Alcoholic hepatitis (AH) is observed in approximately 20% of heavy drinkers. The treatment of AH remains one of the main challenges to clinicians involved in the management of severe alcoholic liver disease. Corticosteroids improved the short-term survival of patients with severe AH. Nevertheless, the efficacy of corticosteroids is still considered controversial for some authors. Pentoxifylline may be considered an alternative to corticosteroids. Early identification of subjects with substantial risk of death according to the Lille model will improve management of patients suffering from severe AH and will aid in the design of future studies for alternative therapies. Alternative therapies are required to improve the prognosis of patients with a severe form of AH. Progress in understanding the pathogenesis of AH is opening up an exciting new era and is lending impetus to future evaluation of new drugs targeting the tumor necrosis factor pathways.