Treatment of Toxic Epidermal Necrolysis With High-Dose Intravenous Immunoglobulins

The clinical characteristics, putative drugs, and optimal management of 62 patients with stevens-johnson syndrome and/or toxic epidermal necrolysis: A retrospective observational study

“…However, despite being a frequent cause of SJS/TEN across studies, the majority of prescriptions apparently have been for asymptomatic hyperuricemia as was noted in our more than 90% cases taking allopurinol. [ 16 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 ] In contrast to a previous report of SJS/TEN in 19.6% of patients from paracetamol, ibuprofen, diclofenac, nimesulide, and etoricoxib, only paracetamol and diclofenac had caused TEN in our one case each, perhaps from their comparatively more frequent use in our setup rather than having a higher propensity for toxicity. [ 16 ] Among ART drugs, nevirapine has been associated with greater risk for developing SJS/TEN compared to others.…”

“…Nevertheless, major beneficial effects noted in our patients were rapid pain relief, reduced healing time, shortened clinical course, and possibly increased survival as has been reported previously. [ 35 38 39 ] It is also possible that these additional benefits of IVIg were from its combination with dexamethasone as reported previously as well. [ 40 ] Whether fresh blood transfusion besides correcting hypovolemia and anemia will improve outcome in terms of faster disease control and reduced morality in SJS/TEN patients noted in this study and previously perhaps needs validation with more studies.…”

Systemic therapies for Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: a SCORTEN‐based systematic review and meta‐analysis

“…They observed an increase in mortality compared to that predicted (32% vs. 24%, respectively), the results being worse in patients with renal insufficiency 42 . It has been suggested that higher doses of IVIG may be necessary to obtain a survival benefit, 38,43,44 and so in this study patients were separated depending on treatment dose (≥ or <3 g/kg IVIG, see Table ), but no differences in the efficacy were observed (Figure ) (for more information, see point 3 in the ) 45‐49 …”

Severe toxic epidermal necrolysis precipitated by amphetamine use

“…There are several studies in support of the use of IVIg in TEN; 9–11 however, two recent reports have questioned the value of this treatment 12,13 . Despite the use of IVIg in this case, the time taken for cessation of epithelial detachment and commencement of re‐epithelialization was considerably longer than that typically observed 7,9 . Because of restrictions on availability, our patient received a total IVIg dose of 1.6 g/kg, considerably lower than the recommended 3 g/kg 9 .…”

“…Despite the use of IVIg in this case, the time taken for cessation of epithelial detachment and commencement of re‐epithelialization was considerably longer than that typically observed 7,9 . Because of restrictions on availability, our patient received a total IVIg dose of 1.6 g/kg, considerably lower than the recommended 3 g/kg 9 . In addition, to achieve maximum benefit, IVIg must be administered as early as possible and in our case there was a 10‐day delay in commencement of low‐dose IVIg 9 .…”