Hacker News Reader

Comment by DoreenMichele | Hacker News Reader

Just as a point of comparison:

Toxic epidermal necrolysis, a severe form of Stevens-Johnson Syndrome, has about a 30% mortality rate. I understand it to be a first world problem typically caused by taking certain strong medications. It's a severe and often deadly allergic reaction.

(I'm not going to provide links because both Wikipedia entries have disturbing photos. I've verified that I'm spelling both correctly so you can google it if you want. However, you probably would be hard pressed to find an article about either condition that didn't have similarly graphic photos.)

To clarify: epidermal means it's a skin condition. Skin conditions that kill people tend to not be pretty and the symptoms are highly visible.

View on HN

Unpacking the name totally is even more brutal!

"necro" -- "death"

"lysis" -- "busting open"

"epidermal" -- "skin"

"syndrome" -- "no known cause"

However, it's a little unclear why TEN is a point of comparison to Ebola, as one is a transmissible disease and one is something that happens to unlucky people typically in response to common small-molecule drugs. I guess TEN sounds like a probable side effect of antiviral immune therapy, but it's not mentioned in the article. And it seems a little tricky to separate the side effects from the disease when dealing with hemorrhagic diseases in particular

The comparison is to show that even in technologically advanced societies, there are diseases with 30% survival rates.

A doctor once told me that so much of our higher survival rate is based on a few key drugs and supportive care to keep us alive while the body heals itself. We seem to possess remarkably few cures for the majority of diseases out there, we are mostly able to treat symptoms to buy time for our bodies to self-repair.

To add, the reason it has such a high mortality rate is TEN/SJS are almost isomorphic to 2nd and 3rd degree burns over a high percentage of your body, which is also very commonly fatal. The "30%" mortality rate is greatly dependent on how bad the SJS/TEN manifests.

Is syndrome = "no known cause" a common definition?

I imagine parent is being a bit tongue in cheek. A syndrome is any group of symptoms that seem to occur together. Often something is called a syndrome before its cause is determined. However, even after a cause is found or if it was known, the name often persists. E.g. AIDS was named before it was traced back to HIV. It persists as the name for the late stages of an HIV infection.

So while it is often the case that when a syndrome is initially named its cause is unknown, the two are really referring to different levels of abstraction of a disease. The syndrome is its effects, irrespective of whether we know its cause.

Nope.

Edit: one usage is for a set of commonly concurrent symptoms, possibly with no known cause. Another common usage is a set of concurrent symptoms with multiple known causes (e.g. toxic shock syndrome).

Joking aside that's not what syndrome means. Things that have no known cause as of today are usually called idiopathic.

Necrotic rashes are no joke. TEN/SJS is literally treated in the burn ward.

Puh. The photos are really disturbing. I really recommend anyone not to do what I just did...

We really need some kind of image-less Wikipedia for things like this.

elinks browser for the win! I bet images can be blocked by extension as well.

You're solving entirely the wrong problem. The issue is linking to the article, not "how do I personally view a page a certain way?"

I was about to reply and say they weren't too bad, 2 of them really not, 2 of them a couple of stages on from really bad sunburn. I was picturing that scene from Raiders of the lost Ark before hand, it's not that bad.

Raiders of the Lost Ark is more accurate in real life, unfortunately. I don't know why they show such sanitized versions of the diseases (for SJS they show a photo of someone with Erythema Multiforme Major). The photo for TEN is almost certainly after a great deal of "clean up".

"Not pretty" is an understatement.

Toxic epidermal necrolysis (TEN) is the most lethal on a scale of 4 related necrotic skin conditions[1]: TEN, SJS, EMMajor, EMMinor. The medical industry sees all 4 as kind of a sliding scale, similar to how burns are classified as different degrees and can be clinically distinguished but are still burns. They are categorized based on the percentage of your skin that becomes necrotic, and additionally which tissue types are affected.

My understanding is that herpes is one of the most common causes, although maybe that's only true for EMM and not TEN/SJS. For some reason, as we age, sometimes our body changes its reaction to herpes or other infections, becoming hypersensitive, resulting in one of the 4 previously mentioned necrotic skin conditions.

I'm sharing this, because even though my symptoms were literally staring the doctors in the face, it took years before a studious dermatologist figured out I had recurrent EMMajor. If you have "cankers" or "rashes" associated with your herpes outbreaks, ask your doctor about it, even if the rashes aren't painful. Recurrent EMMajor can be life-threatening without treatment[2] and can progress with further attacks.

[1]https://www.ncbi.nlm.nih.gov/pubmed/21873140

[2]https://www.nhs.uk/conditions/erythema-multiforme/ (warning: disturbing pictures)

It's interesting to note that even APAP/paracetamol/acetaminophen can cause TEN or SJS, although very very rare. [1]

For those bipolar folks out there, remember even lamotrigine can cause SJS (still very rare), which is why you should always ramp up the dose gradually. [2]

[1] https://www.fda.gov/drugs/drug-safety-and-availability/quest...

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905385/

Almost every bipolar medication has some very scary side effects (either in the medium or the long term). Sadly receiving treatment for it is a constant balance of "If you do not treat it it might destroy your life" and "if you do treat it it might destroy your life".

Reply on news.ycombinator.com