PLASMAPHERESIS IN TOXIC EPIDERMAL NECROLYSIS

Background The treatment of toxic epidermal necrolysis (TEN) is usuall y based on the removal of the offending drug(s), fluid replacement, nu tritional support, and local management, The mortality and morbidity, however, remain high and the death rate may be reduced to 10% only in special centers that use biologic dressings, Plasma exchange (PE) was proven efficacious in small series of patients and of no particular va lue in others. Methods Seven patients suffering from severe TEN coveri ng 30%-80% of body surface area and having two or four mucous membrane s involved, were included in this open study. Malignancy (Hodgkin's di sease, brain tumor) and a variety of medicaments (carbamazepine, allop urinol, diphenylhydantoin, cefaclor, amoxicyllin with clavullanic acid ) were considered as causally implicated. One to four PEs of 2,5 L wer e given on alternate days in six patients and on a daily basis in the seventh. Results All patients recovered successfully from their diseas e. No new lesions appeared after the first PE in four patients. Neithe r adverse reactions from this therapy nor sequelae from TEN were obser ved after a long follow-up lasting up to 8 years. Conclusions Although PE is expensive and requires easy venous access to be performed, it c ould be listed in the first line of TEN therapy. The method is safe an d efficacious, providing prompt relief from pain and rapid cessation o f necrolysis. The alternate day PEs are considered preferable to the e veryday regimen.