Treatment of toxic epidermal necrolysis with the combination of infliximab and high-dose intravenous immunoglobulin.

ABSTRACT

BACKGROUND: Therapeutic evidence for toxic epidermal necrolysis (TEN) is indicative for high-dose intravenous immunoglobulin yet inconclusive for corticosteroids. OBJECTIVE: To describe the combination of corticosteroids, infliximab and a high-dose intravenous immunoglobulin course for TEN. PATIENTS AND METHODS: In three patients (SCORTEN survival probabilities 41.7%, 64.2%, 41.7%) disease control was evaluated by (a) employing quantitative image analysis to measure progression of skin detachment and (b) patients' outcome (complete re-epithelization). Published cases of TEN treatments with infliximab were retrieved from PubMed. RESULTS: Within 48 h skin disease progression was arrested in all patients. Two patients were discharged after 3 weeks without any sequels from skin or conjunctivae. One patient passed away on the ninth day, however with noticeably improved skin (mortality rate 33% observed vs. 50% expected). A PubMed search retrieved five TEN patients treated successfully with infliximab. CONCLUSION: The described combination presents a feasible therapeutic alternative for TEN that warrants further evaluation.