title: Low dose intravenous immunoglobulins and steroids in toxic epidermal necrolysis: a prospective comparative open-labelled study of 36 cases.
abstract: BACKGROUND
  Toxic epidermal necrolysis (TEN) is a severe adverse drug reaction associated with high mortality. Though different modalities of treatment are advocated, there is no consensus regarding specific therapy. Corticosteroids have shown conflicting results and for high dose intravenous immunoglobulins (IVIG), cost is a limiting factor.
  
  
  OBJECTIVE
  To find out the effectiveness of combination therapy with low-dose IVIG and steroids versus steroids alone in our TEN patients.
  
  
  METHODS
  After obtaining Ethical Committee approval, 36 consecutive TEN patients (2008-2012) were alternately allocated to 2 groups - Group A was given combination of low-dose IVIG (0.2-0.5 g/kg) and rapidly tapering course of steroids (intravenous dexamethasone 0.1- 0.3 mg/kg/day tapered in 1-2 weeks) while Group B was given same dose of steroids alone. Outcome parameters assessed were time taken for arrest of disease progression, time taken for re-epithelization, duration of hospital stay and mortality rates.
  
  
  RESULTS
  Both groups had 18 patients. Baseline characteristics like age, sex ratio, SCORTEN, body surface area involvement and treatment interval were comparable. Time for arrest of disease progression and for re-epithelization was significantly lowered in Group A (P = 0.0001, P = 0.0009 respectively). Though duration of hospital stay and deaths were less in Group A, difference was not statistically significant. SCORTEN based standardized mortality ratio (SMR) analysis revealed that combination therapy reduced the probability of dying by 82% (SMR = 0.18 ± 0.36) and steroids by 37% (SMR = 0.63 ± 0.71). Difference in SMR was statistically significant (P = 0.00001). No significant side effects due to either modality were found in any of the patients.
  
  
  CONCLUSIONS
  Combination therapy with low-dose IVIG and steroids is more effective in terms of reduced mortality and faster disease resolution when compared to steroids alone in TEN.
authors.affiliation: Department of Dermatology and Venereology, Government Medical College, Kottayam, Kerala, India.
authors.forename: Soumya
authors.initials: S
authors.lastname: Jagadeesan
authors.forename: K
authors.initials: K
authors.lastname: Sobhanakumari
authors.forename: Sadeep Melethil
authors.initials: SM
authors.lastname: Sadanandan
authors.forename: Sheeba
authors.initials: S
authors.lastname: Ravindran
authors.forename: Manjula Velikkakathu
authors.initials: MV
authors.lastname: Divakaran
authors.forename: Lissy
authors.initials: L
authors.lastname: Skaria
authors.forename: George
authors.initials: G
authors.lastname: Kurien
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013256:Steroids / Q000008:administration & dosage*; D013262:Stevens-Johnson Syndrome / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D016756:Immunoglobulins, Intravenous; D013256:Steroids