Granulocytes, Lymphocytes, and Toxic Epidermal Necrolysis

To the Editor.—  The overall mortality rate of 70% in Westly and Wechsler's¹ ten patients was relatively high and contrasts with the 30% figure cited by Fritsch and Elias² and the 20% to 50% range cited by Lyell,³ making either their patient population or their manner of treatment different from that of other groups. One possibility in this regard is their use of silver sulfadiazine (Silvadene) to treat some patients. An important factor is the capacity of silver sulfadiazine to attain therapeutic plasma concentrations when used to treat large, denuded skin surface areas, as frequently occurs in TEN.⁴ Moreover, both granulocytopenia and pancytopenia may accompany some toxic effects of sulfonamides by inducing bone marrow maturation arrest at the myoblast stage.⁴ Of particular relevance is the conclusion drawn by the authors that steroids are unwarranted in the treatment of TEN. Since three patients had suspected sulfonamide-related