Stevens-Johnson syndrome and toxic epidermal necrolysis in Asian children

Koh, Mark Jean‐Aan; Tay, Yong–Kwang

doi:10.1016/j.jaad.2009.06.085

Cited by 53 publications

(48 citation statements)

References 35 publications

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“…Most studies in children describing aetiological factors are single case reports, although there are a few series reported (table 1). 9 24 26 27 29 – 31…”

Section: Aetiologymentioning

confidence: 99%

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

2013

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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.

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“…Most studies in children describing aetiological factors are single case reports, although there are a few series reported (table 1). 9 24 26 27 29 – 31…”

Section: Aetiologymentioning

confidence: 99%

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

2013

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“…These findings seem consistent with the other case series reviewed. [15][16][17][18][19] In a review conducted at a large pediatric hospital in Spain where there were eight SJS and six TEN cases, they found antiepileptic drugs to be the most common causative agent (50%), followed by antibiotics (36%) and nonsteroidal antiinflammatory drugs (21%). 18 Overall, in our study, it appeared that antiepileptics were implicated as the causative agent in the more severely affected patients (ie, those with greater TBSA affected).…”

Section: Causative Agentsmentioning

confidence: 99%

“…First, systemic corticosteroids may cause more harm than good and the complications such as sepsis and gastrointestinal issues might outweigh the benefits. 16 However, high-dose systemic steroids (dexamethasone therapy) might prevent widespread skin loss when used 21,[40][41][42][43][44] Theoretically, the rationale for the use of IVIG is based on its ability to block programmed cell death (stop the interaction between Fas-L and Fas [CD95]) because of the fact that it contains the receptor ligandblocking antibody. 45 A recent review on the topic conducted by Wootton et al 44 was inconclusive; as no randomized controlled trial exists, which examines their use.…”

Section: Treatmentmentioning

confidence: 99%

“…[11][12][13] There have been a number of small case series that have been published in the pediatric population, and the mortality of SJS/TEN is much lower in children compared with adults. [14][15][16][17][18][19] Although mortality is low in the pediatric population, patients may have longterm complications that persist even after the acute skin issues resolve. For example, the acute inflammation and necrosis of conjunctiva can persist as corneal scarring and decreased visual acuity.…”

mentioning

confidence: 99%

“…Our hospital is a tertiary care pediatric unit with a large catchment area of >1.2 million 20 and four recent cases over the last 2 years prompted the review of previous cases to develop a rationale for future treatment. Review of the literature only revealed five pediatric case series, [15][16][17][18][19] supporting the need for the publication of a greater number of case series that focus on severe cases of SJS/TEN in the pediatric population. The objective of the present study was to retrospectively review the etiologic agents, treatments, mortality predictors, nutritional requirements, complications, and outcomes in patients diagnosed with SJS/TEN and admitted to the Pediatric Intensive Care Unit (PICU), in a large tertiary pediatric hospital.…”

mentioning

confidence: 99%

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Pediatric Toxic Epidermal Necrolysis

Hamilton

Fish

2013

Journal of Burn Care & Research

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Stevens Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare debilitating mucocutaneuous diseases most commonly associated with severe drug reactions. A review of SJS/TEN cases was undertaken to describe the etiology, patient characteristics, treatment, and outcome in children affected at a large tertiary pediatric hospital. A retrospective chart review examined SJS/TEN cases admitted to a pediatric intensive care unit (PICU) between 2001 and 2011. Data concerning total body surface area (TBSA) involvement, causative agents, length of stay, and treatment were reviewed. PICU mortality predictors including Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN), Pediatric Index of Mortality 2 scores, and Pediatric Logistic Organ Dysfunction scores were also reviewed. Nutritional feeding information was collected and compared with calculated and measured (calorimetry) requirements. There were 10 SJS/TEN pediatric patients (mean age = 6.6 years) with significant skin involvement (mean TBSA = 42.2%) requiring PICU admission. Prescription drugs were the most common causative factor (n = 7). Intravenous immunoglobulin and corticosteroids were used for treatment in eight and two of the cases, respectively. The mean length of stay in the PICU was 10.2 days. There were no mortalities, and all mortality scores predicted high likelihood of survival. Actual feeds (n = 9) were uniformly lower than the calculated feeding requirements (mean = 1059 kcal/day vs mean = 2027 kcal/day). This data will help to provide insight into the management of SJS/TEN in an intensive care setting, and will help form the best treatment approach for future cases in a pediatric population.

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