Practice Gaps
Dec 2011

Use of Intravenous Immunoglobulin in Toxic Epidermal NecrolysisComment on “In a Patient With Toxic Epidermal Necrolysis, Does Intravenous Immunoglobulin Improve Survival Compared With Supportive Care? ”

Arch Dermatol. 2011;147(12):1440-1441. doi:10.1001/archdermatol.2011.1610

Toxic epidermal necrolysis (TEN) is a rare, life-threatening, adverse cutaneous drug reaction with a reported mortality rate ranging from 25% to 35%.1 Based on the reported inhibition of Fas-mediated apoptosis of keratinocytes by intravenous (IV) immunoglobulin (IVIg) in vitro, IVIg has since been considered as a potential therapeutic modality in TEN.2 To date, 15 studies including more than 10 patients per study and analyzing the effect of IVIg in TEN have been reported in the literature. They all suffer their imperfect study designs and limitations, and none are of a randomized, controlled design. The problem with TEN to date is that a specific therapy for Stevens-Johnson syndrome/TEN that has shown efficacy in controlled clinical trials unfortunately does not exist.

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