Successful dexamethasone pulse therapy in a toxic epidermal necrolysis (TEN) patient featuring recurrent TEN to oxazepam

A 62-year-old female patient is described who developed toxic epidermal nec rolysis (TEN) after medication with phenytoin and oxazepam. Initially pheny toin was discontinued and dexamethasone pulse therapy (1.5 mg/kg on 3 conse cutive days) was initiated on the tenth day of skin disease. This resulted in clinical improvement. Histologically re-epithelialization could be demon strated below the necrotic epidermis. However, on the eighteenth day of ski n disease (10 days after discontinuation of phenytoin and 8 days after the start of dexamethasone pulse therapy). a histologically verified rebound-TE N developed with a detachment of 95%. Oxazepam was stopped and a second ser ies of dexamethasone pulse therapy was given. Re-epithelialization began wi thin 24 h of the start of the second series of dexamethasone pulse therapy, and continued to almost complete recovery within 1 week.