Challenges in Diagnosing and Treatment of Pediatric Necrotic Skin Conditions: A Retrospective Study

BACKGROUND Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe skin reactions with unclear pathogenesis and lack of established diagnostic and therapeutic protocols. This study investigates the triggering factors, diagnostic challenges, and therapeutic approaches in pediatric patients with necrotic skin reactions. MATERIAL AND METHODS A retrospective analysis of the medical records of 13 patients was performed. The diagnosis of necrotic skin reactions was based on medical history and clinical manifestation. Using Lund-Bowder table, the percentage of skin involvement was calculated. We analyzed demographic data, length of hospitalization, prodromal symptoms, percentage of affected skin, mucous membranes involvement, triggering factors, time form exposure to the causative agent to the onset of symptoms and treatments used. RESULTS The average length of hospitalization was 11.2±4.96 days. Prodromal symptoms were noticed in 7 patients. Lesions of mucous membranes and skin were observed in 8 children, only mucous membranes in 3, only skin in 2. A probable trigger factor was identified in 11 cases, in 2 cases the causative agent was not identified. The treatment with antibiotic and anti-inflammatory drugs resulted in improvement in 12 patients. CONCLUSIONS SJS and TEN can arise as serious complications from infections or medications in children. Prompt identification of causative agents and early intervention with tailored treatments are essential to improve outcomes and prevent lasting complications. Our findings suggest that antibiotics and anti-inflammatory drugs are effective in managing these conditions, though further research is needed to refine therapeutic strategies in the pediatric context.