Treatment of Toxic Epidermal Necrolysis With High-Dose Intravenous Immunoglobulins

High-dose intravenous immunoglobulin in the treatment of toxic epidermal necrolysis: a study of ocular benefits

“…Mucosal lesions responded in a manner similar to the cutaneous lesions after IVIG treatment with no ocular or mucous sequelae 45 days from onset of TEN. 7 However, a prospective open trial of high-dose IVIG (total dose 2 g/kg body weight) in 34 consecutive patients with SJS (nine cases), SJS-TEN (five cases) and TEN (20 cases) showed no effect on the progression of epidermolysis or any significant reduction in mortality, especially in the elderly with impaired renal function. Three patients (8.8%) had ocular sequelae on discharge.…”

“…A review of existing literature 1,7,[12][13][14][15][16][17][18] showed the prevalence of acute ocular complications ranged from 6.1% (n ¼ 98) to 100.0% (n ¼ 17), and longterm sequelae from 1% (n ¼ 98) to 50% (n ¼ 87). The most common long-term sequelae was sicca syndrome 19 (Table 5).…”

“…4 The rationale for the use of IVIG is based on the inhibition of Fas-mediated keratinocyte apoptosis in TEN by naturally occurring Fas-blocking antibodies within the IVIG. 5 Studies on the use of IVIG in TEN [5][6][7][8][9] have so far focused on cutaneous outcomes, including some reports of reduction in mortality rates, with none reporting specifically on the effects on ocular outcomes. In SJS, the severity of systemic involvement is reported to be a factor that determines late ocular complications.…”

Prevention of toxic epidermal necrolysis by regulatory T cells

“…TEN is an acute and life-threatening skin disease that is almost always drug related [15]. Clinically, the extensive detachment of the epidermis is characteristic of the disease and the prognosis is very poor (death rates of 30-40%) [16].…”

Reações cutâneas graves adversas a drogas - aspectos relevantes ao diagnóstico e ao tratamento - Parte I - Anafilaxia e reações anafilactóides, eritrodermias e o espectro clínico da síndrome de Stevens-Johnson & necrólise epidérmica tóxica (Doença de Lyell)

“…27 Existem relatos de casos e estudos não controlados de tratamento da NET, como o uso de imunoglobulina endovenosa, ciclosporina, ciclofosfamida, talidomida, plasmaferese, anticorpos monoclonais anticitocinas, entre outros, na tentativa de cessar o processo de necrose epidér-mica, sendo seu valor questionado, mesmo porque, na maioria dos pacientes, no momento da internação, o fenô-meno da necrose praticamente cessou sua progressão. 15 Recentemente Prins et al 34 publicaram estudo multicêntrico e retrospectivo sobre o uso da imunoglobulina endovenosa no tratamento dos pacientes com NET, obtendo excelentes resultados. Uma coorte de 48 pacientes, com média de idade de 43 anos (±24), constituída por 24 mulheres e 24 homens, com variação de descolamento epidérmico entre 10% e 95% da área de superfície corpórea total.…”