title: Unidentified drugs in traditional medications causing toxic epidermal necrolysis: a developing country experience.
abstract: BACKGROUND
  Drugs are by far the most common cause of toxic epidermal necrolysis (TEN), but unidentified drugs and chemicals present in herbal and traditional medications may also be responsible for this reaction, which manifests as widespread epidermal detachment of the skin and mucous membrane. In contexts in which a subject has used an herbal or traditional medication, it is very difficult to diagnose the condition, identify the offending agent, and prevent the disease from recurring.
  
  
  METHODS
  This prospective study was conducted at a tertiary burn center between July 2004 and October 2012. All patients were referred to this unit by the local department of medicine at least one week after the eruption of vesicles. On arrival, all patients demonstrated a severe form of disease with features of sepsis and electrolyte imbalance (SCORTEN scores of ≥4). All non-fatal cases were followed to observe long-term sequelae and recurrences.
  
  
  RESULTS
  About 34% of patients had developed the condition after ingesting traditional herbal medications and were unable to identify the responsible drug by name. Nineteen (66%) of the 29 patients referred to the unit with TEN died within the first week after being transferred. Nine patients achieved complete recovery, and one developed corneal haziness and alopecia. One patient experienced recurrence within three months but recovered.
  
  
  CONCLUSIONS
  Illiteracy and financial vulnerability were major factors in driving patients towards the use of traditional medications, which were often prepared and preserved improperly. Mortality and other complications could be reduced by the prompt recognition of the condition, immediate withdrawal of the culprit drug, and quick referral to proper care.
authors.forename: Kishore
authors.initials: K
authors.lastname: Kumar Das
authors.forename: Sazzad
authors.initials: S
authors.lastname: Khondokar
authors.forename: Ashrafur
authors.initials: A
authors.lastname: Rahman
authors.forename: Anjana
authors.initials: A
authors.lastname: Chakraborty
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D002648:Child; D003906:Developing Countries; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008419:Materia Medica / Q000009:adverse effects*; D008875:Middle Aged; D028321:Plant Preparations / Q000009:adverse effects*; D011203:Poverty; D011446:Prospective Studies; D012008:Recurrence; D013262:Stevens-Johnson Syndrome / Q000209:etiology* / Q000628:therapy; D035862:Vulnerable Populations; D055815:Young Adult
chemical_list: D008419:Materia Medica; D028321:Plant Preparations