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Published on: September 11, 2018

Severe cutaneous reactions caused by barbiturates in seven Iranian children

Setareh Mamishi1, Fatemeh Fattahi, Zahra Pourpak

  • 1Department of Infectious Diseases, Immunology, Asthma and Allergy Research Institute, Children Medical Center, Medical Sciences/University of Tehran, Tehran, Iran.

International Journal of Dermatology
|January 13, 2010
PubMed

Insights

Barbiturates can cause severe skin reactions like Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in children. Early detection and supportive care are crucial for survival in these rare but serious adverse drug reactions.

Area of Science:

  • Pediatric Dermatology
  • Pharmacovigilance
  • Adverse Drug Reactions

Background:

  • Severe adverse cutaneous reactions, including erythema multiforme (EM), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN), are rare but serious conditions.
  • Antiepileptic drugs, particularly carbamazepine, lamotrigine, barbiturates (phenobarbital, phenytoin), are common culprits.
  • This study focuses on seven pediatric cases of severe cutaneous reactions attributed to barbiturates.

Observation:

  • Seven children aged 2-11 years presented with symptoms 1-3 weeks after initiating barbiturate therapy.
  • Symptoms included a prodrome of malaise, fever, cough, and anorexia, followed by evolving skin lesions (rash to bullae) and mucosal involvement.
  • Barbiturate treatment was immediately discontinued, and patients received supportive care.

Findings:

  • All seven pediatric patients experienced severe cutaneous adverse reactions linked to barbiturate use.
  • The clinical presentation involved characteristic mucocutaneous lesions and a prodromal phase.
  • Prompt cessation of the offending drug and supportive management led to positive patient outcomes.

Implications:

  • Physicians must consider barbiturate-induced severe cutaneous reactions in the differential diagnosis of mucocutaneous lesions.
  • Early recognition and intervention are vital for improving survival rates in SJS/TEN.
  • The presented cases highlight the effectiveness of immediate drug withdrawal and supportive care in managing these life-threatening conditions in children.
Abstract

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