Our therapeutic approach to ten: The retrospective evaluation of rotational and combination therapies

Abstract

Background and design: Toxic epidermal necrolysis (TEN) is a severe, progressive disease most commonly induced by drugs and characterized by the sudden onset of skin necrolysis. It is frequently associated with systemic involvement and has a high mortality. No standard therapeutic regimen exists for the medical therapy of TEN.Material and Methods: We retrospectively evaluated a total of 8 TEN cases followed up by our department since 2000 and documented the demographic features, clinical presentation of these cases and their response to combination and rotational therapies with pulse steroids, IVIgs and plasmapheresis.Results: The most frequently culprit drug was found to be phenytoin followed by ciprofloxaciline and salicilic acid. Three of the cases were diagnosed as "Overlap SJS-TEN", three as "TEN with spots" and two as "TEN without spots". The therapy of five of 8 patients treated with high doses of corticosteroids were combined with IVIgs (0.6-0.7 g/kg/d for 5 days) due to the aggressive course of disease. Plasmapheresis was also performed to three of five cases who received IVIgs. All five cases who receieved the combined immunsuppressive drugs developed sepsis that was effectively controlled with antibiotics.Conclusion: In conclusion, the survival of all TEN patients except one with decompansated renal failure with these therapeutic regimens provides evidence for the efficacy of combined and rotational therapies of corticosteroids, IVIgs and plasmapheresis. We recommend that these therapies should be administered by an experienced team with a multidisciplinary approach.