Eighteen cases of Staphylococcus aureus-induced toxic epidermal necrolysis were studied to determine if systemic steroids were of any value in therapy. Ten patients received nafcillin sodium and dicloxacillin sodium monohydrate alone and experienced a rapid, predictable recovery. Eight patients who received systemic steroids either as sole therapy or in combination with antibiotics experienced longer hospitalizations. In particular, patients treated with systemic steroids alone suffered a progression of their disease until systemic antibiotic therapy was instituted. On the basis of this clinical study and results from experimental models, we concluded that systemic steroids are of no help in S aureus toxic epidermal necrolysis and may, in fact, worsen the clinical picture.