title: Treatment of toxic epidermal necrolysis with the combination of infliximab and high-dose intravenous immunoglobulin.
abstract: BACKGROUND
  Therapeutic evidence for toxic epidermal necrolysis (TEN) is indicative for high-dose intravenous immunoglobulin yet inconclusive for corticosteroids.
  
  
  OBJECTIVE
  To describe the combination of corticosteroids, infliximab and a high-dose intravenous immunoglobulin course for TEN.
  
  
  METHODS
  In three patients (SCORTEN survival probabilities: 41.7%, 64.2%, 41.7%) disease control was evaluated by (a) employing quantitative image analysis to measure progression of skin detachment and (b) patients' outcome (complete re-epithelization). Published cases of TEN treatments with infliximab were retrieved from PubMed.
  
  
  RESULTS
  Within 48 h skin disease progression was arrested in all patients. Two patients were discharged after 3 weeks without any sequels from skin or conjunctivae. One patient passed away on the ninth day, however with noticeably improved skin (mortality rate: 33% observed vs. 50% expected). A PubMed search retrieved five TEN patients treated successfully with infliximab.
  
  
  CONCLUSIONS
  The described combination presents a feasible therapeutic alternative for TEN that warrants further evaluation.
authors.affiliation: Department of Skin and Venereal Diseases, University of Ioannina Medical School, Ioannina, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Gaitanis
authors.forename: Panagiota
authors.initials: P
authors.lastname: Spyridonos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Patmanidis
authors.forename: Vasilios
authors.initials: V
authors.lastname: Koulouras
authors.forename: Georgios
authors.initials: G
authors.lastname: Nakos
authors.forename: Margaret
authors.initials: M
authors.lastname: Tzaphlidou
authors.forename: Ioannis D
authors.initials: ID
authors.lastname: Bassukas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003879:Dermatologic Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013262:Stevens-Johnson Syndrome / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D003879:Dermatologic Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D000069285:Infliximab