A Review of the Active Treatments for Toxic Epidermal Necrolysis

Abstract

Toxic epidermal necrolysis (TEN) is a severe adverse drug reaction associated with the separation of skin and mucous membranes at the dermal-epidermal junction. Although it is rare, many treatments have been trialed because of its high mortality rate. Active interventions performed to date include the use of systemic corticosteroids, intravenous immunoglobulins (IVIg), cyclosporine, plasmapheresis, antitumor necrosis factor drugs and N-acetylcysteine, but none has been established as the most effective therapy. IVIg and short-term high-dose corticosteroids were regarded as the most promising treatments for TEN in a comprehensive review of all reported TEN cases from 1975 2003. When used with an appropriate dose and timing, the beneficial effects of IVIg can be maximized. Although no randomized controlled trials have been conducted, cyclosporine and plasmapheresis are considered to be beneficial.As no gold standard for active intervention for TEN has been established, the choice of treatment relies partly on the available guidelines and the experience of the dermatologist. There is still much to be investigated regarding the pathogenesis of TEN, and new findings may contribute to the identification of an effective active intervention strategy. (J Nippon Med Sch 2017; 84: 110 117)

Treatment of allopurinol-induced toxic epidermal necrolysis with high dose corticosteroids and intravenous immunoglobulins

“…In recent times, there have been numerous studies [12][13][14] that have supported the effectiveness and safety of IVIg. IVIg contains anti-Fas antibodies that inhibit the Fas/Fas ligand (FasL) interaction [6]. We used a combination of high dose systemic corticosteroids and IVIg because of higher age of patient and SCORTEN 4 in our case according to the study results.…”

“…A score called SCORTEN developed by Bastuji-Garin et al [5] determines the variables as predictors of prognosis and risk of death in patients with TEN. Systemic corticosteroids, intravenous immunoglobulins (IVIg), cyclosporine, plasmapheresis, antitumor necrosis factor drugs are the treatment options [6].…”

Stevens-Johnson syndrome and toxic epidermal necrolysis: a review

“…In the literature there is disagreement between the results of patients treated with corticosteroids, these differences may be due to the variation in the dose administered, duration, and time of evolution of the clinical picture in which it was administered. 24 A Third-level pediatric hospital in Thailand reported that despite being corticosteroids the treatment of choice to reduce excessive immune response, their retrospective study at 20 years did not find an increase in the efficacy of use with corticosteroids and symptomatic treatment 25 . Concluding that the administration of corticosteroids is not recommended as a single therapy in cases of SJJ and TEN.…”

“…Recent studies show an increase in predicted mortality, and its use with anti-TNF can, contrary to what was thought, diminish its effect. 24…”

Bullous epidermolysis after allogeneic stem cells transplantation – non-typical clinical presentation of severe graft versus host disease

“…ТЭН -заболевание с тяжелым тотальным эритематозно-буллезным поражением кожи и слизистых оболочек; в большинстве случаев это результат воздействия лекарственных средств или их метаболитов [3]. Есть данные о манифестации ТЭН на фоне эндотоксемии при тяжелых инфекционных осложнениях.…”