Toxic Epidermal Necrolysis: Analysis of Clinical Course and SCORTEN-based Comparison of Mortality Rate and Treatment Modalities in Korean Patients
Kyoung Jin Kim A1, Deuk Pyo Lee A1, Ho Seok Suh A2, Mi Woo Lee A1, Jee Ho Choi A1, Kee Chan Moon A1, Jai Kyoung Koh A1
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).