Abstract: A 48-year-old male presented with severe toxic epidermal necrolysis(TEN) induced by spray paint exposure. The patient was critically ill and had an exfoliated area of 35% at admission. Treatment with glucocorticoids, tumor necrosis factor α inhibitors and high-dose immunoglobulin failed, and the exfoliated area increased to 76%, with septic shock, electrolyte disorder, oxygen saturation drop, high fever. On the 8th day of admission, glucocorticoid shock therapy was administered, methylprednisolone 600 mg on the first day, followed by 400 mg for 4 days and 200 mg for 1 day. On the 17th day of admission, the epidermis of the patient was completely regenerated and the condition continued to improve, the glucocorticoid was gradually reduced, and the skin mucosa returned to normal. After 22 days of hospitalization, the patient recovered and was discharged from the hospital. After 2 weeks of discharge, the glucocorticoid was stopped and there was no recurrence during the follow-up of 2 years.

Key words: toxic epidermal necrolysis, glucocorticoid, pulse therapy