Systemic corticosteroids in toxic epidermal necrolysis

Gurshan K Bedi, Gurvinder P Thami, Amrinder J kanwar

 Chandigarh, India

Correspondence Address:
Gurshan K Bedi
Chandigarh
India

To the Editor

We read with interest the letter by Sandipan Dhar (Ind J Dermatol Venereol Leprol 1996;62:270) regarding role of corticosteroids in toxic epidermal necrolysis (TEN). We are really at a loss to understand as to what the author exactly wants to convey. As in other disciplines of Medicine there are enough controversies in Dermatology. The role of corticosteroids in management of TEN is perhaps most interesting one. Whether corticosteroids are useful or not can only be shown by carrying out a well controlled study in which one group of patients receives corticosteroids early in the course of disease and in the other corticosteroids are not administered at all. There are a few well-controlled studies in the literature from very good centres around the world which clearly show that corticosteroids do not have any role in management of TEN; rather they predispose the patients to develop infections and increase the morbidity as well as mortality. Moreover prognosis in TEN is many a times determined by underlying conditions for which the offending drug was administered, and there are underlying diseases like tuberculosis in which corticosteroids may be contraindicated. We think that all of us who are in the field of Dermatology have enough knowledge and expertise about how to use corticosteroids. We welcome such comments from a fellow colleague if it is based upon well controlled scientific study. Finally, such publications do not add anything to existing knowledge about the subject; rather they further complicate the issues.