Table 1.
Treatments for severe cutaneous adverse reactions (SCARs).
| SCARs | Comments |
|---|---|
| SJS/TEN | |
| Supportive care | It is the most important and fundamental treatment and should include assessment and management of skin wounds, fluid and nutrition status, electrolyte balance, renal and airway function, and adequate pain control. |
| Systemic corticosteroids | They are the most commonly used treatment in SJS/TEN other than supportive care. There are controversies regarding the usage of corticosteroids. There is a trend toward survival benefits of systemic corticosteroids compared to supportive care (odds ratio: 0.54; 95% CI: 0.29–1.01). |
| IVIG | The results were conflicting. A recently published meta-analysis showed no differences in mortality when comparing patients receiving IVIG to those receiving supportive care. |
| Cyclosporine | Three recent meta-analysis studies showed a significant and beneficial effect of cyclosporine compared with supportive care on mortality. |
| Anti-TNF-α agents | There is an unexpected increase in mortality in the patients receiving thalidomide. Several case reports and one case series showed positive results of infliximab or etanercept in the treatment of SJS/TEN. |
| Plasmapheresis | Plasmapheresis may remove toxic and harmful mediators from the patients and has been shown to provide rapid and dramatic improvement in some reports. |
| DRESS | |
| Supportive care | It might have a higher rate of detectable autoantibodies and a higher rate of autoimmune long-term sequelae. Further studies are needed. |
| Systemic corticosteroids | They are the mainstay treatment. They may reduce the occurrence of disease flare-ups and decrease the probability of the development of autoimmune sequelae. Individual adjustments are needed. |
| IVIG | Results are conflicted. It should not be used as monotherapy. |
| Others | These include cyclosporine, cyclophosphamide, mycophenolate mofetil, and rituximab. Antiviral therapies such as ganciclovir have been proposed in addition to systemic corticosteroids or IVIG in patients with severe disease and viral reactivation. |
| AGEP | |
| Supportive care | It includes identification and removal of the possible culprit drugs. |
| Topical corticosteroids | They were correlated with a decreased median duration of hospitalization. |
| Systemic corticosteroids | The beneficial effects of the usage of systemic corticosteroids need further investigations. |
| GBFDE | |
| Supportive care | It includes prompt identification and removal of the possible culprit drugs. |
| Systemic corticosteroids | There is a lack of sufficient evidence. |
AGEP: acute generalized exanthematous pustulosis; DRESS: drug reaction with eosinophilia and systemic symptoms; GBFDE: generalized bullous fixed drug eruption; IVIG: intravenous immunoglobulin; SJS: Stevens-Johnson syndrome; TEN: toxic epidermal necrolysis; TNF: tumor necrosis factor.