ReportsTreatment of toxic epidermal necrolysis with intravenous immunoglobulin in children☆,☆☆,★
Section snippets
Patients and methods
This retrospective study was approved by the Institutional Review board of the University of Utah Medical Center. We reviewed the charts of 8 pediatric patients who were admitted between June 1999 and March 2001 with a diagnosis of TEN, who were identified from the computerized records of the University of Utah Health Sciences Center, Primary Children's Medical Center, and Intermountain Burn Center. In addition, 3 additional pediatric patients with TEN who were not treated with IVIg between
Results
The demographic and clinical characteristics of patients treated with IVIg are summarized in Table I. There were 4 male and 4 female patients, with a mean age of 8.1 years (range, 22 months to 21 years). Antibiotics were implicated in 4 cases (penicillin in 2 cases, sulfonamides in 2 cases) and anticonvulsants in 3 cases (phenobarbital, carbamazepine, lamotrigine); in one case a specific inciting factor could not be determined. Widespread epidermal necrosis was noted in all patients with mean
Discussion
We present a series of 8 pediatric patients who were treated with IVIg for TEN. Despite significant BSA involvement, all patients survived. In addition, treatment with IVIg resulted in arrest in progression of TEN (mean, 3.2 days) and rapid re-epithelialization (mean complete recovery, 8.1 days), without any toxicity from the drug treatment. These results are in agreement with Viard et al16 who reported the successful treatment of 8 adult and 2 pediatric TEN patients with IVIg (dosage, 0.2-0.75
References (26)
- et al.
Toxic epidermal necrolysis
Dermatol Clin
(2000) - et al.
Randomised comparison of thalidomide versus placebo in toxic epidermal necrolysis
Lancet
(1998) - et al.
Plasmapheresis as an adjunct treatment in toxic epidermal necrolysis
J Am Acad Dermatol
(1999) - et al.
High-dose intravenous immunoglobulins: an approach to treat severe immune-mediated and autoimmune diseases of the skin
J Am Acad Dermatol
(2001) - et al.
Use of intravenous immunoglobulin in the treatment of severe cutaneous drug reactions in patients with AIDS
J Allergy Clin Immunol
(1996) Intravenous immunoglobulin in autoimmune and inflammatory dermatoses. A review of proposed mechanisms of action and therapeutic applications
Dermatol Clin
(2000)- et al.
Management of Stevens-Johnson syndrome and toxic epidermal necrolysis in children
J Pediatr
(1989) Acute disseminated epidermal necrosis types 1, 2, and 3: study of sixty cases
J Am Acad Dermatol
(1985)- et al.
Effect of high-dose intravenous immunoglobulin therapy on blood rheology
Lancet
(1992) - et al.
Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis
N Engl J Med
(1995)
Toxic epidermal necrolysis. A comprehensive approach. Multidisciplinary management in a burn center
Clin Pediatr (Phila)
Experience with toxic epidermal necrolysis treated in a burn center
J Burn Care Rehabil
Treatment of toxic epidermal necrolysis with cyclosporin A
J Trauma
Cited by (126)
Low-dose intravenous immunoglobulin (IVIg) in different immune-mediated conditions
2023, Autoimmunity ReviewsStevens-Johnson syndrome post second dose of Pfizer COVID-19 vaccine: a case report
2021, Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyOcular Manifestations of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Children
2016, American Journal of OphthalmologyStevens-Johnson Syndrome/Toxic Epidermal Necrolysis - A Comprehensive Review and Guide to Therapy. I. Systemic Disease
2016, Ocular SurfaceCitation Excerpt :IVIG-treated patients demonstrate reduced Fas and FasL in post-treatment skin biopsies.196 There have been numerous SJS/TEN case reports and case series showing benefit from IVIG.197-213 In a small retrospective study of 8 pediatric TEN patients treated with IVIG, all patients survived.201
Lamotrigine-induced severe cutaneous adverse reaction: Update data from 1999-2014
2015, Journal of Clinical Neuroscience
- ☆
Funding sources: None.
- ☆☆
Conflicts of interest: None identified.
- ★
Reprint requests: John J. Zone, MD, Chairman, Department of Dermatology, University of Utah School of Medicine, 50 N Medical Dr, Salt Lake City, UT 84132. E-mail: [email protected].