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    Toxic Epidermal Necrolysis, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
    Toxic Epidermal Necrolysis, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
    Toxic Epidermal Necrolysis, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
    Ebook111 pages1 hour

    Toxic Epidermal Necrolysis, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

    By Kenneth Kee

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    About this ebook

    This book describes Toxic Epidermal Necrolysis, Diagnosis and Treatment and Related Diseases
    Toxic epidermal necrolysis (TEN) is a very rare, sudden onset, often life-threatening reactions to medicines that occur in the skin and the linings of mouth, gastrointestinal tract, genitalia and eyes.
    The affected patient has a fever and there may be enlargement of the lymph nodes and inflammation in the liver and other organ systems.
    Widespread full-thickness epidermal necrosis forms, causing erythema, and sloughing of the skin and mucosa, affecting internal and external surfaces
    The skin has an appearance similar to a burn.
    It normally involves the trunk, face and one or more mucous membranes.
    Steven Johnson Syndrome (SJS) and TEN are related disorders which can be distinguished by the degree of skin involvement.
    Less of the epidermis peels off in SJS, while TEN may be defined as affecting >30% of the total body surface area
    SJS is a less serious presentation affecting mainly the lips, eyes and genital mucosa.
    People with 10-30% skin loss are categorized as “overlap”.
    TEN is more often observed in people who have a specific genetic make-up (genotype) that leads to slow metabolizing of certain classes of drugs, or those who have HIV or are immune suppressed.

    There is the belief that an immune complex-mediated hypersensitivity reaction happens because of the presence of toxic drug metabolites which collect in the skin.
    This reaction leads to the damage of keratinocytes.
    Specifically, cytotoxic T lymphocytes produce keratinocyte damage and subsequent necrosis, mediated by granzyme B.
    Cytotoxic molecules such as FasL and granulysin have been indicated as causing the widespread keratinocyte apoptosis.
    More than 200 medicines have been linked with TEN, mostly:
    1.Sulfonamides.
    2.Ampicillin.
    3.Quinolones
    4.Cefalosporins.
    5.Anticonvulsants - phenobarbital, phenytoin, carbamazepine, lamotrigine and valproate.
    6.Allopurinol.
    Symptoms:
    There is a prodromal stage normally persisting 2-3 days with fever, symptoms the same as upper respiratory tract infection, conjunctivitis, pharyngitis, pruritus, malaise, arthralgia and myalgia.
    Mucous membrane affliction happens early in 90% of cases and often goes before other symptoms
    The conjunctivae, buccal, nasal, pharyngeal, tracheobronchial, perineal, vaginal, urethral and anal mucosae may all be affected.
    Skin lesions first occur in the pre-sternal region and the face, palms, and soles of the feet.
    A gentle touch or rub can slough the skin off and it is very painful (Nikolsky's sign)
    Diagnosis:
    There is no specific laboratory test required to diagnose TEN.
    Rapid histological examination such as direct immunofluorescence analysis of a lesion skin biopsy is first in the diagnostic work-up of TEN, as it helps to exclude diseases similar to TEN
    Treatment
    The first step is to stop the medicine causing TEN.
    Following this, the treatment for TEN and SJS is mostly supportive care until the top layer of skin regenerates.
    Affected individuals are often sent to a burns or intensive care unit and treated as if they have suffered from very severe burns.
    1.Fluid and electrolyte replacement
    2.Infection control with antibiotics
    3.Pain relief
    4.Skin care such as the use of topical antiseptics and regular wound dressings
    5.Special wound nursing care
    6.Eye, mouth and lung care
    7.Urinary catheterization
    8.Oral hygiene
    Some cases have benefited from the use of immunoglobulins, immunosuppressive agents, systemic steroids or other biologic agents.
    Debridement of necrotic areas of skin may be needed.
    The exposed dermis needs protecting with skin grafting to prevent fluid and protein loss and infection.

    TABLE OF CONTENT
    Introduction
    Chapter 1 Toxic Epidermal Necrolysis
    Chapter 2 Causes
    Chapter 3 Symptoms
    Chapter 4 Diagno

    LanguageEnglish
    PublisherKenneth Kee
    Release dateJul 17, 2018
    ISBN9780463902189
    Toxic Epidermal Necrolysis, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
    Author

    Kenneth Kee

    Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

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      Book preview

      Toxic Epidermal Necrolysis, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions - Kenneth Kee

      Toxic Epidermal Necrolysis,

      A

      Simple

      Guide

      To

      The Condition,

      Diagnosis,

      Treatment

      And

      Related Conditions

      By

      Dr Kenneth Kee

      M.B.,B.S. (Singapore)

      Ph.D (Healthcare Administration)

      Copyright Kenneth Kee 2018 Smashwords Edition

      Published by Kenneth Kee at Smashwords.com

      Dedication

      This book is dedicated

      To my wife Dorothy

      And my children

      Carolyn, Grace

      And Kelvin

      This book describes Toxic Epidermal Necrolysis, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.

      (What The patient Need to Treat Toxic Epidermal Necrolysis)

      This eBook is licensed for your personal enjoyment only. This eBook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader.

      If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.

      Thank you for respecting the hard work of this author.

      Introduction

      I have been writing medical articles for my blog: http://kennethkee.blogspot.com (A Simple Guide to Medical Disorder) for the benefit of my patients since 2007.

      My purpose in writing these simple guides was for the health education of my patients.

      Health Education was also my dissertation for my Ph.D (Healthcare Administration).

      I then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog: http://afamilydoctorstale.blogspot.com.

      This autobiolographical account A Family Doctor’s Tale was combined with my early A Simple Guide to Medical Disorders into a new Wordpress Blog A Family Doctor’s Tale on http://kenkee481.wordpress.com.

      From which many free articles from the blog was taken and put together into 800 eBooks.

      Some people have complained that the simple guides are too simple.

      For their information they are made simple in order to educate the patients.

      The later books go into more details of medical disorders.

      The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

      Since 2013, I have tried to improve my spelling and writing.

      As I tried to bring the patient the latest information about a disorder or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

      Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

      I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

      I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

      I apologize if these repetitions are irritating to some readers.

      Chapter 1

      Toxic epidermal necrolysis

      What is Toxic epidermal necrolysis (TEN)?

      Toxic epidermal necrolysis (TEN) is a very rare, sudden onset, often life-threatening reactions to medicines that occur in the skin and the linings of mouth, gastrointestinal tract, genitalia and eyes.

      The affected patient has a fever and there may be enlargement of the lymph nodes and inflammation in the liver and other organ systems.

      Toxic epidermal necrolysis (TEN) is a possibly life-threatening, idiosyncratic mucocutaneous reaction, normally happening after introduction of a new medicine.

      Widespread full-thickness epidermal necrosis forms, causing erythema, and sloughing of the skin and mucosa, affecting internal and external surfaces

      The skin has an appearance similar to a burn.

      It normally involves the trunk, face and one or more mucous membranes.

      It is considered by some as being part of a group of disease which involves, in order of severity, erythema multiforme, Stevens-Johnson syndrome (SJS) and TEN.

      This relationship remains debatable.

      Erythema multiforme is linked with infections such as herpes simplex virus and Mycoplasma pneumoniae while SJS and TEN are necrolytic bullous skin reactions to certain drugs.

      It may be that erythema multiforme should not be categorized as part of the same disease spectrum

      Many however accept that it differs from SJS (Steven Johnson Syndrome) and TEN.

      Another classification method is based on the fact that SJS and TEN are related disorders which can be distinguished by the degree of skin involvement.

      Less of the epidermis peels off in SJS, while TEN may be defined as affecting >30% of the total body surface area

      Steven

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