Lack of significant treatment effect of plasma exchange in the treatment of drug-induced toxic epidermal necrolysis?

OBJECTIVE

Comparison of outcome in patients with toxic epidermal necrolysis (TEN) in patients who received plasma exchange (PE) compared with the results in two other centres that used almost identical treatment protocols but without PE.

DESIGN

Retrospective comparative case series with two recently published case series serving as controls.

SETTING

National burns intensive care unit (ICU) and Department of Transfusion Medicine at Linköping University Hospital, Sweden.

PATIENTS: 8 consecutive patients admitted with TEN who received PE during 1987-1997.

INTERVENTIONS: Neither prophylactic antibiotics nor cortisone were used. The patients were given a median of 5.5 PE treatments (range 1-8).

RESULTS

Eight patients with a median (range) age of 45 years (5-89) and with a median skin involvement total body surface area (TBSA) of 38% (12-100) were treated. The length of stay in the burns ICU was 15 (13-25) days and the time from onset of the cutaneous signs until complete re-epithelialisation was 24 days (13-55) for the seven survivors. Five patients fulfilled the diagnostic criteria of sepsis. One patient with extensive ischaemic cardiac disease developed septic shock and died (mortality 12.5%). Two patients developed side effects from PE.

CONCLUSIONS

To our knowledge, this is the largest series yet presented using PE in the treatment of TEN. Our results, in patients with less cutaneous involvement, similar causative agents, and similar demographic data as in the other two studies (controls), were no different as far as mortality, length of stay, or time to re-epithelialisation were concerned. This finding does not support the use of PE in the treatment of TEN.