Toxic Epidermal Necrolysis

Fever and skin pain may precede visible epidermal loss. When a patient develops dusky macules, flaccid bullae, or sheets of sloughing skin with oral, ocular, or genital erosions after a medication exposure, treat the presentation as the SJS/TEN spectrum until assessed. The detached BSA determines the label—SJS below 10%, SJS-TEN overlap at 10–30%, and TEN above 30%—but not the urgency. The first clinical decision is not which immunomodulator to choose. Stop suspected culprit medicines, assess airway, breathing, and circulation, provide analgesia, and arrange ICU or specialised burn-centre care. Loss of epidermis removes the barrier that limits fluid loss, heat loss, and microbial invasion; mucosal injury can also impair oral intake, vision, urination, and breathing. Rapid detachment, hypotension, falling urine output, increasing oxygen needs, or altered mental status signals deterioration.