Exploring drug-induced toxic epidermal necrolysis: A case series and comprehensive review

Toxic Epidermal Necrolysis (TEN) is a potentially fatal dermatological condition primarily triggered by adverse drug reactions. It is characterized by extensive epidermal necrosis and separation, affecting more than 30 % of the body surface area, and leading to severe complications such as sepsis and multi-organ failure. Common causative agents include antibiotics, anticonvulsants, and NSAIDs. The pathophysiology of TEN involves an immune-mediated response, where cytotoxic T lymphocytes (CTLs) and natural killer (NK) cells release cytotoxic proteins such as perforin, granzyme B, and granulysin, leading to widespread keratinocyte apoptosis. This immune response results in massive skin detachment and mucosal damage. Despite its rarity, TEN has a high mortality rate, necessitating early diagnosis and intervention. This paper provides a comprehensive review of TEN, discussing its history, pathophysiology, clinical features, and current understanding of treatment strategies. A case series of 11 patients who developed TEN after exposure to various drugs, including Lamotrigine, Phenytoin, Diclofenac, Ibuprofen, Aceclofenac, Amoxicillin, Sulfadoxine-Pyrimethamine, Amoxiclav, and Gabapentin, is presented. The cases highlight the importance of early drug discontinuation, supportive care, and adjunctive therapies such as intravenous immunoglobulin (IVIG) and corticosteroids. Prognostic factors, such as the extent of skin detachment and systemic complications, significantly influenced patient outcomes. All patients recovered with timely intervention and intensive care, except for a few who succumbed to the severity of the condition. This study underscores the need for early intervention, multidisciplinary care, and robust pharmacovigilance systems to reduce the incidence and severity of TEN. Increased awareness of risk factors and early recognition of symptoms associated with high-risk medications are crucial in improving patient outcomes and reducing mortality.