Toxic epidermal necrolysis (TEN) is a rare disease, which predominantly manifests as damage to the skin and mucosa. Antibiotics count among the most common triggers of this hypersensitive reaction. Patients with TEN are highly susceptible to infectious complications due to the loss of protective barriers and immunosuppressant therapy. The aim of this study was to investigate the potential relationship between antibiotics used before the development of TEN and early and late-onset infectious complications in TEN patients. In this European multicentric retrospective study (Central European Lyell syndrome: therapeutic evaluation (CELESTE)), records showed that 18 patients with TEN used antibiotics (mostly aminopenicillins) before the disease development (group 1), while in 21 patients, TEN was triggered by another factor (group 2). The incidence of late-onset infectious complications (5 or more days after the transfer to the hospital) caused by Gram-positive bacteria (especially by Enterococcus faecalis/faecium) was significantly higher in group 1 than in group 2 (82.4% vs. 35.0%, p = 0.007/p corr = 0.014) while no statistically significant difference was observed between groups of patients with infection caused by Gram-negative bacteria, yeasts, and filamentous fungi (p > 0.05). Patients with post-antibiotic development of TEN are critically predisposed to late-onset infectious complications caused by Gram-positive bacteria, which may result from the dissemination of these bacteria from the primary focus.

• Keywords
• antibiotics, early-onset infection, infectious complication, late-onset infection, toxic epidermal necrolysis,
• Publication type
• Journal Article MeSH

Toxic epidermal necrolysis is a rare condition involving the skin at the dermoepidermal junction, with possible inclusion of mucous membranes. The condition is associated with systemic toxicity and high mortality rates. Successful treatment requires optimization of local as well as systemic therapy. We report the case of a young woman who developed toxic epidermal necrolysis, possibly resulting from lamotrigine therapy. Local therapy included a combination of a biological cover and alginate together with a synthetic cover (Aquacel Ag®).

La nécrolyse épidermique toxique est une maladie rare touchant la peau à la jonction dermo-épidermique, avec inclusion possible des muqueuses. La condition est associée à une toxicité systémique et des taux de mortalité élevés. Le succès du traitement nécessite une optimisation de la thérapie locale ainsi que systémique. Nous rapportons le cas d’une jeune femme qui a développé une nécrolyse épidermique toxique, causée peut-être par un traitement par la lamotrigine. Le traitement local a compris une combinaison d’une couverture biologique et de l’alginate avec une couverture en matière synthétique (Aquacel Ag®).

• Keywords
• Xe-Derma, toxic epidermal necrolysis,
• Publication type
• Journal Article MeSH