title: Toxic epidermal necrolysis: five years of treatment experience from a burn unit.
abstract: Toxic epidermal necrolysis (TEN) is a serious drug eruption that results in death in approximately 25% to 50% of patients. There is controversy over whether SCORTEN accurately predicts mortality or if treatment interventions such as intravenous immunoglobulin (IVIg) can alter mortality.
  
  
  
  We sought to determine whether SCORTEN accurately predicts mortality in this cohort, whether IVIg improved survival, and which drugs and medical comorbidities impacted mortality.
  
  
  
  We summarize our experience prospectively over 5 years and 82 patients. Patients either received supportive care, intravenous immunoglobulin, or cyclosporine as treatment. All patients had a SCORTEN on admission, an offending drug on record, and a list of medical comorbidities.
  
  
  
  Of the 82 patients, 29% died from TEN. SCORTEN accurately predicted mortality in this cohort with an area under the curve (AUC) of 0.83 in a receiver operator curve (ROC) analysis. A Kaplan-Meier curve did not show improved mortality if patients received IVIg versus supportive care (P = .9). Medications most often responsible for TEN were trimethoprim/sulfamethoxazole, followed by anticonvulsants, nonsteroidal anti-inflammatories, and allopurinol.
  
  
  
  This prospective cohort study design is not as ideal as patients presenting for a randomized controlled trial.
  
  
  
  SCORTEN was an accurate predictor of mortality in this cohort. Age older than 40 years, the presence of metabolic syndrome and/or gout, higher body surface area involvement, higher SCORTEN, and higher number of medical comorbidities statistically significantly increased risk of death. IVIg did not significantly alter mortality. Although the highest number of cases was due to trimethoprim/sulfamethoxazole, the greatest proportion of deaths was due to allopurinol.
authors.affiliation: Division of Dermatology, University of Texas Health Science Center, San Antonio, Texas 78229, USA. firoz@uthscsa.edu
authors.forename: Bahar F
authors.initials: BF
authors.lastname: Firoz
authors.forename: Jeffrey Scott
authors.initials: JS
authors.lastname: Henning
authors.forename: Lee Ann
authors.initials: LA
authors.lastname: Zarzabal
authors.forename: Brad H
authors.initials: BH
authors.lastname: Pollock
mesh_terms: D000328:Adult; D000368:Aged; D000493:Allopurinol / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D000927:Anticonvulsants / Q000009:adverse effects; D000963:Antimetabolites / Q000009:adverse effects; D019540:Area Under Curve; D002053:Burn Units / Q000706:statistics & numerical data*; D002056:Burns / Q000401:mortality*; D015897:Comorbidity; D004338:Drug Combinations; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D013262:Stevens-Johnson Syndrome / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality*; D013413:Sulfadoxine / Q000009:adverse effects; D014295:Trimethoprim / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000927:Anticonvulsants; D000963:Antimetabolites; D004338:Drug Combinations; D016756:Immunoglobulins, Intravenous; C000301:trimethoprim, sulfadoxine drug combination; D000493:Allopurinol; D013413:Sulfadoxine; D014295:Trimethoprim