Toxic Epidermal Necrolysis (The Scalded Skin Syndrome)

Abstract

A STARTLING dermatosis resembling scalding, toxic epidermal necrolysis, was first described by Lyell¹ and by Lang and Walker² in 1956. Since 1960 it has received increasing attention in medical literature in the United States. Two brief reviews reporting cases in very young children have appeared in the past year.^3,4 In cases occurring in infancy, toxic epidermal necrolysis is characterized by irritability, intense skin tenderness, and erythema, followed by desquamation of the epidermis in sheets over much of the body. Slight pressure on the affected areas causes separation of epidermis—the Nikolsky sign. Conjunctivitis occurs, but the mucous membranes are not extensively involved as a rule. The primary pathological lesion is epidermal necrosis with cleavage within the layers of the epidermis or with a detachment of the epidermis at the dermal-epidermal junction. The corium is not involved as a rule. As Walker⁵ has emphasized, pointing out the error