The most controversial area is the use of steroids. In general, these are condemned by both ICU and burn specialists involved in the treatment of patients with SJS/TEN. Sometimes, though, they are touted by dermatologists and I think they are really treating a different group of patients. There is a big series reported of patients with very short duration of symptoms and limited skin involvement in whom the early use of low dose steroids produced a shorter period of convalescence and a better recovery. But this was in selected adult patients with limited surface area involvement.
IVIG has been used and reported in a series from Texas Children's Hospital. They used 0.5-1 gm/kg/day for 3 days and appeared to have improved their patients, shortening the time of shedding of their skin and the time to reepithelialization. Cyclosporine is an immunosuppressive agent which has been used because of the belief that this is an immune mediated disease; however it takes up to 30 days to be effective and this is usually longer than the time course of this illness. Plasmapheresis has been used with anecdotal support. Thalidomide, nowadays used only in the treatment of leprosy, has anti-tumor necrosis factor (TNF) properties and is occasionally used. Infliximab, a chimeric monoclonal antibody against TNF used in inflammatory bowel disease, has been tried with severe cases in adults. GCSF has also been used anecdotally as well.
I'll present a quick case of a 3-year-old (shown in the picture) and you'll see the difficulty in trying to determine the etiologic agent. This is a child who started with a UTI and fever and was placed on Bactrim by her pediatrician.