HealthProfessionai/pagel)An elderly mate presents with T3N0 laryngeal carcinoma. Treatment is concurrent chemoradiotherapy."Advanced laryngeal cancers are often treated by combining radiation with concurrent chemotherapy for larynx preservation and total laryngectomy for bulky T4 disease or salvage.""Concurrent radiation therapy plus Cisplatin resulted in a statistically higher percentage of patients with an intact larynx at 10 years. ""Concomitant Cisplatin with radiation therapy resulted in a 41% reduction in risk of locoregional failure compared with radiation therapy alone. "A 28-year-old patient of neurocysticercosis develops generalized peeling of skin all over except palms and soles starting one month after taking anti-epileptics. Most probable diagnosis is toxic epidermal necrolysis. Toxic epidermal necrolysis (TEN), also known as Lyell's syndrome, is a rare, life-threatening skin condition that is usually caused by a reaction to drugs.Epidermal Necrolysis (EN)Also known as Stevens-Johnson svndrome-toxic epidermal necrolysis (SJS-TEN) complex.EN is almost always due to drugsQ.Etiology of Epidermal NecrolysisDrugsMiscellaneousIdiopathic* Anticonvulsants: carbamazepine, phenytoin barbiturates, lamotrigineQ* Chemotherapeutic agents: sulfonamides, penicillinQ* NSAlDs: Butazones, oxicams* Others: Allopurinol, nevirapineQ* SUE, GVHD* Lymphoreticular malignancies* Infections (Mycoplasma pneumoniae, herpes virus infection)* 5% of patientsMorphology:Consists of deeply erythematous (often purpuric) irregular lesions that rapidly coalesce.Either develop bullae or peel-off in sheets either spontaneously or when pressure is applied (positive Nikolsky's signQ)On peeling, leave large areas of denuded skin that heal with hyperpigmentation.Based on total body surface area (BSA) of skin detached, EN classified intoSJS 30% BSAQSites:Symmetrical involvement of face, truck and proximal part of extremities; Spares distal part of extremities.Mucous membranes: Mouth & eyes frequently, other mucosae less frequently affected; manifest as hemorrhagic crusts & white pseudomembrane of the lipsComplications:EN is an emergency, associated with high mortality due to;Infections: Including sepsisFluid & electrolyte imbalancePulmonary involvement: Interstitial syndromeRenal failure: A direct nephrotoxic effect of the drug or due to hypotensionOphthalmic complications: Acute complications and late sequelae like dry eyes, symbiepharonInvestigations:Biopsy: Subepidermal split with necrotic epidermisQProvocation: Causative drug can be identified by provocation test, but this is controversialTreatment:General measures: Withdrawal of suspected drug with supportive careSpecific therapy: Use of steroids is controversial. IVIg & cyclosporine are promising modalities.Fixed Drug EruptionAdverse cutaneous drug reaction appearing soon after ingestionQ (from 30 min to 8 hours) of offending agent in previously sensitized individuals.Drugs Implicated in Fixed Drug Eruption* PhenolpthaleinQ (present in some laxatives)* BarbituratesQ* MetronidazoleQ* FluoroquinolonesQ* SulphonamidesQ (Cotrimoxazole, dapsone)* TertracyclineQ* Salicylates & phenacetinQCharacteristic Features:Mucocutaneous junction (lip, glans) is most frequently involved, genital skin (glans) is the most commonly involved siteQ.Most commonly lesions are solitaryQ but they may be multiple.Lesions evolve from macules to papules to vesicles & bullae then erodeQ.Lesions heal by hyperpigmentationQUsually asymptomaticQ but may be pruritic, painful, or burning (when eroded)Lesions persist if the drug is continued and resolve days to w eeks after drug is continuedFDE occurs repeatedly at the same (i.e. fixed) site within hours, every time drug is taken and heals by residual grayish or slate colored hyperpigmentationv.Diagnosis:Diagnosis is confirmed by provocation.Rechallenging the patient to the suspected offending drug is the only known test to possibly discern the causative agent.Treatment:The main goal of treatment is to identify the causative agent and avoid it.Symptomatic treatment: Systemic antihistamines and topical corticosteroids may be all that are required.">