Toxic epidermal necrolysis (TEN) is a life-threatening skin condition. It causes peeling and blistering skin over much of the body, including the mouth, eyes, and genitals. TEN is the most severe form of Stevens-Johnson syndrome. Both conditions are caused by a reaction to medication. About 25% of people who develop TEN don’t survive.
Toxic epidermal necrolysis (TEN) is a painful, life-threatening skin condition. It causes large areas of blistering and peeling skin on at least 30% of your body, including mucous membranes like the mouth, eyes and genitals. It's the result of a reaction to certain medications. Widespread damage to the skin can lead to dangerous fluid loss and infections.
TEN, or TEN syndrome, is a rare, severe form of Stevens-Johnson syndrome (SJS). SJS causes blistering and peeling skin on less than 10% of the body. The two conditions overlap when there is 10% to 30% body coverage.
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People with weakened immune systems are more likely to develop SJS or TEN. Immune system problems can be the result of:
Genetics may also play a role. Some people cannot normally break down certain medications, which can cause their body to develop Stevens-Johnson syndrome or toxic epidermal necrolysis. Mutations (changes) to certain genes may make individuals (or ethnic groups) more likely to react to particular medications.
People of any age can get TEN, though it’s more common in older populations.
TEN is a rare disease. Together, SJS and TEN affect about 1 million to 2 million people each year.
In most cases, experts think that certain medications trigger TEN syndrome. These medications may include:
Other rare triggers may include:
There are some cases where the cause of TEN is not known.
TEN symptoms may develop a few weeks after you start taking a medication. It usually begins with flu-like symptoms, including:
TEN then causes a painful skin rash before progressing to large areas of blistering and peeling skin. Erosions, or painful open wounds that look like burns, develop as the skin peels away.
Erosions tend to start on the face and chest. They often spread to the following areas of the body:
Erosions can make it difficult and painful to eat, swallow, breathe, see, urinate and perform other functions.
Life-threatening complications of TEN syndrome can include:
Your healthcare provider can usually diagnose TEN after evaluating your skin and symptoms. In some cases, you may need a skin biopsy to confirm the diagnosis. A pathologist (healthcare provider who examines body tissues) studies a sample of your skin under a microscope. The biopsy shows:
TEN requires emergency medical treatment at a hospital. You’ll receive care in an intensive care unit (ICU) or burn center. Immediate treatment includes:
Other treatments for TEN may include:
You may be able to prevent TEN by seeking immediate medical care at the first signs of Stevens-Johnson syndrome.
About 25% of people who develop TEN don’t survive. For those who do survive, the erosions usually heal and skin grows back on its own. Most people don’t need skin grafts.
People who survive TEN may experience a wide range of long-term effects. Talk to your doctor about your specific symptoms, which may show up in your:
Skin, hair and nails:
Mucous membranes of the mouth, nose, throat and airways:
Urinary tract, anus and genitals:
A note from Cleveland Clinic
Toxic epidermal necrolysis (TEN) is a rare, life-threatening skin condition. It’s the most severe form of Stevens-Johnson syndrome. TEN is usually the result of your body’s immune system reacting to a medication. It causes painful, blistering, peeling skin on at least 30% of the body, leading to open erosions. Open erosions may lead to dangerous complications such as sepsis, organ failure, infections or death. TEN requires immediate medical attention.
Last reviewed by a Cleveland Clinic medical professional on 06/22/2021.
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