Introduction 
Toxic epidermal necrolysis (TEN) is a rare and life-threatening skin disease characterized by extensive skin necrosis and detachment of the mucous membranes. The overwhelming majority of cases is caused by a drug reaction. Its estimated incidence is 0.4 to 1.2 cases per million-persons per year. TEN is considered a medical emergency and its mortality rate is 25-30 %. As of now there is no standardized therapy because both intravenous immunoglobulin (IVIG) and cyclosporine failed to demonstrate a reduction of the mortality rate. 
Materials and methods
Observing the important role of TNF alfa in the pathogenesis of TEN, we decided to treat our TEN-patients with etanercept, a soluble TNF alfa receptor, commonly used in rheumatic disease, psoriasis, and graft versus host disease. Since 2012 we collected thirty consecutive TEN-patients, aged 18 to 90 years. The clinical severity of the disease and the expected number of deaths were computed using the SCORTEN scale, while the time of healing (complete re-epithelialization) was analyzed with the Kaplan-Meier index. All patients received 50 mg of etanercept in a single subcutaneous injection. 
Results
All patients promptly responded to treatment, achieving complete re-epithelialization without complications or side effects. However, two patients died of other underlying causes.  The comparison between observed (2/30) vs. expected deaths (17/30) was statistically significant (p = 0.012). Median time to healing was 8.5 days. 
Conclusion
These results suggest that etanercept is an effective and safe therapy for TEN and that this drug could be proposed as first line of therapy in TEN-patients, since IVIG and cyclosporine, that are mostly administered, did not show the same outcome.

Use of etanercept in toxic epidermal necrolysis: a single center experience in a cohort of 30 patients