Use of granulocyte colony-stimulating factor in the treatment of toxic epidermal necrolysis--experience with 3 patients.

The use of recombinant granulocyte colony-stimulating factor has recently been advocated in the treatment of toxic epidermal necrolysis as it may help in faster regeneration of detached skin. Three patients who presented with toxic epidermal necrolysis were managed as per the protocol followed at our department. In addition, they received recombinant granulocyte colony-stimulating factor in a dose of 300 microg/d (5 microg/ kg/d) for 5 days. Severity of Illness Score for Toxic Epidermal Necrolysis was calculated on day 1 and the lesions were observed for re-epithelialization. The 3 patients were aged 16 years, 20 years, and 65 years, with the latter showing leucopenia at presentation. All 3 patients showed a significant rise in total leukocyte count (reaching up to 45,000/mm3) after administering recombinant granulocyte colony-stimulating factor, with the rise being comparatively less in the third patient (maximum of 12,000/mm3). A similar pattern was seen in re-epithelialization of skin, with rapid re-epithelialization occurring in the first 2 patients and much slower re-epithelialization in the third. The first two survived but the third died from refractory sepsis. Recombinant granulocyte colony-stimulating factor improves epithelialization of skin and should be used for treating toxic epidermal necrolysis irrespective of the leucopenic status of the patient.