Toxic epidermal necrolysis is often a severe form of bullous drug eruption, but not in all patient.Minor inflammatory changes of the transitional mucosae and the conjunctivae often appear ten to 14 days before the syndrome. Other prodromal symptoms include a burning sensation of the skin and transitional mucous membranes, and sometimes a sensation of heat.

These symptom are followed by erythema, and macular rashes resembling those of measles, scarlet fever, or drug eruptions. The erythema may begin in the skin folds. On these sites, flaccid, wrinkled blister develop, often with lightning rapidity, as in genuine pemphigus ; this is what gave rise to the old term of acute, malignant febrile pemphigus with extensive vesiculation.

The condition is marked by extensive superficial separation of the epidermis which lies on the body like a damp,  smoothed on the sheet. Nikolsky’s sign is positive even in seemingly normal skin. The patient’s subjective condition is poor; there is often high fever. The massive loss of fluids and electrolytes results in involvement of internal organ.

Myocarditis has been reported and a child died of sudden heart failure even after complete regression of the disease. if the patient survives the acute phase, the condition will regress in two to three weeks. The bullae affecting the transitional mucosae, especially the glans penis and the conjunctivae, are slower to heal. There is a danger of synechiae and consequently corneal damage. Melanodermas, i.e, hyperpigmented areas, may persist for a long time at the sites of former lesions. The overall impression of the acute phase is that of a second degree burn. (HC - Team)