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Review of Toxic Epidermal Necrolysis
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Journal Article
Review of Toxic Epidermal Necrolysis
2016
Overview
Toxic epidermal necrolysis (TEN) is a rare but life threatening mucocutaneous reaction to drugs or their metabolites. It is characterised by widespread keratinocyte apoptosis and sloughing of the skin, erosions of the mucous membranes, painful blistering, and severe systemic disturbance. The pathophysiology of TEN is incompletely understood. Historically, it has been regarded as a drug-induced immune reaction initiated by cytotoxic lymphocytes via a human leukocyte antigen (HLA)-restricted pathway. Several mediators have been identified as contributors to the cell death seen in TEN, including; granulysin, soluble Fas ligand, perforin/granzyme, tumour necrosis factor-α (TNF-α), and TNF-related apoptosis-inducing ligand. Currently, granulysin is accepted as the most important mediator of T cell proliferation. There is uncertainty around the accepted management of TEN. The lack of definitive management guidelines for TEN is explained in part by the rarity of the disease and its high mortality rate, which makes it difficult to conduct randomised control trials on emerging therapies. Developments have been made in pharmacogenomics, with numerous HLA alleles identified; however, these have largely been ethnically specific. These associations have translated into screening recommendations for Han Chinese.
Publisher
MDPI AG,MDPI
Subject
Antigens, Differentiation, T-Lymphocyte - metabolism
/ Cyclosporine - therapeutic use
/ Drug-Related Side Effects and Adverse Reactions - immunology
/ Drug-Related Side Effects and Adverse Reactions - pathology
/ Fas Ligand Protein - metabolism
/ Granulocyte Colony-Stimulating Factor - therapeutic use
/ Humans
/ Immunoglobulins, Intravenous - therapeutic use
/ Infliximab - therapeutic use
/ Review
/ Stevens-Johnson Syndrome - drug therapy
/ Stevens-Johnson Syndrome - pathology
/ TNF-Related Apoptosis-Inducing Ligand - metabolism
