The Retrospective Study Of 18 Cases Of Toxic Epidermal Necrolysis

Objective: To compare the efficacy of systemic steroids monotherapy and systemic steroids combined with intravenous immunoglobulin(IVIG)in the treatment of toxic epidermal necrosis(TEN).Methods: We retrospectively analyzed Chinese inpatients with TEN between April,2008 and April,2013 in the First Affiliated Hospital of China Medical University,in which 9cases treated with systemic corticosteroids combined with IVIG(the combined group)and 9 cases treated with systemic corticosteroids monotherapy(the steroids group),and the age matched between the two groups.Results: Of the 18 cases reviewed,11 were male and 7 were female.The mean age was(56.8±10.5)years.The main causative agents were antibiotics(38.9%),followed by nonsteroidal anti-inflammatory drugs(33.3%).The incubation period was(6.3±6.7)days(range: 1-20 days),the duration before admission was(7.4±6.0)days(range: 2-20 days).Fever occurred in 88.9% of the patients,and mucosal involvement was seen in 100% of the patients(the proportion of oral mucosa,ocular mucosa,genital mucosa and all the three were 94.4%,77.8%,72.2% and 61.1%,respectively).The main laboratory abnormalities included hypoalbuminemia,impaired liver function,leukocytosis or leukopenia,anemia,higher C-reactive protein levels and so on.IVIG was administered at a dose from 0.2 to 0.4 g/kg daily for 5 consecutive days in the combined group.The duration before admission in the combined group was longer than that in the steroids group,however,the difference was not statistically significant.The SCORTEN score of the combined group was significantly higher than that in the steroids group(P=0.015).Compared with the steroids group,the combined group showed lower starting daily prednisone equivalent dose and cumulative prednisone dose during hospitalization,but there were no statistical significance.Meanwhile,the prednisone dose at discharge in the combined group was significantly lower than that in the steroids group(P=0.020).Lesion healing time in the combined group was longer than that of the steroids group(P=0.002).There was no death in all two groups.Complications were found in 8 cases in the combined group and 3 in the steroids group.Except for 1 case with ophthalmic sequelae in the combined group demanded the long-term and regular examination in ophthalmology after discharge,complications of the rest patients were cured before discharge.Conclusion: Either systemic steroids monotherapy or IVIG-steroids combination therapy was effective for TEN;IVIG-steroids combination therapy can significantly reduce the dosage of steroids.