What complications can occur?
If you are diagnosed with toxic epidermal necrolysis, complications may include:
- Development of a serious bacterial infection.
- Severe dehydration, which can cause death of the patient.
- Loss of significantamount of skin. If a person loses more than half of the epidermis, certain death awaits him.
- Drying of the skin, the appearance of scars on it, changes in pigmentation.
- Chronic erosions of the mucous membranes.
Forecast
If the treatment of the pathology was not started on time, then the mortality rate can reach 70%. The loss of a significant part of the skin will make the patient too susceptible to various infections.
Timely started therapy will not only help get rid of the disease, but will also make it possible to avoid such terrible complications as internal bleeding, damage to the genitourinary system, inability to eat, kidney and liver failure.
It should be noted that children die from this disease much less frequently than adults. If the patient has crossed the 60-year mark, then his prognosis is disappointing. However, the right treatment can improve his condition.
Prevention of pathology
Another name for such a pathology as toxic epidermal necrolysis is Lyell's syndrome. Photos of this disease are better not to look at impressionable people. This is a complex pathology that can be avoided if preventive measures are followed:
- Medication should only be taken if prescribed by a doctor.
- The specialist should know if you are experiencing any allergic reactions.
- Whatever pathology you have, you should not take more than 7 drugs at the same time.
- Do not self-medicate staphylococcal and inflammatory diseasesleather.
- Avoid contact with any irritant that can cause allergies.
As for treatment, it all depends on the characteristics of the body and the patient's desire to fight the disorder. Stay he althy!
