skin disorders
Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)
Treatment of SJS and TEN
Treatment in a burn center or intensive care unit Possiblycyclosporine, corticosteroids, plasmapheresis, immune globulin, or immunosuppressants People with Stevens-Johnson syndrome or toxic epidermal necrolysis are hospitalized. Any drugs suspected of causing either disorder are immediately discontinued. When possible, people are treated in a burn center or intensive care unit and given scrupulous care to avoid infection (see Severe burns ). If the person survives, the skin grows back on its own, and, unlike burns, skin grafts are not needed. Fluids and salts, which are lost through the damaged skin, are replaced by vein (intravenously). Use of drugs to treat these disorders is controversial because, although there are theoretical reasons why certain drugs might be helpful, none have clearly been shown to improve survival.Cyclosporinemay lessen the duration of active blistering and peeling and possibly increase the survival rate. Some doctors believe that giving large doses of corticosteroids within the first few days is beneficial, whereas others believe they should not be used because they might increase the risk of serious infection. If infection develops, doctors give antibiotics immediately. Doctors may do a Apheresis . During this procedure, the person's blood is removed, and the plasma is separated from the blood and discarded. This procedure removes certain harmful substances from the blood, possibly including drugs and antibodies (immune system proteins) that could be causing either disorder. After the substances are removed, the blood cells are returned to the person. Doctors may give intravenous human immune globulin to treat toxic epidermal necrolysis. This substance may help prevent further damage to skin cells. Drugs called immunosuppressants may be given. Immunosuppressants weaken (suppress) the immune system and help keep it from attacking the body's own tissues. Tumor necrosis factor (TNF)–inhibiting drugs are a type of immunosuppressant. TNF inhibitors, such asinfliximabandetanercept, are given to people with Stevens-Johnson syndrome or toxic epidermal necrolysis to help suppress the immune process that is causing inflammation. 