Toxic epidermal necrolysis with the use of tamoxifen

Description A pre-menopausal woman aged 40 years was diagnosed with locally advanced carcinoma of the breast. Since her malignancy was strongly positive for oestrogen receptors, after completion of treatment with surgery (modified radical mastectomy), chemotherapy (four cycles of doxorubicin-cyclophosphamide, followed by four cycles of paclitaxel) and radiotherapy (50 Gy in 25 fractions, delivered to the chest wall, and the ipsilateral supraclavicular and axillary nodal stations), she was initiated on oral tamoxifen at a dose of 20 mg once daily. Since keratinocytes are responsible for holding surrounding skin cells together, their death causes skin detachment. 1 2 Despite being rare, with an incidence of 0.4-1.9 cases per million per year, TEN warrants early diagnosis given its life-threatening potential. 2 The definitive diagnosis of TEN depends on histopathological confirmation, as revealed by scattered necrotic keratinocytes (in early cases), or full-thickness epidermal necrosis with subepidermal split (in advanced cases).