A 34-year-old woman on phenytoin for epilepsy develops widespread painful erythema with 40% skin detachment, positive Nikolsky sign, and erosions involving oral, conjunctival, and genital mucosae. The SCORTEN score is calculated at 3. Which single intervention has the strongest evidence for improving mortality in this patient?

• A High-dose intravenous corticosteroids (dexamethasone 1.5 mg/kg)
• B Intravenous immunoglobulin (IVIG) 2–3 g/kg over 3–5 days
• C Transfer to a specialist burn unit with aggressive supportive care ✓
• D Immediate cyclosporine 3–5 mg/kg/day

Explanation

Toxic Epidermal Necrolysis (TEN) carries a mortality predicted by SCORTEN; the single intervention with the most robust evidence for reducing mortality is early transfer to a specialised burn unit offering optimal wound care, thermoregulation, fluid management, nutritional support, and ophthalmological monitoring. IVIG, cyclosporine, and steroids are debated adjuncts with inconsistent trial evidence. Corticosteroids may actually increase infection risk if used alone without burn-unit support.

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.