Stevens‐Johnson syndrome and toxic epidermal necrolysis in children: a review of the experience with paediatric patients in a University Hospital

Abstract

The SJS/TEN complex is a true dermatological critical condition that also affects children. Any drug can be the causative agent, more frequently anticonvulsants and antibiotics. Depending on the extension of the affected body surface, patients should be rapidly admitted to a critical care area with experience in the care of burn patients. Discontinuation of the suspected offending drugs is mandatory. Optimal supportive care and management of denuded skin areas are still the mainstay of treatment. The use of specific therapies remains controversial. Compared with adults, the disease in children seems to be milder with lower mortality.

Zespół toksycznej nekrolizy naskórka

“…Forman and colleagues [16] demonstrated a correlation between SJS/TEN sulphonamides and both penicillins and cephalosporins. Similar results regarding children were reported by Spanish authors [14]. In their study, the most common causes of SJS/TEN were anticonvulsants (carbamazepine, lamotrigine, phenytoin), followed by antibiotics (penicillins, macrolides) and NSAIDs, except for oxicam.…”

“…Acute injuries to the skin and mucous membranes are accompanied by symptoms in other organs: conjunctival ulceration with purulent inflammation, painful inflammatory ulcerated lesions in the airway, gastrointestinal tract and sexual organs that manifest as bleeding and evidence of infection [14].…”

“…According to Ferrandiz-Pulido [14,20], late complications occur in approximately 29% of cases and include skin discolouration, nail deformities, chronic ulcerations of the oral cavity and sexual organs, lingual papilla atrophy, photophobia, dry conjunctivitis, conjunctival adhesions, impaired growth of lashes, and blindness. Finkelstein [15] assessed the incidence of late complications at 47%.…”

“…Similar mortality rates in the paediatric population were observed in studies based on case series. According to Spies and colleagues [13] and Ferrandiz-Pulido and colleagues (14), the mortality was 7%; Finkelstein and co-workers [15] found it to be even lower, i.e., 2%.…”

Lyell – szindróma gyermekkorban

“…A legtöbb adat az intravénás kortikoszteroid és IVIG alkalmazását illetôen áll rendelkezésre, egyes eset riportokban a kombinált szteroid + IVIG kezelésrôl szá-molnak be. Az IVIG hatékonyságára vonatkozó adatok is ellentmondóak (2,27,28). A pro-és retrospektív vizsgálatok, eset riportok eredményei nehezen vethetôek össze, hiszen jelentôs különbségeket találunk az immunglobulin készítmény típusát, dózisát és a kezelés idôtar-tamát illetôen is.…”