Der Hautarzt

, Volume 57, Issue 3, pp 185–194 | Cite as

Behandlung der toxischen epidermalen Nekrolyse

Erfahrungen bei 9 Patienten unter Berücksichtigung von intravenösen Immunglobulinen
  • P. Spornraft-Ragaller
  • H. Theilen
  • G. S. Gottschlich
  • M. Ragaller

Zusammenfassung

Die toxische epidermale Nekrolyse (TEN) ist als Maximalvariante schwerer bullöser Arzneimittelreaktionen durch eine hohe Mortalitätsrate von 30–40% gekennzeichnet. Die Behandlung ist eine interdisziplinäre Aufgabe und sollte in einer hierfür ausgestatteten Intensiveinheit erfolgen. Bisher existiert keine spezifische Therapie, sodass der supportiven intensivmedizinischen Therapie und der Lokalbehandlung besondere Bedeutung zukommen. Von 1995–2005 wurden 9 Patienten mit einer TEN auf der anästhesiologischen Intensivstation des Universitätsklinikums Dresden in Kooperation mit der Klinik für Dermatologie betreut. Alle Patienten erhielten initial Steroide und 5 Patienten zusätzlich intravenöse Immunglobuline (IVIG). Die Mortalitätsrate von insgesamt 33% wurde mit der nach dem SAPS-II-Score ermittelten Prognose eher unterschätzt, mittels eines spezifischen Scores (SCORTEN) jedoch deutlich überschätzt. Bei schwerer betroffenen Patienten sollten daher auch andere intensivmedizinische Scores zur Ermittlung der Prognose und des Erfolgs therapeutischer Maßnahmen herangezogen werden. Die Mortalität bei unseren mit IVIG behandelten Patienten betrug 20 vs. 50% in der Gruppe ohne IVIG. Obwohl aufgrund der uneinheitlichen Datenlage eine generelle Empfehlung zur Anwendung von IVIG bei TEN nicht gegeben werden kann, sollte nach unseren Erfahrungen die Indikation von IVIG frühzeitig erwogen werden.

Schlüsselwörter

Toxische epidermale Nekrolyse Arzneimittelreaktion Intravenöse Immunglobuline Mortalitätsrate Steroide 

Treatment of toxic epidermal necrolyis

Experience with 9 patients with consideration of intravenous immunoglobulin

Abstract

Toxic epidermal necrolysis (TEN) is the maximal variant of severe bullous drug reactions with a high mortality rate of 30–40%. Treatment should be interdisciplinary and is best provided in an intensive care setting. Since no specific therapy has been established, supportive intensive care and topical treatment are of crucial importance. Between 1995 and 2005, nine patients with TEN were treated in the anesthesiology intensive care unit in cooperation with dermatology in the University Hospital of Dresden. All patients initially received corticosteroids and five patients were additionally treated with intravenous immunoglobulins (IVIG). The overall mortality of 33% was underestimated by the SAPS II-Score, whereas it was overestimated by the TEN-specific SCORTEN. In more severely affected patients, other scoring systems in addition to SCORTEN should be used for prediction of prognosis and evaluation of therapy. The mortality rate of our IVIG treated patients was 20% vs. 50% compared to the non-IVIG-group. However, due to the small number of patients and contradictory results in the literature, IVIG cannot be generally recommended for the treatment of TEN, but should be considered in early stages of the disease.

Keywords

Toxic epidermal necrolysis Drug reaction Intravenous immunoglobulins Mortality rate Corticosteroids 

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Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  • P. Spornraft-Ragaller
    • 2
  • H. Theilen
    • 1
  • G. S. Gottschlich
    • 1
  • M. Ragaller
    • 1
  1. 1.Klinik und Poliklinik für Anästhesiologie und IntensivmedizinUniversitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden
  2. 2.Klinik und Poliklinik für DermatologieUniversitätsklinikum Carl Gustav Carus an der Technischen Universität DresdenDresden

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