title: Successful dexamethasone pulse therapy in a toxic epidermal necrolysis (TEN) patient featuring recurrent TEN to oxazepam.
abstract: A 62-year-old female patient is described who developed toxic epidermal necrolysis (TEN) after medication with phenytoin and oxazepam. Initially phenytoin was discontinued and dexamethasone pulse therapy (1.5 mg/kg on 3 consecutive days) was initiated on the tenth day of skin disease. This resulted in clinical improvement. Histologically re-epithelialization could be demonstrated below the necrotic epidermis. However, on the eighteenth day of skin disease (10 days after discontinuation of phenytoin and 8 days after the start of dexamethasone pulse therapy), a histologically verified rebound-TEN developed with a detachment of 95%. Oxazepam was stopped and a second series of dexamethasone pulse therapy was given. Re-epithelialization began within 24 h of the start of the second series of dexamethasone pulse therapy, and continued to almost complete recovery within 1 week.
authors.affiliation: Department of Dermatology (Centre of Blistering Skin Diseases), Faculty of Medical Sciences, University Hospital Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands. secreteriaat@derm.azg.nl
authors.forename: J B
authors.initials: JB
authors.lastname: van der Meer
authors.forename: M L
authors.initials: ML
authors.lastname: Schuttelaar
authors.forename: G G
authors.initials: GG
authors.lastname: Toth
authors.forename: S H
authors.initials: SH
authors.lastname: Kardaun
authors.forename: G
authors.initials: G
authors.lastname: Beerthuizen
authors.forename: M C
authors.initials: MC
authors.lastname: de Jong
authors.forename: M F
authors.initials: MF
authors.lastname: Jonkman
authors.forename: P
authors.initials: P
authors.lastname: Nieuwenhuis
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000188:drug therapy / Q000556:secondary; D003907:Dexamethasone / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D004817:Epidermis / Q000187:drug effects / Q000473:pathology; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D008175:Lung Neoplasms / Q000188:drug therapy; D008875:Middle Aged; D010076:Oxazepam / Q000009:adverse effects*; D010672:Phenytoin / Q000627:therapeutic use; D020551:Pulse Therapy, Drug; D013262:Stevens-Johnson Syndrome / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology
chemical_list: D000927:Anticonvulsants; D005938:Glucocorticoids; D006993:Hypnotics and Sedatives; D010672:Phenytoin; D010076:Oxazepam; D003907:Dexamethasone