Combination Therapy Effective for Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
The efficacy of TNF- inhibition plus steroid for treatment of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) was evaluated.

The addition of tumor necrosis factor (TNF) -a inhibition to steroid treatment was found to be effective when treating Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), according to findings from a study published in the Journal of American Academy of Dermatology.

A total of 25 patients (14 women; age range 40.20 ± 18.28 years) with SJS/TEN participated in this study from January 2017 to September 2021 at the First Affiliated Hospital of Sun Yat-sen University, China. Steroid monotherapy was administered to 10 patients, and 15 patients were treated with the combination therapy of methylprednisolone and etanercept, a TNF-a inhibitor. The efficacies of the 2 treatments were then compared and levels of cytokines were analyzed in both the acute and resolution phases of the disease.

All 25 patients achieved significant clinical improvement without any sequela. Treatment with the combination therapy led to significantly shorter courses of initial steroid use, acute stage of the disease, and hospitalization stay, the researchers noted. The combination therapy also decreased skin healing time (median, 12 days) compared with steroid monotherapy (median, 16 days). Also, there were fewer incidences of post-treatment infection in the cohort treated with the combination therapy.

Cytokine testing showed that the addition of etanercept helped inhibit the levels of cytokines–shortening the course of the disease and addressing the damage associated with cytokine storms. Testing was performed to detect which, if any, cytokines have the potential to predict the course of the disease. Upon analysis it was found that skin healing time was positively correlated with initial IL-15 level in both the steroid monotherapy and combination therapy groups. Furthermore, the investigators found acute stage duration and skin re-epithelization showed positive correlations with the initial IL-6 level in the combination therapy group. Thus, the researchers believed that IL-15 served as a biomarker for both therapies, while IL-6 was a biomarker for the group treated with the combination therapy, systemic steroids plus a TNF- a inhibitor. 

As limitations to the study, the investigators cited the limited sample size.

Data from this study led researchers to conclude that their study “confirmed the effectiveness of etanercept in combination with systemic steroids in SJS/TEN. Particularly, the additional etanercept could significantly shorten the clinical courses measured by acute duration and skin healing time.” They wrote that this strategy “provides a practical approach to reduce hospital stays and remedy the defects of systemic steroid monotherapy.


Ao S, Gao X, Zhan J, et al. Inhibition of tumor necrosis factor improves conventional steroid therapy for Stevens-Johnson syndrome/toxic epidermal necrolysis. J Am Acad Dermatol. Published online February 1, 2022. doi:10.1016/j.jaad.2022.01.039