Toxic Epidermal Necrolysis

Abstract

Dear Editor, It is indeed commendable for the authors of the case report titled, “Toxic Epidermal Necrolysis: A case report” [MJAFI 2006; 62: 271-2] for having successfully managed this rare and potentially fatal disease. Some points deserve to be mentioned. Toxic Epidermal Necrosis (TEN) has been reported to develop in spite of treatment with corticosteroids [1, 2]. So the authors contention that the onset of TEN was delayed because of prior steroids may not be really tenable. A more plausible cause of this delayed onset could be the type of the drug incriminated, a fact the authors have mentioned elsewhere in their report. Fluid replacement regimen advised in patients with TEN is lower than (two thirds to three-fourths) and not the same as advised for burn patients; since tissue destruction, underlying vascular injury and subcutaneous oedema is milder in TEN [3]. The dose of cyclosporine for treatment of TEN reportedly ranges from 3-5 mg/kg body weight [4]. The high dose given in the case reported is worthy of highlighting in view of the successful outcome. A challenge test by reinstitution of potentially incriminating drugs is fraught with danger, as it could bring on such a potentially fatal disease process once again. It must be emphasized that such a test should be undertaken, with extreme caution, under controlled conditions and after obtaining informed consent.