Toxic epidermal necrolysis treated with intravenous high-dose immunoglobulins: our experience.
BACKGROUND
Toxic epidermal necrolysis (TEN) is a rare severe acute exfoliative drug-induced skin disorder which has recently been ascribed to alterations in the control of keratinocyte apoptosis, mediated by an interaction between the cell surface death receptor Fas and its respective ligand. A therapeutic approach with intravenous immunoglobulins (IVIG) associated with pulse methylprednisolone, based on the inhibition of Fas-mediated keratinocyte death by naturally occurring Fas-blocking antibodies included in human immunoglobulin preparations, has produced good preliminary results.


OBJECTIVE
To analyse the efficacy of IVIG in the treatment of TEN.


METHODS
Nine patients with erythematous body surface area ranging from 38 to 85% and dermo-epidermal detachment from 4 to 37% were treated.


RESULTS
Eight patients were healed and 1 died of septic shock and multiple organ failure. Interruption of further epidermal detachment occurred after an average of 4.8 days from the onset of IVIG therapy. Complete wound healing occurred after an average of 12 days. Concerning complications, 3 out of 8 surviving patients had acute respiratory failure requiring mechanical ventilation and 1 acute renal failure was treated with dialysis. Late sequelae were limited to dyschromia and nail dystrophies. No hypertrophic scars were observed.


CONCLUSIONS
IVIG therapy represents a safe and valid approach for TEN.
Stella
M
M
Department of Plastic Surgery and Burn Centre, Trauma Centre, Torino, Italy.
Cassano
P
P
Bollero
D
D
Clemente
A
A
Giorio
G
G
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D013262:Stevens-Johnson Syndrome / Q000150:complications / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous