A patient presents with history of bullae involving >30% BSA along with rashes all over body with erosions of the lips and other mucosa for few days. What can be the triggering factor?

Ans. B. Drug induced* Toxic epidermal necrolysis (TEN) is a potentially life-threatening dermatologic disorder characterized by widespread (TEN involves more than 30% of the body surface, whereas SJS involves less than 10%) erythema, necrosis, and bullous detachment of the epidermis and mucous membranes, resulting in exfoliation and possible sepsis and/or death. Mucous membrane involvement can result in gastrointestinal hemorrhage, respiratory failure, ocular abnormalities, and genitourinary complications.* TEN is most commonly treated by drug-induced antibiotics (sulfonamides), antiepileptic drugs (Phenobarbital, Phenytoin), nonsteroidal anti-inflammatory drugs (NSAIDs), ampicillin, allopurinol, and the antiretroviral drugs (nevirapine, abacavir).* The mainstay of treatment is supportive care until the epithelium regenerates.