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[Severe cutaneous drug reactions in children]
1Dokumentationszentrum schwerer Hautreaktionen (dZh), Universitätsklinik für Dermatologie und Venerologie, Hauptstr. 7, 79104, Freiburg, Deutschland. dzh@uniklinik-freiburg.de.
Summary
Drug reactions in children, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), require distinct management from DRESS (drug reaction with eosinophilia and systemic symptoms). Identifying the causative drug is crucial for effective treatment, with different therapies for SJS/TEN and DRESS.
Area of Science:
- Pediatric Dermatology
- Clinical Pharmacology
- Immunology
Background:
- Severe cutaneous adverse drug reactions (SCARs) in children encompass Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and DRESS (drug reaction with eosinophilia and systemic symptoms).
- SJS/TEN represent a spectrum of severity, while DRESS is characterized by multiorgan involvement and must be differentiated from SJS/TEN and other severe exanthems.
- While SJS/TEN are often drug-induced (75% overall, 50% in children), DRESS is also frequently linked to medications.
Purpose of the Study:
- To differentiate between SJS/TEN and DRESS in pediatric patients.
- To highlight the importance of accurate diagnosis for appropriate therapeutic strategies.
- To identify common causative agents and outline treatment approaches for these severe drug reactions in children.
Main Methods:
- Review of clinical presentations and diagnostic criteria for SJS/TEN and DRESS in pediatric populations.
- Analysis of medication histories to identify potential inducing agents.
- Comparison of therapeutic interventions for SJS/TEN and DRESS.
Main Results:
- Antibacterial sulfonamides and antiepileptics are frequently implicated in SJS/TEN and DRESS in children.
- Minocycline is another common trigger for DRESS in this age group.
- Allopurinol is a rare cause of SJS/TEN and DRESS in children compared to adults.
Conclusions:
- Accurate differentiation between SJS/TEN and DRESS is essential for guiding treatment in pediatric patients.
- Withdrawal of the offending drug is a critical first step in managing both conditions.
- Supportive care with topical treatments and pain management is standard for SJS/TEN, with promising results for cyclosporine A. DRESS management involves systemic glucocorticosteroids with gradual tapering.