Abstract To the Editor — Rudolph et al, in the Archives (110:559, 1974), have presented evidence that steroids should not be used in bacterial-induced toxic epidermal necrolysis (TEN). I agree with their conclusions, since immunosuppression should only enhance such a disease.1They also believe that "cases of clear-cut S. aureus toxin mediated TEN can be safely and quickly aborted with systemic antibiotic therapy alone." This statement is supported by their clinical observation that "all 10 patients had swift defervescence with a cessation of spread of erythema and necrolysis in two to three days . . ."I believe that these authors have mistaken the natural course of the disease for a response to therapy. In order to make such a statement they would have to know the natural course of untreated staphylococcal TEN. To my knowledge, that information has never been published. The animal models of Melish and Glasgow2 have been used References 1. Wiley BB, et al: Staphylococcal scalded skin syndrome: Potentiation by immunosuppression in mice: Toxin mediated exfoliation in a healthy adult . Infect Immun 9:636-640, 1974. 2. Melish M, Glasgow L: Staphylococcal scalded skin syndrome: The expanded clinical syndrome . J Pediatr 78:958-967, 1971.Crossref 3. Lowney ED, et al: The scalded skin syndrome in small children . Arch Dermatol 95:359-369, 1967.Crossref 4. Rothenberg R, et al: Staphylococcal scalded skin syndrome in an adult . Arch Dermatol 108:408-410, 1973.Crossref
Archives of Dermatology – American Medical Association
Published: May 1, 1975
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