Treatment of toxic epidermal necrolysis. Experience with 9 patients with consideration of intravenous immunoglobulin

Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete
P Spornraft-RagallerM Ragaller

Abstract

Toxic epidermal necrolysis (TEN) is the maximal variant of severe bullous drug reactions with a high mortality rate of 30-40%. Treatment should be interdisciplinary and is best provided in an intensive care setting. Since no specific therapy has been established, supportive intensive care and topical treatment are of crucial importance. Between 1995 and 2005, nine patients with TEN were treated in the anesthesiology intensive care unit in cooperation with dermatology in the University Hospital of Dresden. All patients initially received corticosteroids and five patients were additionally treated with intravenous immunoglobulins (IVIG). The overall mortality of 33% was underestimated by the SAPS II-Score, whereas it was overestimated by the TEN-specific SCORTEN. In more severely affected patients, other scoring systems in addition to SCORTEN should be used for prediction of prognosis and evaluation of therapy. The mortality rate of our IVIG treated patients was 20% vs. 50% compared to the non-IVIG-group. However, due to the small number of patients and contradictory results in the literature, IVIG cannot be generally recommended for the treatment of TEN, but should be considered in early stages of the disease.

References

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Citations

Jul 11, 2009·Clinical Reviews in Allergy & Immunology·Shaye KivityYehuda Shoenfeld
Jan 14, 2011·Journal of Burn Care & Research : Official Publication of the American Burn Association·Peggy SekulaMaja Mockenhaupt
Sep 8, 2012·Journal of Burn Care & Research : Official Publication of the American Burn Association·Qin-yuan ZhuHui-yuan Huang
Dec 19, 2006·Seminars in Cutaneous Medicine and Surgery·Mary Jo J KernsMichael P Heffernan
Jul 11, 2006·Annales Françaises D'anesthèsie Et De Rèanimation·G MionJ-L Daban
May 20, 2015·The Journal of Dermatology·Michiko AiharaUNKNOWN SJS/TEN Study Group

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