Skip to main content

Toxic Epidermal Necrolysis

Medically reviewed by Last updated on Jul 4, 2022.

What is toxic epidermal necrolysis?

Toxic epidermal necrolysis (TEN) is a rare skin condition that causes you to lose your outer layer of skin. It may look like a second-degree burn. You may lose 30% of your skin or more.

What causes TEN?

TEN is usually caused by new medicines that you started to take within the past 3 weeks. The most common medicines include antibiotics, seizure medicines, antiretrovirals, and certain NSAIDs. Other causes may include infections, graft versus host disease, or vaccinations.

What are the signs and symptoms of TEN?

The first symptoms include fever, tiredness, cough, itchy skin, muscle aches, and sore throat. You will then develop redness, swelling, blisters, and wounds on your lips and in your mouth. These symptoms develop 1 to 3 days before skin lesions appear. The redness and blisters will then spread to the rest of your body. You may have painful blisters in your eyes and genitals. You may also have sores in your stomach, lungs, and intestines. The blisters and sores may be very painful and feel like they are burning. When your skin dies, it may fall off in large amounts. Your skin will be dark red and look badly burned.

How is TEN diagnosed?

Your healthcare provider can diagnose your condition by looking at your skin. Tell him if you have started any new medicine. You may need a skin biopsy to confirm that you have TEN.

How is TEN treated?

The goal of treatment is to find out which medicine is causing your condition and stop it. You will be taken to a hospital and placed in a burn unit or intensive care unit.

  • IV liquids will help prevent dehydration caused by skin loss.
  • Medicines will help decrease pain or itching, or prevent an infection. You may also need medicine to strengthen your immune system.
  • Surgery may be needed if your skin does not heal properly. You may need any of the following:
    • Debridement is done to clean and remove dirt or dead tissues from the injured area.
    • A skin graft is when a healthy piece of skin is taken from one area of the body and attached to the injured area. Donor skin (from another person) may also be used.

Treatment options

The following list of medications are in some way related to or used in the treatment of this condition.

View more treatment options

How can I manage my symptoms?

  • Care for you wounds as directed. You may need to change your bandages to help decrease pain and promote healing.
  • Care for your mouth as directed. You may need a medicated mouthwash, sponge, or soft toothbrush if you have mouth sores.
  • Drink liquids as directed. Liquids will help prevent dehydration from skin loss. Ask your healthcare provider how much liquid to drink each day and which liquids are best for you.
  • Go to physical therapy. A physical therapist teaches you exercises to help improve movement and strength, and to decrease pain.

When should I contact my healthcare provider?

  • You have a fever.
  • Your pain gets worse, even after you take medicine.
  • You have questions or concerns about your condition or care.

When should I seek immediate care or call 911?

  • You have severe pain.
  • You suddenly have trouble breathing.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© Copyright IBM Corporation 2022 Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or IBM Watson Health

Learn more about Toxic Epidermal Necrolysis

Treatment options

Care guides

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.