High‐Dose Intravenous Immunoglobulins in the Treatment of Toxic Epidermal Necrolysis: An Asian Series

• Published in: Journal of dermatology 2005-01, Vol.32 (1), p.1-6
• Main Authors: Tan, Audrey W., Thong, Bernard Y., Yip, Leonard W., Chng, Hiok Hee, Ng, See Ket
• Format: Article
• Language: English
• Subjects: Adult; Aged; drug hypersensitivity; Female; Humans; Immunoglobulins, Intravenous - therapeutic use; immunotherapy; Length of Stay; Male; Medical Records; Middle Aged; Retrospective Studies; Singapore - epidemiology; Stevens-Johnson Syndrome - drug therapy; Stevens-Johnson Syndrome - mortality; Stevens-Johnson Syndrome - pathology; Stevens‐Johnson syndrome; Survival Analysis
• ISSN: 0385-2407; 1346-8138
• DOI: 10.1111/j.1346-8138.2005.tb00704.x

Toxic epidermal necrolysis (TEN) is a severe, immune‐mediated, mucocutaneous reaction resulting in extensive keratinocyte apoptosis. High‐dose human intravenous immunoglobulins (IVIG) have been proposed as an effective treatment for TEN. Retrospective data from 8 patients with TEN and 4 patients with Stevens‐Johnson syndrome‐toxic epidermal necrolysis (SJS‐TEN) overlap treated with high‐dose IVIG were analysed. The total dose of IVIG administered was 2 g/kg body weight, with the exception of 2 patients who received a total dose of 1.5 g/kg body weight. Their mean age was 49.9 ± 18.8 years (range, 19 to 70 years). The mean time from the first sign of skin lesion or mucosal or epidermal detachment to commencement of IVIG was 8.7 ± 5.5 days (range, 3 to 22 days). Of the 11 patients who survived, the mean time to objective response was 3.6 ± 1.9 days (range, 2 to 8 days). The length of stay (LOS) in hospital was 20.4 ± 8.0 days (range, 10 to 37 days). The survival rate was 91.6%. One patient developed permanent mucocutaneous sequelae following TEN. There were no adverse reactions to IVIG. We conclude that high‐dose IVIG may be a safe and effective therapy for Asian patients with TEN.