Dermatological and Ophthalmological Sequels in Toxic Epidermal Necrolysis

Abstract

Background: Toxic epidermal necrolysis (TEN) is a rare, drug-induced disease characterized by epidermal detachment and mucosal involvement. After an acute period, potentially disabling cutaneous and ocular sequels may appear. Although long-term complications are not rare, only few outcome studies are published. Objective: To evaluate the incidence of dermatological and ophthalmological sequels following TEN, to describe its clinical aspects and correlation with acute involvement. Patients and Methods: Eight patients surviving to TEN were submitted to dermatological and ophthalmological observation ranging from 0.5 to 8 years after hospitalization. Cutaneous and ocular involvement, during the acute phase, was retrospectively analysed. Results: Dermatological sequels were observed in 6 patients (75%) corresponding to those with more extensive skin involvement in the acute phase. The most frequent complications were cutaneous dyschromia (62.5%) and nail dystrophies (37.5%). Six patients (75%) had ocular complications with tarsal conjunctiva keratinization in 5 (62.5%) and keratoconjunctivitis sicca in 4 of them (50%). Trichiasis, corneal neovascularization and symblepharon were observed in 1 case. There was no correlation between the severity of acute ocular involvement and long-term complications. Conclusion: Following TEN, most patients have dermatological and ophthalmological sequels that persist for several years.

Facial Scars following Toxic Epidermal Necrolysis: Role of Adnexal Involvement?

“…Magina et al [7] described the dermatological and ophthalmological sequelae following TEN in 8 surviving patients. The most frequent long-term dermatological complication was dyspigmentation.…”

Síndrome de Lyell por imipramina: relato de caso

“…A formação de defeitos epiteliais, neovascularização, ulceração estromal com cicatrizes e queratinização são os principais fatores corneanos que podem levar à cegueira (14)(15) . O oftalmologista deve estar atento às doenças dermatológi-cas associadas a condições oculares.…”

“…A retirada imediata de medicações que causam a SL está muito bem documentada como principal ação para diminuir a mortalidade desses pacientes (16) . Mesmo após cessar o quadro agudo o paciente deverá ser acompanhado freqüentemente em intervalos apropriados, com distanciamento progressivo das consultas ambulatoriais, já que a probabilidade de acometimento ocular na fase crônica da SL não é pequena e nem mesmo isenta de complicações do que a fase aguda (15) . O uso de lubrificantes oculares é importante na maioria dos casos para prevenir lesões corneanas e ajudar na cicatrização, deve-se, porém, ter cuidado com os conservantes.…”

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“…The biopsy of the skin can be carried out with the help of Direct Immunofluorescence analysis technique [42].…”