Research on use of IVIG published in leading dermatology journal

Intravenous immunoglobulin (IVIG) could benefit people with the most severe form of drug reaction in the skin but proper studies need to be carried out to show that it does so, according to research led by Professor Hywel Williams that has been published by the leading Archives of Dermatology.

Toxic epidermal necrolysis is the most severe form of drug reaction in the skin resulting in widespread death of the outermost layers of the skin – very much like an extensive burn. Around 30% of people die when such “skin failure” occurs – mainly from infections or loss of fluid and heat.

At the moment, there is still uncertainty over how best to treat the condition apart from withdrawing the offending drug as soon as possible, and making sure the patient has the best possible supportive care. All sorts of drugs have been tried to limit the impact of the skin reaction, but some may cause more harm than good. One drug that has become very fashionable in recent years is intravenous immunoglobulin, or IVIG.

The researchers wanted to see what the evidence for intravenous immunoglobulin was by undertaking a “critically appraised topic” or CAT. They searched for all relevant scientific articles, and just as they suspected, not a shred of good quality evidence could be found to support the use of IVIG in this condition. Although there were some studies, they were prone to all sorts of biases such as lack of a control group of patients not treated by IVIG.

The bottom line is that IVIG could benefit people with toxic epidermal necrolysis, but proper studies (randomized controlled trials) need to be done to show that it does so, especially as IVIG itself might have side effects such as increased infection. Until such a study is done, the Nottingham study recommends concentrating efforts on intensive supportive care as might be offered on a burns unit.

Reference:
ARCHIVES OF DERMATOLOGY -CHICAGO- VOL 147; NUMB 12 (2011) pp.1437-1437 In a Patient With Toxic Epidermal Necrolysis, Does Intravenous Immunoglobulin Improve Survival Compared With Supportive Care? Wootton, C.I.; Patel, A.N.; Williams, H.C. doi:10.1001/archdermatol.2011.300