toxic epidermal necrolysis

Lyell's syndrome (toxic epidermal necrolysis) - toxic-allergic lesions of the skin and mucous membranes, often accompanied by changes in the internal organs and the nervous system. Arises as a reaction to the medication (usually sulfonamides, antibiotics, phenylbutazone, barbiturates), leads to the development necrolysis all layers of the epidermis and its detachment.

Symptoms within. The disease begins with high fever, severe weakness, sometimes a sore throat. Against this background, there are extensive erythematous-cystic lesions of the skin and mucous membranes. After opening the blistering defeat acquires similarity to burn I-II degree; Nikolsky sign of sharply positive. With the advent of rash condition of patients worsens. The process may take a generalized, accompanied by degenerative changes in the internal organs (liver, kidneys, intestines, heart, etc.), Toxic lesions of the nervous system. In smears from erosion when stained with Romanovsky-Giemsa revealed kuboidnye cells with large nuclei.

The diagnosis is the presence of large bubbles and positive symptom Nikolsky, in the absence of smears typical acantholytic cells, pointing out the previous medications. The similarity with Lyell's syndrome may have a staphylococcal lesion: in this case, the smears are determined by large epithelial cells with small nuclei and necrolysis occurs only in the superficial parts of the epidermis.

Treatment. Prednisolone (or other glucocorticoids) at 60-100 mg / day, detoxifying agents (unitiol 5 ml 2 times a day or gemodez et al.), Antihistamines, hemosorbtion, plasmapheresis, symptomatic therapy. Locally appointed dermatolovuyu 5% ointment. Forecast serious: nearly 25% of patients die despite intensive care. Early diagnosis and early initiation of corticosteroid therapy improves prognosis.