The case for etanercept in the management of toxic epidermal necrolysis

Toxic epidermal necrolysis (TEN) is a dermatological emergency with devastating morbidity and mortality rates. It is most often caused by medications. Management guidelines have focused on conservative measures, partly due to a previous lack of large randomized controlled trials evaluating systemic agents, and because experts have differing views on initiating active medical management. Tumour necrosis factor alpha (TNF-α) is a cytokine that is involved in immune defence against various infectious agents by exerting a powerful anti-inflammatory effect. Inhibition of TNF-α is well established in the management of noninfectious inflammatory (including dermatological) conditions. Patients with TEN have prominent expression of TNF-α in keratinocytes and macrophages in affected skin as well as in blister fluid. This review article aims to summarize the recent and emerging evidence for using anti-TNF-α treatment, particularly etanercept, in the management of TEN.