Author: Dr Shadi Habib, Dermatologist, Ibn al-Walid Hospital, Homs, Syria (June 2023). Reviewing dermatologist: Dr Ian Coulson (2023)
Edited by the DermNet content department
This 11-year-old female presented with disseminated flaccid blisters which were easily torn, exposing a red oozing dermis. These blisters mainly affected the mucosal membrane of the eyes, mouth, and genitalia, in addition to the skin of the face, trunk, and proximal extremities two days prior to presentation.
She had hepatitis A before the blisters developed and was treated with tablets containing vitamins and supplements.
Drug-induced epidermal necrolysis.
Differential diagnoses include:
Since the lesions affected >30% of the body surface area with a history of taking supplements, and there was no malignancy suspected, the diagnosis suggests drug induced toxic epidermal necrolysis.
This is a dermatological emergency.
Eye care:
Mouth care:
Nutrition:
Airway:
Genitourinary care:
Prevent recurrence:
Systemic corticosteroids (1–2 mg/kg/day for 3–5 days) and ciclosporin could be used, although this remains controversial.
The skin lesions will ultimately heal and any pigmentary changes will resolve.
Potential long term problems include:
