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Correspondence |

The Management of Severe Ocular Complications of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis—Reply

Julie Gueudry, MD; Michel Binaghi, MD; Marc Muraine, MD, PhD
Arch Dermatol. 2009;145(11):1337-1338. doi:10.1001/archdermatol.2009.294.
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We appreciate the interest and comments of Sotozono et al regarding our article on the severity and management of ocular complications of SJS and TEN.1 Both conditions are recognized as 2 of the most devastating ocular surface diseases, and there is no standardized ophthalmologic treatment for the prevention of ocular complications.

Because accumulated clinical and experimental data suggest that the mechanisms of SJS and TEN depend on a medication-specific immune response, corticosteroids and immunosuppressive drugs are used by many physicians. However, these drugs are of unproven benefit at the acute stage, and their use remains highly controversial.2,3 Furthermore, results of retrospective analyses performed in several burn departments in the United States suggest that the prolonged use of high doses of systemic corticosteroids is associated with increased mortality.4 That is why we noted in our discussion1 that current management strategies based on the use of systemic and local corticosteroids seem unable to prevent late ocular complications, even though our study did not assess corticosteroid efficacy.

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November 1, 2009
Chie Sotozono, MD, PhD; Mayumi Ueta, MD, PhD; Shigeru Kinoshita, MD, PhD
Arch Dermatol. 2009;145(11):1336-1337. doi:10.1001/archdermatol.2009.293.
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