In later stages of TEN, differential diagnosis includes the following: Toxic shock syndrome (usually has more prominent multiple organ involvement and different cutaneous manifestations, such as macular rash on palms and soles that evolves to desquamation over about 2 weeks) Exfoliative erythroderma (usually spares mucous membranes and is not as painful) Paraneoplastic pemphigus (sometimes with different mucocutaneous findings or in patients with evidence of cancer) In children, TEN is less common and must be distinguished from staphylococcal scalded skin syndrome.