Tumor necrosis factor alpha inhibitors in the treatment of toxic epidermal necrolysis

Cutis. 2018 Jan;101(1):E15-E21.

Abstract

Toxic epidermal necrolysis (TEN) is a rare, life-threatening adverse drug reaction for which there is no standardized or consistently effective treatment. Due to a greater understanding of disease pathogenesis and the identification of tumor necrosis factor (TNF) α as a mediator of keratinocyte death, TNF-α antagonists have been used in the treatment of TEN. Specifically, infliximab and etanercept have been shown to be effective at halting disease progression. The objective of this study is to review published case reports and case series using anti-TNF-α medications in the treatment of TEN. Results of many of the articles reviewed support the use of TNF-α inhibitors in TEN in both adult and pediatric populations; however, the risks caused by these potent immunosuppressants must be weighed, and if administered, patients must be closely monitored for infections. Additional studies are needed to further characterize the role of TNF-α inhibition in the treatment of TEN.

Publication types

  • Review

MeSH terms

  • Adult
  • Child
  • Dermatologic Agents / adverse effects
  • Dermatologic Agents / pharmacology
  • Dermatologic Agents / therapeutic use
  • Etanercept / adverse effects
  • Etanercept / pharmacology
  • Etanercept / therapeutic use
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / pharmacology
  • Immunosuppressive Agents / therapeutic use
  • Infliximab / adverse effects
  • Infliximab / pharmacology
  • Infliximab / therapeutic use
  • Stevens-Johnson Syndrome / drug therapy*
  • Stevens-Johnson Syndrome / physiopathology
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*

Substances

  • Dermatologic Agents
  • Immunosuppressive Agents
  • Tumor Necrosis Factor-alpha
  • Infliximab
  • Etanercept