A patient presents with TEN covering 65% BSA. SCORTEN calculated on day 1 gives a score of 5. Which single intervention has been shown in a large retrospective study to significantly reduce mortality in TEN?
- A Cyclosporine 3–5 mg/kg/day ✓
- B High-dose systemic corticosteroids (methylprednisolone 2 mg/kg/day)
- C Intravenous immunoglobulin (IVIg) 3 g/kg over 3 days
- D Etanercept 50 mg subcutaneous single dose
Correct answer: A. Cyclosporine 3–5 mg/kg/day
Explanation
Multiple retrospective cohort studies, particularly the French EuroSCAR and subsequent analyses, demonstrate that cyclosporine significantly reduces mortality in TEN by inhibiting cytotoxic T lymphocyte activity and FasL-mediated keratinocyte apoptosis. IVIg showed variable results in trials. Corticosteroids are controversial and associated with increased infection risk in TEN. Etanercept (anti-TNF) shows promise in small trials but is not first-line. Cyclosporine is now the preferred immunomodulatory treatment by many TEN experts.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.