Skin biopsies to assess response to systemic corticosteroid therapy in early-stage TEN: case report and review of the literature

Toxic epidermal necrolysis (TEN) is a severe, mucocutaneous, necrolytic reaction to a variety of antigenic stimuli. The use of systemic corticosteroids in the treatment of TEN is controversial because of a lack of randomized, controlled, prospective studies, and because the effects of steroid therapy vary depending on the dosage and time of its administration during the course of TEN. Immediate intervention is crucial, and the response to corticosteroids in early-stage TEN can be difficult to clinically assess. In this report, we describe the use of serial skin biopsies to determine the efficacy of high-dose corticosteroids in patients with early-stage TEN. We present the case of a woman who was started on antiepileptic therapy with phenytoin sodium and developed TEN shortly thereafter. She was treated with intravenous methylprednisolone acetate for 1 week. The progression of the skin eruption was halted and the patient's condition began to stabilize. Skin biopsy specimens taken before and after steroid therapy revealed substantial improvement of the lymphocytic infiltrate and arrested epidermal necrosis. Serial skin biopsies in patients with early-stage TEN are helpful in assessing the initial response to corticosteroids and thus guide further therapy.