Lyell's syndrome ( toxic epidermal necrolysis , allergic to antibiotics ) - Causes, Symptoms and Treatment .MF .

Lyell Syndrome - toxic-allergic lesions of the skin and mucous membranes, often accompanied by changes in the internal organs and the nervous system.Synonyms: LyeU-syndrom, epidermal necrolysis sharp, toxic epidermal necrolysis, acute toxic epidermal necrolysis, skin-allergic epidermal necrolysis, necrotizing vascular allergid with a primary lesion of the skin and mucous membranes.

Lyell's Syndrome - a serious disease accompanied by bullous skin lesions and mucous membranes with the detachment of the epidermis, or the formation of epithelial cells, often caused by the use of drugs.Lyell's syndrome - severe, immunoallergic, drug-induced disease, threatening the patient's life, is an acute dermal-visceral pathology characterized by intense epidermal exfoliation and necrosis of the epidermis with formation of large blisters and erosions on the skin and mucous membranes.

general, clear definitions of toxic epidermal necrolysis and Stevens-Johnson is still no.Both syndrome are among the most severe for

ms of drug-drug reaction.Some believe Lyell's syndrome is the most severe cases of Stevens-Johnson syndrome, however, according to other researchers, the pathogenesis of the disease is different and Lyell's syndrome is a toxic manifestation of idiosyncrasy from the epithelial cells to specific drugs or their metabolites.

Lyell Syndrome Causes

Fully reasons Lyell's syndrome have not been studied.Lyell syndrome occurs as a result of taking certain medications (drugs: sulfonamides, antibiotics, barbiturates), leads to necrosis of all layers skin.Therefore it is important to remember that self-medication, especially with the use of such powerful tools as antimicrobial, it is dangerous to health.

pathogenesis of toxic epidermal necrolysis unclear.In cases associated with taking drugs that involve allergic mechanisms (III and IV types of allergic reactions), where the drug is likely to play a role hapten is fixed to the proteins of the skin cells.Some researchers consider Lyell's syndrome as the most severe manifestation of erythema multiforme.

appearance of erythematous patches on the skin and mucous membranes (erythematous stage), for 2-3 days turning into flabby thin-walled blisters irregular shape (bullous stage) with a tendency to merge easily bursting with erozirovaniem large surfaces (deskvamatsionnaya stage).In the midst of sickness stunned by the surface resembles a burn boiling water II-III degrees

Positive symptoms Nikolsky (detachment of the epidermis) and of asbestos-Hansen (with pressure on the bladder increases its size due to the detachment of the epidermis at the periphery of the bubble under the influence of high pressure of its contents)

Mucosalmembranes of the mouth, starting with canker and evolving to necrotic-ulcerative stomatitis

defeat genitals (vaginitis, balanoposthitis)

Hemorrhagic (with transition in necrotizing) conjunctivitis - the earliest manifestation of the disease • Severe general symptoms with increasing intoxication caused byloss of fluids and proteins through the affected eroded surface, violation of water-salt balance, the development of infectious lesions (often pneumonia, a secondary infection of the skin), bleeding from the gastrointestinal tract or death.

differential diagnosis spend with staphylococcal syndrome "burnt" skin.The diagnosis of acute epidermal necrolysis is set on the basis of history (medication), clinical (acute development of the disease, severe general condition of the patient; the bubbles on the background of erythema, a symptom of detachment of the epidermis, the defeat of the oral cavity mucous membranes, eyes and genitals), laboratory findings, pathologicresearch (epidermal necrolysis, the formation of intra- and podepidermalnyh bubbles).

Lyell Syndrome be distinguished from the scalded skin syndrome. Lyell's syndrome occurs mainly in adults, it is usually caused by drugs and is accompanied by a high mortality rate.For the differential diagnosis is carried out with a puncture skin biopsy study of frozen sections: exfoliate the horny layer of the epidermis with the syndrome scalded skin with toxic epidermal necrolysis - the whole entire epidermis.

symptoms of toxic epidermal necrolysis

The disease starts with a high body temperature to 39-40 ° C, severe weakness, sometimes a sore throat.The skin and mucous membranes occur bubbles.With the advent of rash the patient's condition deteriorates.After opening the blisters on the skin remains large weeping wound surface.The disease may be associated with lesions of the internal organs - liver, kidneys, heart.

forecast unfavorable when Severing during, late onset of active therapeutic interventions, as well as the accession of secondary infection.The mortality rate can reach 30-60%.

Complications: Blindness with deep lesions of the conjunctiva.Conjunctivitis and photophobia for a few months. www.7gy portal about

treatment of toxic epidermal necrolysis

When symptoms Lyell syndrome requires urgent hospitalization of the patient.Appointed agents for removing poisons (detoxifying), gluco-corticoids, anti-allergic agents.

Management of

- patients subject to compulsory hospitalization in the intensive care unit or intensive care unit
- Patients are both burn (desirable "burn parliament") to the maximum sterile conditions to prevent exogenous infection
- Applicable to Developmentsyndrome drugs are subject to immediate cancellation.


Local treatment

Opening bubbles is not recommended.Irrigation erosion aerosol glucocorticoid (hydrocortisone + oxytetracycline, oksitsiklozol et al.).Lubrication water erosion p-set the aniline dyes;on moist erosion prescribe lotions with disinfectant (1-2% solution of boric acid, p-ra Castellani).Apply creams, oil mash, kseroformnuyu, solkoserilovuyu ointment, ointment GC (betamethasone + salicylic acid, methylprednisolone atseponat).With the defeat of the oral mucosa shows astringent, disinfectant p-ry: camomile, pp boric acid, borax, potassium permanganate for rinsing.Also, use water r-ry aniline dyes, pp glitsirine borax, egg white.With the defeat of the eye using zinc or hydrocortisone drops.

Systemic therapy

GC: preferably in / methylprednisolone from 0.25-0.5 g / day to about 1 g / day in the most severe cases, during the first 5-7 days followed by dose reduction.Detoxification and rehydration terapiyayu.In order to maintain water, electrolyte balance, and protein - an infusion up to 2 liters of fluid per day: reopoligljukin or gemodez, plasma and / or albumin, pp isotonic sodium chloride, 10% solution of calcium chloride, pp Ringer.When hypokalemia used protease inhibitors (aprotinin).Systemic antibiotic indicated for the secondary infection under control sensitivity to them microflora.

Lyell Syndrome Prevention

Appointment of drugs based on their tolerance in the past, non-use of drug cocktails.Recommended immediate hospitalization of patients with drug reaction, accompanied by general phenomena, fever, and treatment of glucocorticoid in high doses.Persons who have had Lyell's syndrome, for 1-2 years, it is necessary to limit the implementation of preventive vaccinations, exposure to the sun, the use of tempering procedures.