Systemic Corticosteroids In Combination With Intravenous Immunoglobulin Therapy In The Successful Treatment Of Children Toxic Epidermal Necrolysis:three Cases Report And Literature Review

Background:Toxic epidermal necrolysis (TEN) also known as drug-inducedbullosa epidermolysis is a rare, characterized by explosive widespread epidermalsloughing of skin accompanied by mucous membrane involvement with high mortalityrate.Induced by drug or upper respiratory tract infection,for children besides druginduced,often induced by infection factors, such as mycoplasma pneumoniae andherpes simplex virus, and organ transplantation or bone marrow transplantation.TENis one of the dermatology severities with high mortality.The risk is greater when ithappens to children.Its pathogenesis is not fully clear, and the treatment is stillcontroversial.Case presentation:Our department using systemic corticosteroids incombination with intravenous immunoglobulin therapy in the successful treatment ofchildren toxic epidermal necrolysis between July2011and September2011.Threechildren had exfoliation involving more than30%of the body surface area within2days after admitted to hospital,and conjunctiva,oral cavity mucous membrane andmucous membrane of the perineum also involved.Three cases of TEN were initiallytreated with Methylprednisolone at a dose of2~3mg／(kg·d).High-dose intravenousimmunoglobulin at a dose of0.4g／(kg·d) for5consecutive days was added to thetherapeutic regimen.The dosage of corticosteroid tapered shortly after the lesions ofthe skin and mucous membranes were successfullycontrolled.Simultaneously,supportive treatment and intensive nursing were given.After treatment，all the3cases of patients with skin and mucous membrane damage were effectively controlled.Considering the younger children,dose corticosteroids wasreduced in a relatively short period of time. When they were discharged from hospitalafter recovery,all of the three children stopped taking corticosteroids.No obviousadverse reactions in the treatment process.Conclusion:Systemic corticosteroids in combination with intravenousimmunoglobulin therapy is ideal for children toxic epidermal necrolysis currently.Theefficacy of intravenous immunoglobulin for TEN is affirmative.children with TENwho were treated with IVIG had a much better prognosis no matter the dosage ofIVIG compared with adults.The combination therapy can timely control the progressof the patients, shorten the length of hospital stay,contribute to the rapid reduction ofcorticosteroids, reduce its side effects and the mortality rate of the disease.