A review on toxic epidermal necrolysis-like superficial wound lesions: Issue and challenge on 10 clinical entities

Abstract

Toxic epidermal necrolysis (TEN) is a severe skin reaction caused by extensive epidermal and mucosal necrosis. This clinical phenomenon is known as an acute syndrome of apoptotic pan-epidermolysis (ASAP). The ASAP phenomenon is observed in conditions that mimic TEN, highlighting the challenge in distinguishing these conditions. While TEN is a well-recognized entity, distinguishing it from other TEN-like conditions presents significant diagnostic and treatment challenges. These conditions include drug rash with eosinophilia and systemic symptoms (DRESS), generalized bullous fixed drug eruption (GBFDE), acute generalized exanthematous pustulosis (AGEP), TEN-like methotrexate toxicity, mustard gas toxicity, pseudoporphyria, mycoplasma-induced rash and mucositis (MIRM), multisystem inflammatory syndrome in children (MIS-C), graft versus host disease (GVHD), and acute cutaneous lupus erythematosus and subacute cutaneous lupus erythematosus. This review explores these ten separate entities and debates their clinical features, pathophysiology, diagnosis and management.