Severe Cutaneous Adverse Reactions in Korean Pediatric Patients: A Study From the Korea SCAR Registry

Abstract

Purpose Although severe cutaneous adverse drug reactions (SCARs) are rare, they are associated with high morbidity and mortality, and thus early diagnosis and treatment are critical for improving prognoses. However, few studies have reported the characteristics of SCARs in children. Thus, we aimed to evaluate the clinical characteristics, current management and prognosis of pediatric SCARs. Methods We analyzed pediatric data in the Korean SCARs registry, which was built retrospectively in 2016 with SCAR cases treated in 34 tertiary referral university hospitals during 2010–2015. Using these cases, we descriptively analyzed detailed data regarding etiology, clinical and laboratory features, treatment strategies, and prognosis. Results Forty-seven pediatric SCAR cases from 15 tertiary referral hospitals were included. The median patient age was 10 (interquartile range, 3-15.5) years and 68.1% (n = 32) were males. The culprit drug was identified in 95.7% (n = 45) of the patients; antibiotics (44.7%) and antiepileptic drugs (19.1%) were the most common and second most common culprits, respectively. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) cases presented with the largest area of skin involvement without permanent sequelae. Stevens-Johnson syndrome (SJS) cases involved relatively small areas of skin but serious sequelae in two children. Of 4 patients with toxic epidermal necrolysis (TEN), 1 died. Of all patients assessed, 36 (76.6%) received systemic steroids and 21 (44.7%) received intravenous immunoglobulin (IVIG). Thirteen (27.7%) received both systemic steroids and IVIG. Cyclosporine was administered to only 1 patient along with a systemic steroid. Conclusions In patients with pediatric SCARs, including those with DRESS, SJS and TEN, clinical presentations were variable. Thus, there was no clear continuous disease spectrum. Although the mortality rate was low (2.1%), clinical suspicion may be the best tool for proactive SCAR management.

Severe Cutaneous Adverse Reactions to Drugs in Latin America: The RACGRAD Study

“…Although SCARs can be caused by a diverse group of drugs, in this study, the most frequent culprits were the aromatic anticonvulsants drugs. This is in contrast to what was found in otherstudiesthat evaluated SCARs when antibiotics were the predominant responsible drugs [21,22,24,25]. This could be due to the fact that there were a higher number of patients with DRESS-DiHSreported in the present study, in which the use of antiepileptic drugs was predominant.…”

“…Several pharmacogenomics studies carried out in the Asian and European population [29][30][31] Otherstudies have shown that bacterial infections were the second most common underlying condition that indicated the use of these antibiotics. This result is consistent with previous studies [21,24]. Allopurinol has been another medication frequently implicated in SCARs, [3,22]; however, in our study, it has been identified as a potential cause of SCARs in 6 patients (8.6%); 3 of them with TEN, 2 with DRESS or DIHS and one with AGEP.Fifty-three patients (75.7%) were exposed to only one suspected drug, 17 patients (24.2%) received two or more drugs, the additional drugs having a much lower risk of causing SCARs.…”

Drug Allergy in Children: What Should We Know?

“…However, some findings are consistent across all SCARs: a certain period must pass before SCARs become fullblown, and early drug withdrawal and supportive care with antiinflamma tory medication is the management of choice. 26,27) In our previous study based on the Korean SCARs registry, we analyzed 47 pediatric cases of DRESS, SJS, and TEN from 15 tertiary hospitals. 27) The latency period between drug exposure and symptoms was longest in DRESS patients (mean, 23.5 days) and shorter in SJS and TEN patients (mean, 4 and 6.5 days, res pectively).…”

“…26,27) In our previous study based on the Korean SCARs registry, we analyzed 47 pediatric cases of DRESS, SJS, and TEN from 15 tertiary hospitals. 27) The latency period between drug exposure and symptoms was longest in DRESS patients (mean, 23.5 days) and shorter in SJS and TEN patients (mean, 4 and 6.5 days, res pectively). Cutaneous lesion extent was largest in DRESS cases without mucosal involvement in most cases and without per manent sequelae in all cases.…”

“…The culprit drugs were commonly used, including antibiotics and antipyretics, or uncommon but chronically used drugs, including AEDs, which was comparable to other different pediatric SCAR research. 25,27)…”