Epidermal Necrolysis: 60 Years of Errors and Advances

Y.K. Heng; H.Y. Lee; J.-C. Roujeau


The British Journal of Dermatology. 2015;173(5):1250-1254. 

In This Article

How Shall we Progress?

The low incidence of this disease makes organizing a RCT challenging as an estimated recruitment of more than 300 unselected cases would be required to achieve sufficient statistical power. The numbers might be lowered by using stringent recruitment criteria (e.g. exclusion criteria related to associated chronic disease or age group) but inclusion would become more difficult. An alternative, albeit less rigorous approach would be to evaluate the effectiveness of treatment by using SCORTEN as an internal control and comparing the observed death vs. that predicted by the SCORTEN (SCORTEN is a validated severity-of-illness score based on seven independent risk factors: age, active malignancy, heart rate, serum urea, BSA detached, serum bicarbonate and serum glucose).[34] With newer treatments reported, a continued vigilance towards new biases needs to be maintained to avoid repeating the errors of the IVIG story. With improvement in care and management of SJS/TEN, SCORTEN may overestimate the risk of death.