To the Editor —
Rudolph et al, in the Archives (110:559, 1974), have presented evidence that steroids should not be used in bacterial-induced toxic epidermal necrolysis (TEN). I agree with their conclusions, since immunosuppression should only enhance such a disease.1They also believe that "cases of clear-cut S. aureus toxin mediated TEN can be safely and quickly aborted with systemic antibiotic therapy alone." This statement is supported by their clinical observation that "all 10 patients had swift defervescence with a cessation of spread of erythema and necrolysis in two to three days . . ."I believe that these authors have mistaken the natural course of the disease for a response to therapy. In order to make such a statement they would have to know the natural course of untreated staphylococcal TEN. To my knowledge, that information has never been published. The animal models of Melish and Glasgow2 have been used
Rasmussen JE. Toxic Epidermal Necrolysis. Arch Dermatol. 1975;111(5):658–659. doi:10.1001/archderm.1975.01630170116028
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