What is the role of IVIG in the treatment of Stevens-Johnson syndrome?

Updated: Jan 17, 2019
  • Author: C Stephen Foster, MD, FACS, FACR, FAAO, FARVO; Chief Editor: Andrew A Dahl, MD, FACS  more...
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The rationale for the use of IVIG is the most appealing. Based on in vitro and clinical data, IVIG can block the Fas receptors on the surface of the keratinocytes, thus interfering with the Fas-Fas ligand mediated apoptosis. [43] Encouraging results were reported when IVIG was used in high doses very early in the course of the disease and for a short period. Unfortunately, there is no consensus regarding either the dose or the duration of treatment with IVIG. [6]

Prophylactic use of IVIG has also been reported. One group used IVIG in a patient who underwent cardiac catheterization but who had 4 previous Stevens-Johnson syndrome episodes after intravenous contrast injection. [44]

However, a large European study designed to evaluate the efficacy of various treatments, the EuroSCAR Study, "found no sufficient evidence of a benefit for any specific treatment." [45] The group looked at mortality in patients treated with IVIG and corticosteroids. However, in a letter to the editor, Pehr disagreed with the findings in the EuroSCAR study citing inadequate doses of IVIG and corticosteroids in that study. [46]

Interestingly, few studies have addressed the effect of systemic steroids or IVIG on either the development or the outcome of ocular manifestations in Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN). Neither treatment appeared to influence the ocular outcome in patients in two reports. [47, 2]

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