Beneficial therapeutic effects of hemoperfusion in the treatment of severe Stevens-Johnson syndrome/toxic epidermal necrolysis: preliminary results.

OBJECTIVE

Most of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe drug eruptions. There is currently no established treatment due to a lack of controlled/blinded studies. High-dose glucocorticoids and intravenous immunoglobulins (IVIG) therapy have been widely used, but these approaches remain controversial. This study introduces a novel method by which to treat severe SJS/TEN patients who were refractory to glucocorticoids and IVIG.

PATIENTS AND METHODS

Seven patients with SJS and three patients with TEN were enrolled in this non-blinded, uncontrolled study. The average patient age was 8.1 years. The male to female ratio was 1:1. Hemoperfusion was conducted daily using a HA280 resin sorbent column until new skin lesions ceased appearing and the skin started healing with visible re-epithelialization.

RESULTS

The average BSA involvement in SJS and TEN was 8.57% and 75%, respectively. The number of hemoperfusion sessions ranged from 3 to 5. Hemoperfusion led to prompt improvements in general health and halted the disease progression. All children were discharged and recovered completely. The average length of stay was 14.4 days. Four patients experienced adverse reactions: femoral vein thrombosis (N = 2), hypotension (N = 1), and cardiac palpitation (N = 1).

CONCLUSIONS

Hemoperfusion may be a useful adjunct treatment for patients with severe SJS/TEN if the initial treatment with glucocorticoids and IVIG fails.