Toxic Epidermal Necrolysis: Unmuddying the Waters

Toxic epidermal necrolysis (TEN), or Lyell's syndrome, 1 holds a unique place among dermatologic diseases for its frightening, rapidly progressive, and all too often tragic outcome. Our lack of understanding of the pathogenesis of this disease, coupled with its infrequency and the lack of objective laboratory criteria for its diagnosis, have created considerable confusion and controversy over its nosology. Still, we have made some important progress in differentiating TEN from staphylococcal scalded skin syndrome (SSSS), 2,3 in providing supportive care, 4,5 and in determining the prognosis of cases. 6,7 Yet investigators both at the bedside and in the laboratory have been impeded by a disease that seemingly can have varied presentations and an unpredictable course, and can be triggered by a panoply of causes; eg, drug, 8 infectious, 9 and immunologic factors. 10,11 Although there is general agreement that TEN is characterized by widespread blistering of the skin with a