A Case of Toxic Epidermal Necrolysis-Like Dermatosis Associated With Contact Exposure to a Flurbiprofen Plaster

Topical nonsteroidal anti-inflammatory drug (NSAID) formulations are widely used for the management of chronic musculoskeletal pain and are generally well tolerated. Severe cutaneous adverse reactions to topical agents are rare. We report a case of toxic epidermal necrolysis (TEN)-like dermatitis arising from contact dermatitis induced by a flurbiprofen plaster in an 81-year-old man. The patient developed erythroderma, extensive erosions, and systemic manifestations after two days of plaster application to the lumbar region. The clinical presentation initially suggested TEN; however, histopathologic examination revealed marked dermal lymphocytic infiltration without keratinocyte necrosis, a finding inconsistent with true TEN. Direct and indirect immunofluorescence studies and serologic testing for autoimmune bullous and connective tissue diseases were negative. The patient was treated with methylprednisolone pulse therapy followed by systemic corticosteroids and supportive care, achieving complete re-epithelialization after two months. This case demonstrates that severe contact dermatitis caused by topical NSAIDs can clinically mimic TEN and underscores the critical importance of histopathologic evaluation in establishing an accurate diagnosis.