A review of causes of Stevens–Johnson syndrome and toxic epidermal necrolysis in children

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare life-threatening conditions almost exclusively attributed to drugs. The incidence in children is lower than in adults and has a better outcome. Mycosplama pneumoniae infection may be involved in some cases of paediatric SJS. The main etiologic factors for both SSJ and TEN are sulphonamides and anticonvulsants, followed by penicillins and non-steroidal anti-inflammatory drugs. In rare instances, paracetamol is the only suspected drug. By contrast with adults, allopurinol, oxicams and nevirapine are not identified as causative agents in children, probably due to differences in drug prescriptions. The only aspects of treatment that have been proved to improve survival are the rapid withdrawal of the suspected offending drugs and an optimal supportive therapy with emphasis in nutritional support, accompanied by management of denuded skin areas. The use of specific therapies remains controversial.

Markers of innate and adaptive immunity in the skin and peripheral blood of patients with erythema migrans as an early manifestation of Lyme disease

“…При изуче-нии цитокинового профиля у больных МЭ в сыво-ротке крови исходно наблюдалось значительное по-вышение уровня провоспалительных цитокинов IL1b, IL-2 и IL-4, их средние значения составили (19,6±1,9 и 37,2±2,7 пг/мл) на фоне повышения 10,6±2,1 11 (10,4; 11,3) 9,3±1,6* 9,2 (9; 10,2) 11,2±2,4* 11 (11; 11,7) 2-я подгруппа (очаги более 30 дней) 6 5,8±1,6* # 5,4 (4,9) 6,8±2,5 6,6 (6,(2)(3)(4)(5)(6)(7)3) 4,2±1,5 3,9 (3,6) 8,3±1,7 8,3 (8,(1)(2)(3)(4)(5)(6)(7)(8)7) 16,4±2,5* 16,4 (15,(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)5) 21±4,6* 20,9 (18,(6)(7)(8)(9)(10)(11)…”

“…Развитие МЭ при ЛБ как стадии локальной инфекции, вы-званной Borrelia burgdorferi, происходит на фоне не-достаточности клеточных и/или гуморальных фак-торов неспецифической резистентности организма, что определяет направленность патогенетической терапии ранней стадии ЛБ [1,3,7,12]. В последние десятилетия отмечается рост частоты тяжелых, хро-нических, торпидных форм ЛБ, склонных к рециди-вированию [6,7,14,26]. Несмотря на мощную анти-биотикотерапию МЭ с длительным курсом и отно-сительно большими разовыми дозами формирова-ние хронических форм инфекции наступает у 3,5-30% больных [5,15,25].…”

Evaluation of the patients diagnosed with Stevens Johnson syndrome and toxic epidermal necrolysis: a single center experience

“…Inflammatory changes including purulent conjunctivitis, erosion, ulcer and crusts may be observed in the eye, mouth, nose, pharynx, esophagus, trachea, gastrointestinal tract, urinary tract and genital mucosae (1,2,8). Life-threatening bleeding and infections may be observed as a result of these changes (8). The rates of severe complications or sequelae secondary to Stevens-Johnson syndrome and TEN are higher in patients with mucosal and opthalmic involvement (2).…”

“…The second period during which epidermal separation occurs and vesciles and bullae are formed follows the early stage of the disease which is characterized by red-purple maculopapular eruptions (1). Inflammatory changes including purulent conjunctivitis, erosion, ulcer and crusts may be observed in the eye, mouth, nose, pharynx, esophagus, trachea, gastrointestinal tract, urinary tract and genital mucosae (1,2,8). Life-threatening bleeding and infections may be observed as a result of these changes (8).…”

Study of Stevens - Johnson syndrome

“…Stevens-Johnson syndrome is also reported in India secically in HIV patients. Phenytoin-induced risk is also identified in Japanese and Euporeans who carries HLA-A301 allele [27][28][29][30][31][32][33][34][35][36].…”