Pediatric Toxic Epidermal Necrolysis: Experience of a Tertiary Burn Center

Rizzo, Julie A; Johnson, Rebekah J.; Cartie, Richard

doi:10.1111/pde.12657

Cited by 11 publications

(16 citation statements)

References 16 publications

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“…Small case series and anecdotal uncontrolled and unpublished series suggest that systemic immunosuppression (including IVIg) may reduce long-term keratopathy and subconjunctival fibrosis, although further research is required. 47,[55][56][57] However, IVIg can have adverse effects, particularly renal impairment, 1,58 and in one paediatric series, higher rates of ophthalmic complications were seen in children given IVIg compared with those who were not. 9 7.6 What are chronic complications of Stevens-Johnson syndrome/toxic epidermal necrolysis and can these be prevented?…”

Section: Ivigmentioning

confidence: 99%

British Association of Dermatologists' guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis in children and young people, 2018

et al. 2019

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Section: Ivigmentioning

confidence: 99%

British Association of Dermatologists' guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis in children and young people, 2018

et al. 2019

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“…Early diagnosis, immediate withdrawal of the offending agent, appropriate supportive care, and a multidisciplinary approach improves outcomes 11,14,16,20 . The commonly used immunomodulatory therapies in TEN include systemic corticosteroids and intravenous immunoglobulin (IVIG).…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6] The mortality in adults is high (25-35%) compared to that in children (3-16%) due to associated comorbidities, sepsis, or multi-organ failure. 2,3,[7][8][9][10][11][12] TEN is a multisystem disease with significant morbidity and mortality and warrants prompt admission and management in an intensive care unit (ICU). 13 The intensive care needs in the acute phase of illness include airway management, hemodynamic stabilization, temperature regulation, fluid and electrolyte homeostasis, nutrition, analgesia, care of skin and mucosal surfaces, asepsis, and prevention of long-term complications.…”

Section: Introductionmentioning

confidence: 99%

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Intensive care needs and long‐term outcome of pediatric toxic epidermal necrolysis – A 10‐year experience

et al. 2020

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Background Toxic epidermal necrolysis (TEN) is a life-threatening severe cutaneous adverse reaction. Data on pediatric TEN is limited. Methods Case records of 44 children, 1 month-12 years with a diagnosis of TEN (>30% body surface area [%BSA] detachment) admitted to a tertiary pediatric intensive care unit (PICU) between 2009 and 2018 were analyzed retrospectively. The primary outcome was mortality, and secondary outcomes were organ dysfunction, length of stay (LOS), and longterm sequelae. Results Median (IQR) age was 6.5 (3.6, 8.0) years, and 25 (57%) were boys. Median (IQR) %BSA involved, SCORTEN score, and PRISM-III were 65% (45, 80); 2 (2, 3) and 13 (10, 16), respectively. Antiepileptics (n = 24, 54.6%) and antimicrobials (n = 8, 18.2%) were the most common offending agents. Twenty-four (54.5%) children had culture positive sepsis. Immunomodulatory therapy was provided in 35 (79.5%) and conservative management in nine (20.5%) children. Intravenous immunoglobulin (IVIG) was given in 22 (50%), steroids in three (6.8%), and both IVIG and steroids in 10 (22.7%) children. Respiratory failure (n = 14, 31.8%) was the commonest organ failure. Mortality was 15.9% (n = 7), and median (IQR) PICU-LOS in survivors was 8 (4, 11.75) days. There was no association between IVIG, steroids, or conservative management with mortality or LOS. Ocular sequelae (n = 20, 54.1%) were the most common long-term complication followed by skin (18, 40.1%). Conclusion Immunomodulation with IVIG or steroids was not associated with any mortality benefit as compared to conservative management alone. Further research is required to determine the most effective treatment in pediatric TEN.

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“…Toxic epidermal necrolysis (TEN) is a rare, life-threatening condition characterized by extensive skin and mucosal involvement. A lower incidence of 0.5 cases per million person-years is estimated in the pediatric population, when compared to adults [1]. Although the exact etiology remains unclear, medication reactions have been implicated as causative [2].…”

Section: Introductionmentioning

confidence: 99%

Long Term Hypopharyngeal Dysfunction in a Pediatric Patient after Toxic Epidermal Necrolysis: A Case Report and Literature Review

Reckley¹,

Tolisano²,

Cable³

2016

J Clin Case Rep

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We report the case of an 8-year-old male who experienced failure to thrive and dysphagia following idiopathic Toxic Epidermal Necrolysis (TEN). Despite a normal barium esophagram preoperatively, a significant degree of hypopharyngeal scarring was noted during direct laryngoscopy and bronchoscopy one year after initial presentation. Hypopharyngeal dysfunction following TEN has been reported in adults. However, there are no cases in the published literature examining this phenomenon in a pediatric patient. The purpose of this report is to highlight the potentially significant aerodigestive tract abnormalities following TEN in a pediatric patient, and to advocate for early direct laryngoscopy in children with mild symptoms. Additionally, this case demonstrates the need for a multidisciplinary approach to TEN in order to minimize morbidity.

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Pediatric Toxic Epidermal Necrolysis: Experience of a Tertiary Burn Center

Abstract: Our experience in treating this rare but devastating disease affords us the opportunity to share the diagnostic dilemmas we faced and the treatment principles we used to treat this unique patient population successfully.

Cited by 11 publications

References 16 publications

British Association of Dermatologists' guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis in children and young people, 2018

British Association of Dermatologists' guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis in children and young people, 2018

Intensive care needs and long‐term outcome of pediatric toxic epidermal necrolysis – A 10‐year experience

Long Term Hypopharyngeal Dysfunction in a Pediatric Patient after Toxic Epidermal Necrolysis: A Case Report and Literature Review

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