The role of intravenous immunoglobulin in toxic epidermal necrolysis: a retrospective analysis of 64 patients managed in a specialized centre

Lee, Haur Yueh; Y, Lim; Thirumoorthy, T; Pang, Shiu Ming

doi:10.1111/bjd.12607

Cited by 96 publications

(70 citation statements)

References 46 publications

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“…Interestingly, it has been shown that IVIg do not reduce the levels of granulysin. This might be, at least, partly responsible for the lack of efficacy of IVIg in some patients [21,22]. Alternatively, a recent study has shown excellent efficacy of cyclosporine in the treatment of TEN [23,24].…”

Section: Discussionmentioning

confidence: 99%

The Phytotherapeutic Fenugreek as Trigger of Toxic Epidermal Necrolysis

Bentele-Jaberg¹,

Guenova²,

Mehra

et al. 2015

Dermatology

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We describe the case of a 32-year-old woman who presented to the hospital with generalized painful exanthema, blisters and erosions 1 month after giving birth to a healthy girl. The patient's medical history was inconspicuous for comorbidities; however, it included the incidental intake of pain killers and a herbal preparation (fenugreek), which she took regularly over the last 4 weeks to improve lactation. Based on the clinical characteristics, we suspected toxic epidermal necrolysis (TEN), a severe cutaneous adverse drug reaction, which was confirmed by skin biopsy. The patient was treated with high-dose intravenous human immunoglobulins and was discharged 2 weeks after hospital admission in good condition. The allergological workup identified fenugreek as the most likely causative agent. Given the increased self-medication of freely available phytotherapeutics by patients in industrialized countries, herbal mixtures should be taken into consideration in the diagnostic workup of TEN.

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Section: Discussionmentioning

confidence: 99%

The Phytotherapeutic Fenugreek as Trigger of Toxic Epidermal Necrolysis

Bentele-Jaberg¹,

Guenova²,

Mehra

et al. 2015

Dermatology

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“…In addition to the dose, the timing of administration may affect mortality. single-center studies presumably treating the patients without differences, allowing the effectiveness of IVIg to be analyzed 17,20 . In a study in 2012, all the patients received 4 g/kg IVIg within 72 hours after admission to a burn unit, over a 3 day period, but there was no improvement in survival.…”

Section: Intravenous Immunoglobulinsmentioning

confidence: 99%

“…More than half of the patients were Chinese, and the mean age was 57 years old. Such factors could have affected the results 20 . What can be said for both the studies discussed above is that, considering the incidence rate of TEN reported throughout the world, the number of patients reported seems very high.…”

Section: Intravenous Immunoglobulinsmentioning

confidence: 99%

A Review of the Active Treatments for Toxic Epidermal Necrolysis

Kinoshita

Saeki

2017

J Nippon Med Sch

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Toxic epidermal necrolysis (TEN) is a severe adverse drug reaction associated with the separation of skin and mucous membranes at the dermal-epidermal junction. Although it is rare, many treatments have been trialed because of its high mortality rate. Active interventions performed to date include the use of systemic corticosteroids, intravenous immunoglobulins (IVIg), cyclosporine, plasmapheresis, antitumor necrosis factor drugs and N-acetylcysteine, but none has been established as the most effective therapy. IVIg and short-term high-dose corticosteroids were regarded as the most promising treatments for TEN in a comprehensive review of all reported TEN cases from 1975 2003. When used with an appropriate dose and timing, the beneficial effects of IVIg can be maximized. Although no randomized controlled trials have been conducted, cyclosporine and plasmapheresis are considered to be beneficial.As no gold standard for active intervention for TEN has been established, the choice of treatment relies partly on the available guidelines and the experience of the dermatologist. There is still much to be investigated regarding the pathogenesis of TEN, and new findings may contribute to the identification of an effective active intervention strategy. (J Nippon Med Sch 2017; 84: 110 117)

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“…Toxic epidermal necrolysis, StevensJohnson syndrome (no mortality benefit) [38] Multifocal motor neuropathy (GPP) [7] Haemolytic disease of the newborn Secondary antibody deficiency (including myeloma, CLL (RCT), drugs and other causes) (GPP) [46] Immunobullous disease (A) [37] Myasthenia gravis (GPP) [13] Dermatomyositis/polymyositis (GPP) [14] Autoimmune haemolytic anaemia (GPP)…”

Section: Specific Antibody Deficiency (Gpp)mentioning

confidence: 99%

“…[37] However, although widely used, pooled analysis shows no mortality benefit for use in patients with Stevens-Johnson syndrome/toxic epidermal necrolysis. [38] IV Ig is a well-established first-line therapy for Kawasaki disease to prevent new coronary artery abnormalities, with high-quality evidence supporting use of a single 2 g/kg dose within 10 days of symptom onset. [39] Combination with corticosteroids may offer additional benefit.…”

Section: Use In Other Disciplinesmentioning

confidence: 99%