Dermatological and ophthalmological sequels in toxic epidermal necrolysis.
BACKGROUND
Toxic epidermal necrolysis (TEN) is a rare, drug-induced disease characterized by epidermal detachment and mucosal involvement. After an acute period, potentially disabling cutaneous and ocular sequels may appear. Although long-term complications are not rare, only few outcome studies are published.


OBJECTIVE
To evaluate the incidence of dermatological and ophthalmological sequels following TEN, to describe its clinical aspects and correlation with acute involvement.


METHODS
Eight patients surviving to TEN were submitted to dermatological and ophthalmological observation ranging from 0.5 to 8 years after hospitalization. Cutaneous and ocular involvement, during the acute phase, was retrospectively analysed.


RESULTS
Dermatological sequels were observed in 6 patients (75%) corresponding to those with more extensive skin involvement in the acute phase. The most frequent complications were cutaneous dyschromia (62.5%) and nail dystrophies (37.5%). Six patients (75%) had ocular complications with tarsal conjunctiva keratinization in 5 (62.5%) and keratoconjunctivitis sicca in 4 of them (50%). Trichiasis, corneal neovascularization and symblepharon were observed in 1 case. There was no correlation between the severity of acute ocular involvement and long-term complications.


CONCLUSIONS
Following TEN, most patients have dermatological and ophthalmological sequels that persist for several years.
Magina
S
S
Department of Dermatology and Venereology, Faculty of Medicine, Hospital S. João, Porto, Portugal. smagina@mail.med.up.pt
Lisboa
C
C
Leal
V
V
Palmares
J
J
Mesquita-Guimarães
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D004892:Erythema Multiforme / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017495:Hyperpigmentation / Q000453:epidemiology / Q000209:etiology*; D007637:Keratoconjunctivitis / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009260:Nail Diseases / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D013262:Stevens-Johnson Syndrome / Q000150:complications* / Q000175:diagnosis; D013997:Time Factors