Toxic epidermal necrolysis.
BACKGROUND
Most studies on drug-induced toxic epidermal necrolysis (TEN) report a high mortality rate. This has been attributed partly to the use of corticosteroids for its treatment. However, we consider corticosteroids to be the sheet anchor for saving the patients having TEN.


METHODS
Our approach to the treatment of this disease consists of administering a relatively high dose of corticosteroids to control the reaction at the earliest possible time and then withdrawing corticosteroids at the fastest possible rate.


RESULTS
As illustrated by the five case reports, the reaction is controlled within 24 to 48 hours and the corticosteroids are withdrawn within the next 7 to 10 days. During this period, the skin also shows almost complete healing. With the confidence gained with this approach, we undertake the provocation test as a rule in every patient to find the actual drug responsible for the reaction..


CONCLUSIONS
Corticosteroids used in an appropriate dosage schedule constitute an important component of the treatment for TEN to ensure early recovery.
Pasricha
J S
JS
Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
Khaitan
B K
BK
Shantharaman
R
R
Mital
A
A
Girdhar
M
M
D000293:Adolescent; D000328:Adult; D002648:Child; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D013262:Stevens-Johnson Syndrome / Q000188:drug therapy* / Q000473:pathology
D005938:Glucocorticoids; D003907:Dexamethasone