Toxic epidermal necrolysis in patients receiving glucocorticosteroids

Despite the lack of evidence of an immunologically mediated mechanism for Toxic Epidermal Necrolysis (TEN), glucocorticosteroids are frequently used for the treatment of patients afflicted with TEN. We investigated the data of 216 patients with TEN for therapy with glucocorticosteroids prior to the beginning of TEN. The data had been collected between 1984 and 1985 during the epidemiological study on severe skin reactions in West-Germany spanning the years 1981-85. 11/216 (5%) patients could be traced, who had been treated with glucocorticosteroids for at least a week prior to the first dermatological sign of TEN. Glucocorticosteroids had been administered predominantly for neurological or neurosurgical conditions. The period of treatment ranged from 1 week to several months. Doses ranging between 7.5 and 325 mg prednisolone/per day were found. There were no major differences between patients with or without steroid therapy with regard to sex, age and lethality. The observation of TEN in patients receiving therapy with glucocorticosteroids raises questions about the usefulness of treating patients with TEN with glucocorticosteroids.