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Byline: Vinod. Sharma, Gomathy. Sethuraman
We thank Dr. Pasricha for his interest in our paper and his comments about the use of steroids in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). It is apparent from the title that our paper was focused mainly on the etiological agents and outcome of SJS and TEN.[sup]  The role of steroids in the treatment of SJS-TEN generates a lot of discussion and the recommendation has recently been published in the IADVL therapeutic guidelines.[sup]  In our report we have used systemic steroids in all except one.[sup] 
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe adverse cutaneous drug reactions characterized by massive keratinocyte apoptosis. It has been shown that the apoptosis is mediated by the drug specific cytotoxic T cells through the activation of the Fas receptor by increased Fas ligand expression, via the perforin / granzyme pathway. Several cytokines produced by the T cells, macrophages,and keratinocytes, upregulate the adhesion molecules and enhance the expression of Fas and FasL on keratinocytes.[sup] , Hence there are enough reasons to start immunosuppressive therapy such as steroids in the early evolving stage of the disease. The exact mode of action of steroids in SJS/TEN is not known. But they have a plethora of …