Toxic epidermal necrolysis (TEN) represents the most severe
drug-related skin condition that is potentially life-threatening with no well-established treatments. The application of
corticosteroid therapy is controversial, whereas recently
intravenous immunoglobulin (
IVIG)
therapy is emerging as a promising new method. A severity-of-illness score for TEN (SCORTEN) has gained acceptance in some western countries. In this study, our objectives were to assess the applicability of SCORTEN in Chinese patients with TEN and to evaluate the efficacy of the combination
therapy of
IVIG and
corticosteroid in these patients. We performed a retrospective review of data from 61 patients with TEN treated at our intensive care unit from 2000 to 2010 to assess the performance of SCORTEN. In particular, 55 patients between 2002 and 2010 were grouped as a series to compare the
therapeutic effects of
corticosteroid therapy and
IVIG combined
therapy contemporaneously. During this period, 16 patients were administered with
corticosteroid therapy and 39 were treated with the combination
therapy. An initial dose of 1.5 mg/kg/day of
methylprednisolone was given to all TEN patients. The combination
therapy was combined with a total dose of 2 g/kg
IVIG within 5 days. Areas under receiver operating characteristic curves and Hosmer-Lemeshow statistic were analyzed to illustrate the performance of SCORTEN. The comparison of the efficacy of the two
therapies was conducted on the basis of clinical outcomes, standardized mortality ratio (SMR), and survival analysis. The overall actual mortality of patients between 2000 and 2010 was 16% (10/61), statistically insignificantly lower than predicted (24%, SMR = 67.98). Excellent discriminatory power (the areas under the receiver operating characteristic curves: 88.9, 88.2, 90.6%) and good calibration (P = .637, .833, .530) were found in all the groups. In patients admitted between 2002 and 2010,
IVIG combined
therapy showed a trend toward reducing the mortality rate (13%, SMR = 52.35), whereas
corticosteroid monotherapy suggested no such difference (31%, SMR = 123.92). Besides, the cumulative survival rates of the combination
therapy were higher at almost all the levels of SCORTEN (P = .002), especially at the score of 5 (P = 3.10 × 10⁻⁷). Compared with
corticosteroid alone, the combination
therapy arrested progression earlier (P = .013), although it did not significantly lead to a tapering of
corticosteroid or a reduction of the time of hospitalization. We concluded that SCORTEN was generally applicable to Chinese patients with TEN. The comparison of the effect indicated that the combination
therapy might achieve a better
therapeutic effect than the administration of
corticosteroid alone, especially in severe TEN patients.