糖皮质激素联合静脉注射用人免疫球蛋白治疗中毒性表皮坏死松解症2例

Systemic corticosteroids in combination with intravenous immunoglobulin pulse therapy in the treatment of toxic epidermal necrolysis

在2例中毒性表皮坏死松解症(TEN)患者发病早期,给予甲泼尼龙1.5mg/(kg·d)静脉滴注,同时应用静脉注射用人免疫球蛋白(IVIG)0.28g/(kg·d)连续冲击治疗3d。经治疗2例患者皮肤及黏膜损害得到有效控制,在较短时间内可将糖皮质激素减量。2例TEN患者在IVIG治疗结束后第3天无新发皮损,表皮坏死剥脱得到有效控制。第8天皮损明显减轻,创面干燥,且有新表皮再生。治疗过程中未见明显不良反应。

Two cases of TEN were initially treated with methylprednisolone at a dose of 1.5 mg/(kg·d), which did not improve the condition. High-dose intravenous immunoglobulin at a dose of 0.28 g/(kg·d) for 3 consecutive days was added to the therapeutic regimen. The dosage of corticosteroid tapered shortly after the lesions of the skin and mucous membranes were successfully controlled. Simultaneously, supportive treatment and intensive nursing were given. No new blisters developed within 72 hours after IVIG administration, and rapid recovery ensued. Epidermal necrolysis exfoliation disappeared and re-epithelialization occurred within 8 days. No obvious side effects of IVIG were observed. So high-dose corticosteroids could be used for TEN in its early stage.IVIG should be the first alternative if corticosteroids are contra-indicated or do not respond.Our cases demonstrated that IVIG is highly effective and safe in the treatment of TEN.