Complex dermatological diseases that could be life-threatening are not very common. However, they are. One of these is considered epidermal toxic necrolysis. This pathology is a rare disease of the skin that can lead to death.
What is a pathology?
Epidermal toxic 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 undergoes powerful intoxication. Without qualified treatment, a person can experience sepsis and death.
Not only skin integuments, but also mucous membranes can undergo bullous transformation and death. The disease is very insidious. The fact is that even the internal mucous membranes can be affected , which often leads to stomach bleeding, respiratory failure and other disorders of the body.
Most often, epidermal toxic necrolysis develops after the use of certain drugs. However, there may be other reasons. The appearance and course of the disease is almost impossible to predict.
Development reasons
The most common cause of the development of pathology is the use of certain types of drugs:
- Sulfonamides.
- Macrolides: Erythromycin.
- Penicillin preparations.
- Anticonvulsants: Lamotrigine, Carbamazepine, Phenobarbital.
- Quinolones: Trovafloxacin.
- Anti-inflammatory non-steroidal drugs: Indomethacin, Ibuprofen, Piroxicam.
The incidence rate is extremely low and amounts to only 1 case per 1,000,000 people per year. Women suffer more often. Age also matters, since most cases of pathology develop after 55 years.
In addition to taking medications, a staphylococcal infection can become the cause of necrolysis.
Features of the development of the disease
Epidermal toxic necrolysis develops quite quickly. In the case of a disease, the immune system cannot correctly recognize and neutralize a toxic substance, in our case, a drug. An allergic reaction is very strong.
In this case, the immune system attacks the skin, as it considers them to be a foreign body. Moreover, the regulation of the breakdown of protein substances is disrupted. Toxins begin to accumulate in the skin, which lead to general intoxication of the body. If you do not start therapy in time, then the person will die.
Varieties and localization
Toxic epidermal necrolysis (the symptoms of pathology we have already considered) can be classified as follows:
- Idiopathic. It occurs independently, and its cause may not be established.
- Caused by the influence of certain drugs.
- Arisen under the influence of staphylococcal infection. This type of pathology is diagnosed mainly in children. In this case, the possibility of death is excluded.
- Combined with other diseases.
Lesions can be found in such places: buttocks, shoulders, chest, abdomen and back, oral mucosa.
Symptoms of the disease
Toxic epidermal necrolysis (Lyell syndrome) is usually characterized by the following symptoms:
- A general violation of the state of the body, which manifests itself in loss of appetite, headaches, and an increase in basal temperature. A frequent sign of pathology is increased thirst.
- Pain and discomfort in the mucous membranes. At the same time, their sensitivity increases significantly. For example, while eating, when swallowing, the patient feels pain.
- The 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 indicator can be significantly 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.
- Renal 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, as well as hypotension can be observed.
- Muscle pain.
- Fever and cough.
- Anorexia.
- Nausea and vomiting.
It must be borne in mind that lesions of the mucous membrane appear faster than disorders of the skin. If at the initial stages toxic epidermal necrolysis, the photo of which is not for the faint of heart, is poorly visible, then later it is seen very well.
Diagnostic Features
If you have a suspicion of toxic epidermal necrolysis, then you need to urgently consult a doctor. He must conduct a differential and very thorough diagnosis, which includes:
- Fixing complaints of the victim. Attention is paid to every rash, sensation of pain.
- A history of the patient. That is, the doctor must find out if he has any allergies that contributed to the development of such a complex reaction. It is advisable to find out if the patient's relatives have similar problems.
- External examination of the patient. In this case, a dermatologist draws attention to the shade of the skin, the presence of rashes and blisters on the mucous membrane. The patient may not respond adequately to the surrounding reality.
- The blood test is general. It will make it possible to determine whether the level of leukocytes is increased, whether there are unripe blood cells, acceleration of erythrocyte sedimentation. If these parameters go beyond the norm, then the situation indicates the presence of an inflammatory process.
- Biochemical blood test. If the result is an increased level of bilirubin or too little protein, then the patient may have problems with the kidneys.
- Urinalysis 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 in scope.
- 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.
Treatment features
The presented disease must be treated. Otherwise, the patient may 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 be sterile, which will exclude the possibility of joining other infections. Treatment of pathology involves the elimination of the factor that provoked the disease.
As for drug therapy, corticosteroids and antihistamines will come to the rescue. In addition, infusion therapy should be organized . Antibiotics can only be used if the patient has a secondary infection.
Toxic epidermal necrolysis (what it is, you already know) must also be treated with local drugs that will help restore normal skin regeneration: anesthetics (painkillers), ointments, antiseptics.
In addition, you will need to adhere to the following principles of therapy:
- It is necessary to quickly cleanse the body of previously taken drugs. For this, enemas are used.
- It is advisable to take medications that help restore normal water-salt metabolism, such as Regidron.
- The doctor will prescribe medications to protect the liver, in particular Gepabene.
- The intake of substances that reduce the level of blood coagulability.
What complications may occur?
If you are diagnosed with toxic epidermal necrolysis, complications may include:
- The development of a serious bacterial infection.
- Severe dehydration, which can cause the death of the patient.
- Loss of a significant amount 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, a change in pigmentation.
- Chronic erosion of the mucous membranes.
Forecast
If the treatment of the pathology was not started on time, then mortality can reach 70%. Loss of a significant part of the skin will make the patient too susceptible to various infections.
Timely started therapy will help not only get rid of the disease, but also make it possible to avoid such terrible complications as internal bleeding, damage to the genitourinary system, inability to absorb food, and kidney and liver failure.
It should be noted that children die from this disease much less often than adults. If a patient has crossed a 60-year milestone, then his prognosis is disappointing. However, proper treatment can improve his condition.
Pathology Prevention
Another name for such a pathology as toxic epidermal necrolysis is Lyell syndrome. Photos of this disease is better not to watch impressionable people. This is a complex pathology that can be avoided if preventive measures are observed:
- Medications should be taken only if they are prescribed by a doctor.
- The specialist should know if you have any allergic reactions.
- Whatever pathology you have, you should not take more than 7 drugs at a time.
- Do not self-medicate staphylococcal and inflammatory skin diseases.
- Avoid contact with any irritant that may cause allergies.
As for treatment, it all depends on the characteristics of the body and the patient’s desire to deal with the violation. Be healthy!