Intravenous immunoglobulins in the treatment of severe drug eruptions

To present and discuss the rationale for using high-dose intravenous human immunoglobulins in the treatment of severe drug eruptions and the clinical results of recently published series.

In toxic epidermal necrolysis, intravenous human immunoglobulins were expected to inhibit the apoptosis of epidermal cells by blocking the Fas/Fas ligand pathway. Some controversies persist both on the role of Fas/Fas ligand pathway and on the anti-apoptotic effect of human immunoglobulins in vitro. The clinical results of the treatment of toxic epidermal necrolysis with intravenous immunoglobulins are also controversial, the important differences between series being difficult to explain.

More evidence is needed before high-dose intravenous human immunoglobulins can be considered as standard therapy of toxic epidermal necrolysis.