Successful Combination Therapy Including Plasma Exchange for Severe Toxic Epidermal Necrolysis

Abstract

Toxic epidermal necrolysis (TEN) is a rare life-threatening disorder. Although its treatment is not standardised due to the unknown pathogenesis and the lack of randomized clinical trials, systemic corticosteroids, immunoglobulins (IVIG) and immunosuppressive drugs such as cyclophosphamide have been used in the treatment of TEN with some success. We present a case with severe TEN treated successfully with combination therapy including plasma exchange. Although it is expensive and requires venous access, use of plasma exchange may be an effective measure leading to rapid cessation of dermal necrolysis, by the removal of inflammatory cytokines, autoantibodies, immune complex or other unknown toxic substances.