Clinical features and outcomes in children with Stevens-Johnson syndrome and toxic epidermal necrolysis.

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening cutaneous conditions. However, studies of pediatric SJS/TEN are limited. To investigate the causes, clinical course, outcomes and complications of SJS and TEN in children. This retrospective study included 47 pediatric patients (aged < 18 years) with SJS, SJS/TEN, or TEN treated at Chang Gung Memorial Hospital, Taiwan, between January 2009 and December 2019. ALDEN scores and serological tests were used to assess causes and SCORTEN scores were applied to evaluate disease severity. Forty-seven patients, including 30 with SJS, 6 with SJS/TEN, and 11 with TEN were included. Median age was 8 years (range 1-17 years); 51.1% were male. Thirty-three cases (70.2%) were caused by drugs and infectious pathogens were suspected in 14 cases (29.8%). Oxcarbazepine (5/47, 10.6%) and amoxicillin (5/47, 10.6%) were the most often-implicated drugs, and Mycoplasma infection (9/47, 19.1%) was the predominant infectious cause. Only one TENS patient died (mortality rate 1/47, 2.1%) due to septic shock with ARDS, acute renal failure and cardiopulmonary shock. Median hospital stay was 15.5 (3-42) days. Pulmonary involvement (2/39, 5.1%), including pneumonia and ARDS, was noted in acute stage. Long-term sequelae were ocular involvement (6/39, 15.4%), nail dystrophy (4/39, 10.3%) and post-inflammatory hypo-/hyperpigmentation (3/39, 7.7%). In the present study, pediatric patients with SJS, SJS/TEN, or TEN have good outcomes with few long-term complications and low mortality. Mycoplasma is the most common infectious cause in pediatric SJS/TEN. Ocular discomfort, nail dystrophy and skin dyschromia are common long-term sequelae requiring regular follow-up.

• Authors: Min-Hui Chi, Wen-Hung Chung, Rosaline Chung-Yee Hui, Chun-Bing Chen, Chun-Wei Lu, Tsu-Man Chiu, David Hui-Kang Ma, Chuang-Wei Wang, Chin-Yi Yang, Taiwan Severe Cutaneous Adverse Reaction Consortium
• Journal: The Journal of dermatology (J Dermatol) Vol. 49 Issue 9 Pg. 895-902 (Sep 2022) ISSN: 1346-8138 [Electronic] England
• PMID: 35715971 (Publication Type: Journal Article)
• Copyright: © 2022 Japanese Dermatological Association.

Topics

• Adolescent
• Child
• Child, Preschool
• Female
• Humans
• Infant
• Length of Stay
• Male
• Respiratory Distress Syndrome
• Retrospective Studies
• Severity of Illness Index
• Stevens-Johnson Syndrome (complications, diagnosis, therapy)