Intravenous Immunoglobulin Use in the Treatment of Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome: A 10-year Retrospective Analysis of Patients of a Single Burn Center

Abstract

Stevens - Johnson syndrome and Toxic Epidermal Necrolysis Syndrome are rare, but serious conditions affecting skin and mucous membranes that are primarily treated with supportive care. Other more specific therapies have limited evidence to support the benefit of their use; one such treatment is intravenous immunoglobulin (IVIG). The use of IVIG in the treatment of these syndromes remain controversial due to mixed results demonstrated in the literature, and at present is not considered a component of the standard of care. This study seeks to provide additional data regarding the efficacy of IVIG treatment on mortality in a small cohort of patients presenting with these syndromes at a regional burn center over a 10-year period; data was retrospectively collected from patient medical records. On analysis of this data, IVIG use showed a potential, but not significant. improvement on mortality in comparison to the non-treatment group. Compared with the non-treatment group, odds ratios for death were 0.81 (95% CI 0.3-2.0) for IVIG. There is ultimately no new evidence that the benefit of IVIG in the treatment of Stevens - Johnson syndrome and Toxic Epidermal Necrolysis Syndrome is anything more than potential. Further investigation should include a rigorous analysis and comparison of different dosing regimens.