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To the Editor.—
In the first paragraph of his letter, Dr. Rasmussen states that he is in agreement with our conclusion that systemically administered steroids should not be used alone in bacterial-induced toxic epidermal necrolysis (TEN). This, however, is contradicted by his later statement that 11 of 83 patients were treated successfully with systemically administered steroids alone. In our minds, this raises the possibility that these cases were in fact drug-induced varieties and not due to Staphylococcus aureus. In our experience, systemic steroid therapy without antibiotic coverage produced a clear-cut extension of the disease process. Melish and Glasgow, in addition, have come to similar conclusions in their experimental model.Dr. Rasmussen points out that in the experimental situation antibiotic therapy prevents severe exfoliation and death only if the antibiotic is given within four hours of injecting newborn mice with live S aureus organisms. He then argues that antibiotic
Rudolph RI, Leyden JJ. Toxic Epidermal Necrolysis-Reply. Arch Dermatol. 1975;111(5):659. doi:10.1001/archderm.1975.01630170117029