Kyoung Jin Kim, Deuk Pyo Lee, Ho Seok Suh, Mi Woo Lee, Jee Ho Choi, Kee Chan Moon, Jai Kyoung Koh
DOI: 10.1080/00015550510038232

Toxic epidermal necrolysis (TEN) is a rare, life-threatening, drug-induced cutaneous reaction. We herein report our experience regarding causes, clinical course, treatment and sequelae of TEN in Korean patients. In addition, we used the SCORTEN, a severity-of-illness score for TEN, to compare the predicted and actual mortality rates, and to evaluate the efficacy of treatment modalities. A retrospective study of 38 patients with TEN during a 13- year period (1990–2003) at the Asan Medical Center was performed. The mean involved body surface area was 49¡17%. All except three cases were associated with medications, most commonly antibiotics, followed by nonsteroidal anti-inflammatory drugs, acetaminophen and herbal remedies. Fourteen patients had a history of current infection, including upper respiratory infection, pneumonia and herpes simplex infection. The mean time from initial drug administration to the onset of TEN was 9.8¡5.7 days. Twenty-one patients were treated with systemic corticosteroids. Fourteen received high dose intravenous immunoglobulin therapy. The actual mortality rate was 23.7% (9/38), not significantly different from the SCORTEN-predicted rate (25.5%, 9.699/38). Also based on SCORTEN, treatment with high dose intravenous immunoglobulin showed a trend to lower actual mortality than predicted mortality (standardized mortality ratio (SMR)50.425; 95% CI, 0.011–2.368), whereas corticosteroid therapy showed no such difference (SMR51.004; 95% CI, 0.369–2.187).