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Antiepileptic Medication-induced Severe Cutaneous Adverse Reactions in Hospitalized Children: A Retrospective Study
Bahareh Abtahi-Naeini1, Reza Makhmali2, Niloufar Amini3
1Division of Pediatric Dermatology, Department of Pediatrics, Imam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran AND Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. abtahi.baharah@yahoo.com.
Insights
Severe cutaneous adverse reactions (SCARs) in children are linked to antiepileptic drugs. Phenobarbital was the most common cause, with hypersensitivity syndrome being most frequent. Risk factors like lymphadenopathy and sex influenced specific SCAR types.
Area of Science:
- Pediatric Pharmacology
- Dermatology
- Clinical Toxicology
Background:
- Limited data exists on severe cutaneous adverse reactions (SCARs) from antiepileptic drugs in children.
- Antiepileptic medications are frequently prescribed, necessitating understanding of their adverse effects.
Purpose of the Study:
- To investigate the clinical and epidemiological characteristics of antiepileptic medication-induced SCARs in hospitalized children.
- To identify common antiepileptic drugs causing SCARs and associated risk factors.
Main Methods:
- A five-year retrospective study at Isfahan University of Medical Sciences, Iran.
- Included children with SCARs (hypersensitivity syndrome, DRESS, SJS/TEN) due to antiepileptic drugs.
- Data analyzed using multinomial logistic regression.
Main Results:
- Phenobarbital was the most frequent antiepileptic drug implicated in SCARs.
- Hypersensitivity syndrome (76.83%) was more common than DRESS (16.22%) and SJS/TEN (6.95%).
- Lymphadenopathy increased DRESS risk 35-fold; girls had 6x higher SJS/TEN risk. Age, weight, and mucosal involvement impacted hospitalization.
Conclusions:
- Clinical and epidemiological features of antiepileptic drug-induced SCARs in Iranian children show variations.
- Understanding these characteristics is crucial for early diagnosis and management of SCARs in pediatric populations.
Background:
There are limited data on severe cutaneous adverse reactions (SCARs) associated with antiepileptic medications. The current study aims to investigate the clinical and epidemiological characteristics of antiepileptic medication-induced SCARs in hospitalized children.
Materials And Methods:
The current five-year retrospective study was conducted at Isfahan University of Medical Sciences, Iran. This study included all children with a definite diagnosis of SCARs secondary to the use of antiepileptic medications based on the world health organization (WHO) definition. In our study SCARs were categorized into three fields: Hypersensitivity syndrome, drug reaction with eosinophilia and systemic symptoms (DRESS), and Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN).
Results:
Among 259 children with SCARs induced by antiepileptic medications, 199 (76.83%), 42 (16.22%), and 18 (6.95%) had hypersensitivity syndrome, DRESS, and SJS/TEN, respectively. Phenobarbital was the most common offending drug in all types of SCARs. The multinomial logistic regression model revealed that lymphadenopathy increased the occurrence of DRESS by 35 times compared to hypersensitivity syndrome (P < 0.001). Girls were at risk of SJS/TEN approximately 6 times more than boys (P = 0.027). Age (P = 0.021), weight (P = 0.036), and mucosal involvement (P < 0.001) affected the hospitalization duration in children with SCARs related to antiepileptic medication.
Conclusion:
There are some similarities and differences in the clinical and epidemiological features of Iranian children suffering from antiepileptic medication-induced SCARs.
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