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Characterizing drug-induced epidermal necrolysis in a pediatric cohort

Ariel B Brown1, Andrew J Park2, Nnenna G Agim3,4

  • 1Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Pediatric Dermatology
|July 9, 2024
PubMed

Insights

Pediatric drug-induced epidermal necrolysis is often caused by antiepileptic drugs (AEDs), which can have a delayed onset. Monitor children on AEDs longer for early signs of this severe skin reaction.

Area of Science:

  • Pediatric Dermatology
  • Pharmacovigilance
  • Toxicology

Background:

  • Drug-induced epidermal necrolysis (DIEN) is a severe, life-threatening mucocutaneous reaction.
  • Understanding the specific clinical course of DIEN in pediatric populations is crucial for timely diagnosis and management.

Purpose of the Study:

  • To characterize the timeline and clinical features of onset, progression, and management of drug-induced epidermal necrolysis in pediatric patients.
  • To identify common culprit drugs and specific risk factors associated with DIEN in children.

Main Methods:

  • Retrospective identification and analysis of 16 pediatric patients (<18 years) with confirmed DIEN.
  • Review of patient records to determine culprit drug exposure, onset, progression, and management strategies.

Main Results:

  • Antiepileptic drugs (AEDs) were the most frequent culprit drugs (75%), followed by antibiotics (25%).
  • AEDs were associated with a delayed onset of DIEN and symptom precipitation by dose escalations.
  • Typical onset window for AED-induced DIEN may be longer than previously established.

Conclusions:

  • Antiepileptic drugs pose a significant risk for drug-induced epidermal necrolysis in pediatric patients.
  • Healthcare providers should consider prolonged monitoring for prodromal symptoms in children prescribed AEDs, especially those with dose escalations.
  • Further research into pediatric DIEN is warranted to refine diagnostic and management guidelines.

Keywords:
Stevens–Johnson syndromeanti‐epileptic drugsdrug reactiondrug‐induced epidermal necrolysistoxic epidermal necrolysis

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