title: Intravenous immunoglobulin treatment for Stevens-Johnson syndrome and toxic epidermal necrolysis: a prospective noncomparative study showing no benefit on mortality or progression.
abstract: BACKGROUND
  It has been proposed that Fas-Fas ligand interaction was responsible for the apoptosis of epidermal cells in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) and that high doses of intravenous immunoglobulin (IVIG) could help patients by blocking the apoptosis.
  
  
  OBJECTIVE
  To study the effects of IVIG on SJS and TEN.
  
  
  METHODS
  Prospective open trial.
  
  
  METHODS
  Referral center of a university hospital.
  
  
  METHODS
  Thirty-four consecutive patients admitted for SJS (n = 9), SJS-TEN (n = 5), or TEN (n = 20) a mean of 4.3 days after onset.
  
  
  METHODS
  A dose of 2 g/kg of IVIG was administered within 2 days (half doses or full doses over a longer period for patients with low creatinine clearance).
  
  
  METHODS
  Detached plus detachable proportions of the total body surface area measured before and after treatment and predicted death rate estimated on admission with a validated prognostic score.
  
  
  RESULTS
  Epidermal detachment involved a mean +/- SD 19% +/- 16% of the total body surface area on admission and 32% +/- 26% after IVIG treatment (progression in 22 of 34 cases, including most patients referred early). The prognostic score predicted 8.2 deaths (24%); 11 were observed (32%; 95% confidence interval, 17%-51%). Most deaths occurred in elderly patients who had initially impaired renal function.
  
  
  CONCLUSIONS
  The confidence interval of the observed death rate excludes a dramatic decrease in mortality. No measurable effect was observed on the progression of detachment or on the speed of reepidermalization. These results do not support the routine use of IVIG treatment for patients with SJS or TEN, especially in cases of impaired renal function.
authors.affiliation: Department of Dermatology, Hôpital Henri Mondor, Créteil, France. bachot.nicolas@wanadoo.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bachot
authors.forename: Jean
authors.initials: J
authors.lastname: Revuz
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Roujeau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012867:Skin / Q000473:pathology; D013262:Stevens-Johnson Syndrome / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D015996:Survival Rate
chemical_list: D016756:Immunoglobulins, Intravenous