Shock Syndromes II

Immunomodulating therapy

Corticosteroids—Despite some evidence of benefit, use is controversial and not universally

recommended. More recent case reports suggest that high-dose pulse therapy during the

first 3 days of presentation decreases disease progression. Associated risks (eg, infection;

hyperglycemia, poor wound healing) may outweigh benefits.

2009;147(6):1004-1011.e1). This prospective observational case series enrolled 5 patients

with SJS or TEN who presented with ocular complications during the acute stage of the

disease between May 2003 and June 2005 at Kyoto Prefectural University of Medicine,

Japan. The treatment regimen included intravenous pulse therapy with methylprednisolone

(500 or 1000 mg/d for 3 or 4 days) initiated within 4 days of disease onset, supplemented by

topical applications of 0.1% betamethasone more than five times daily for at least 2 weeks.

The study found significant improvements in skin eruptions after the steroid pulse therapy,

and although ocular inflammation initially increased, it subsided with the disappearance of

pseudomembranes and regeneration of corneal and conjunctival epithelium within 6 weeks.

One year from onset, all treated eyes exhibited clear corneas with visible palisades of

Vogt, suggesting preservation of corneal epithelial stem cells. Best-corrected visual acuity

(BCVA) was 20/20 or better in all eyes, with only minor complications such as superficial

punctate keratopathy and slight fornix shortening in 1 eye. No significant adverse effects

from the steroids were observed. The study concluded that early steroid pulse therapy

combined with topical betamethasone is crucial in preventing severe ocular complications

and preserving corneal health in patients with SJS and TEN.

with SJS and TEN (J Am Acad Dermatol. 2008;58(1):33-40). This retrospective analysis

was part of the EuroSCAR study, a larger prospective case-control study evaluating risk

factors involving patients from France and Germany. The study specifically examined

the effectiveness of intravenous immunoglobulin (IVIG) and corticosteroids compared

with supportive care alone. The results indicated that neither IVIG nor corticosteroids

significantly affected mortality rates compared with supportive care. Specifically, the odds

ratios for death with IVIG were 1.4 in France and 1.5 in Germany, whereas odds ratios for

death with corticosteroids were 0.4 in France and 0.3 in Germany, none of which showed

significant differences. The study highlighted the limitations inherent in such observational

studies, such as data collection variability, heterogeneity in supportive care practices, and

differences in treatment approaches across countries. Ultimately, the study concluded that

evidence was insufficient to recommend any specific treatment for reducing mortality in

SJS and TEN. However, the data suggested a potential beneficial trend for corticosteroids

that could warrant further investigation.

cohort of patients with SJS and TEN as part of the RegiSCAR study (J Invest Dermatol.

2013;133(5):1197-1204). This research aimed to assess risk factors for mortality, including

patient treatment modalities, up to 1 year after the reaction. In patients for whom treatment

details were available (n = 442), there was no observed benefit or harm with corticosteroids

(HR, 1.3; 95% CI, 0.8-1.9).

systemic corticosteroids in addition to supportive treatment, found that corticosteroid

treatment was associated with a modestly decreased risk of death compared with supportive

treatment alone (OR, 0.67; 95% CI, 0.46-0.97).