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August 1975

Staphylococcal Toxic Epidermal Necrolysis

Arch Dermatol. 1975;111(8):1073. doi:10.1001/archderm.1975.01630200133027

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To the Editor.—  I have previously written concerning the article "Treatment of Staphylococcal Toxic Epidermal Necrolysis" in the Archives (110:559-562,1974) by Rudolph et al. In that letter in the Archives, I presented one and only one suggestion: "I believe that these authors have mistaken the natural course of the disease for a response to therapy."In support of my position, I offered experimental and clinical evidence. Experimentally, the animal models of Melish and Glasgow (J Pediatr 78:958-967,1971), injected with live Staphylococcus aureus of phage group II, show that parenterally administered antibiotics are only effective if given before the onset of the rash. Once exfoliation begins, treatment with antibiotics does not change its extent or duration.Clinically, my position is based on a series of 83 patients from the Buffalo Children's Hospital who met the criteria of Melish and Glasgow for the diagnosis of staphylococcal scalded skin syndrome, who had not

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