Harms

We found poor evidence that corticosteroid use is detrimental. It is suggested that corticosteroids provoke prolonged wound healing, increased risk of infection, masking of early signs of sepsis, severe gastrointestinal bleeding and increased mortality. Thirty patients with SJS or TEN were included in an uncontrolled prospective study. The first 15 patients received corticosteroids, and the mortality rate was 66%. Therefore, the next 15 patients were treated without corticosteroids, and the mortality rate was 33%. Both groups were similar in other aspects. However, 11 of the 15 patients treated without corticosteroids had taken corticosteroids before referral. Thus no conclusion can be drawn about exclusive early administration of corticosteroids.15

In a retrospective study, a multivariate analysis of prognosis factors showed that corticosteroid therapy is an independent factor for increased mortality.16 Other series seem to come to the same conclusion.17 Moreover, many cases of TEN occur during treatment with high doses of corticosteroids for pre-existing disease. Data from 216 patients with TEN were investigated in a retrospective study; 11 of them had been treated with corticosteroids for at least a week before the first sign of TEN (from 1 week to several months, at doses of 7-5-325 mg prednisolone/day).18 In another series of 179 patients, 13 were undergoing long-term glucocorticosteroid therapy before TEN developed. Compared with 166 other cases, these patients had a longer delay between the introduction of the suspect drug and the onset of TEN, and a longer time elapsed between the first symptom of TEN and hospital admission. No other differences were observed.19

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