Reply to: “Prognosis and management of Stevens-Johnson syndrome and toxic epidermal necrolysis”

Abstract

Reply to: ''Prognosis and management of Stevens-Johnson syndrome and toxic epidermal necrolysis''To the Editor: We read the editorial by Schneider and Cohen with great interest. 1 We appreciate the authors' affirmation that malignancy and renal failure are important predictors of mortality in pediatric Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS-TEN), as we previously demonstrated. 2 The authors cited their recent publication highlighting the importance of supportive care. 3 We could not agree more. It is of utmost importance that both children and adults with SJS-TEN receive multispecialty supportive care that includes dermatology, critical care, skilled nursing, nephrology, ophthalmology, wound care, nutrition support, respiratory therapy, pain management, infectious disease, hematology-oncology, and hepatology.Supportive care is a critical part of treatment given the lack of consistent evidence in favor of using systemic corticosteroids, intravenous immunoglobulin, or other immunosuppressants to treat the underlying disease pathophysiology. As the authors point out in their review, there is inadequate evidence to support a standardized supportive treatment regimen. 3 It is likely that appropriate supportive care reduces mortality in SJS-TEN. However, more studies are sorely needed to categorize risk and standardize the management of SJS-TEN in both children and adults.