Etoricoxib‐induced toxic epidermal necrolysis: Successful treatment with infliximab

Treatment of Toxic Epidermal Necrolysis with the Combination of Infliximab and High-Dose Intravenous Immunoglobulin

“…High-dose corticosteroids can protect keratinocytes from lymphocyte-induced apoptosis [16]. TNFα blockade with infliximab (table 2) [8,9,10,11,12] or etanercept [13] has been proven efficacious in controlling TEN in a limited number of patients. It seems that compared to the ineffectiveness of thalidomide [17], anti-TNFα biologicals efficiently abrogate the skin damage caused by circulating and tissue TNFα in TEN [18,19] as clinically observed in five published cases (table 2) and the three patients treated in our department.…”

“…Suggested treatment options include high-dose corticosteroids with overall contradicting results, high-dose intravenous immunoglobulin (IVIg), cyclosporine and plasmapheresis in addition to supportive best care in burn units or equivalent facilities [1,5,6,7]. More recently, based on pathophysiological considerations, tumor necrosis factor alpha (TNFα)-targeting biologicals have also been used in a limited number of patients with overall promising results [8,9,10,11,12,13]. …”

Randomized, controlled trial of TNF-α antagonist in CTL-mediated severe cutaneous adverse reactions

“…Systemic corticosteroids (22), intravenous immunoglobulin (IVIG) (23), and cyclosporine (24) are often used to treat CTL-mediated SCARs; however, the clinical outcomes of these therapies remain controversial (25,26). Recently, several studies revealed that treatment with anti-TNF-α biologic agents appeared beneficial in patients with TEN and TEN-like acute cutaneous lupus erythematosus (17,(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). However, all of these studies were based on case reports and lacked a randomized, systematic trial design compared with traditional therapy studies.…”

Chronic Ocular Complications of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: The Role of Systemic Immunomodulatory Therapy

“…93 This was thought to be secondary to co-stimulation of CD8 + T-lymphocytes resulting in paradoxical increased levels of TNF-a, IL-2, and IFN-Ç. [94][95][96][97][98] However, the efficacy of TNF-a inhibitors in the treatment of chronic ocular SJS/TEN remains largely unknown due to a paucity of data. There have been sporadic case reports citing the benefits of TNF-a inhibitors in the treatment of OCP, and one randomized control study demonstrated improvement in conjunctival fibrosis, inflammatory infiltration, and serum TNF-a levels after the addition of pentoxifillin, a TNF-a inhibitor, to patients' immunosuppressive regimens.…”