Uppal Encarl, Dear Kate, Exton Lesley, Ryan David, Bunker Christopher B
Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK.
Clinical Standards Unit, British Association of Dermatologists, London, UK.
Skin Health Dis. 2025 May 28;5(4):247-255. doi: 10.1093/skinhd/vzaf012. eCollection 2025 Aug.
Toxic epidermal necrolysis (TEN) is a dermatological emergency with devastating morbidity and mortality rates. It is most often caused by medications. Management guidelines have focused on conservative measures, partly due to a previous lack of large randomized controlled trials evaluating systemic agents, and because experts have differing views on initiating active medical management. Tumour necrosis factor alpha (TNF-α) is a cytokine that is involved in immune defence against various infectious agents by exerting a powerful anti-inflammatory effect. Inhibition of TNF-α is well established in the management of noninfectious inflammatory (including dermatological) conditions. Patients with TEN have prominent expression of TNF-α in keratinocytes and macrophages in affected skin as well as in blister fluid. This review article aims to summarize the recent and emerging evidence for using anti-TNF-α treatment, particularly etanercept, in the management of TEN.
中毒性表皮坏死松解症（TEN）是一种具有极高发病率和死亡率的皮肤科急症。其最常见的病因是药物。管理指南一直侧重于保守措施，部分原因是此前缺乏评估全身性药物的大型随机对照试验，且专家们对于启动积极的药物治疗存在不同观点。肿瘤坏死因子α（TNF-α）是一种细胞因子，通过发挥强大的抗炎作用参与针对各种感染因子的免疫防御。在非感染性炎症（包括皮肤科疾病）的管理中，抑制TNF-α已得到充分证实。TEN患者在受累皮肤的角质形成细胞和巨噬细胞以及水疱液中TNF-α表达显著。这篇综述文章旨在总结使用抗TNF-α治疗，尤其是依那西普，来管理TEN的最新及新出现的证据。
