acetylcysteine, ulinastatin, infliximab, and granulocyte colony-stimulating factors (if TEN associated-leukopenia exists). There is mixed evidence for use of corticosteroids and scant evidence for the other therapies. A meta-analysis from 2002 concluded that there is no reliable evidence for the treatment of TEN. Thalidomide did not show any benefit and was associated with increased mortality compared with placebo. Prognosis The mortality for toxic epidermal necrolysis is 25–30%. People with SJS or TEN caused by a medication have a better prognosis the earlier the causative medication is withdrawn. Loss of the skin leaves patients vulnerable to infections from fungi and bacteria, and can result in sepsis, the leading cause of death in the disease. Death is caused either by infection or by respiratory distress which is either due to pneumonia or damage to the linings of the airway. Microscopic analysis of tissue (especially the degree of dermal mononuclear inflammation and the degree of inflammation in general) can play a role in determining the prognosis of individual cases. Severity score The "Severity of Illness Score for Toxic Epidermal Necrolysis" (SCORTEN) is a scoring system developed to assess the severity of TEN and predict mortality in patients with acute TEN. One point is given for each of the following factors: age >40 heart rate >120 beats/minute carrying diagnosis of cancer separation of epidermis on more than ten percent of body surface area (BSA) on day 1. Blood Urea Nitrogen >28 mg/dL Glucose >252 mg/dL (14 mmol/L) Bicarbonate <20mEq/L Score 0–1: 3.2% mortality 2: 12.2% mortality 3: 35.3% mortality 4: 58.3% mortality ≥5: 90% mortality Of note, this scoring system is most valuable when used on the first and third day of hospitalization, and it may underestimate mortality in patients with respiratory symptoms. References External links DermNetNZ Drug eruptions Medical emergencies Wikipedia medicine articles ready to translate Wikipedia emergency medicine articles ready to translate