Delayed-Type Drug-Induced Cutaneous Adverse Reactions in Children: Clinical Spectrum, Diagnostic Challenges and...

Area of Science:

• Pediatric Dermatology
• Clinical Immunology
• Pharmacovigilance

Background:

• Delayed-type cutaneous adverse drug reactions (CADRs) are T-cell-mediated hypersensitivity reactions in children.
• These reactions range from mild maculopapular exanthema (MPE) to severe syndromes like DRESS, SJS, and TEN.
• Limited data exist on pediatric CADRs, which are a significant cause of morbidity.

Purpose of the Study:

• To characterize the clinical features, causative agents, management, and outcomes of pediatric delayed-type CADRs.
• To provide insights into CADR presentation and treatment in a tertiary pediatric setting.

Main Methods:

• Retrospective case series of 33 pediatric patients diagnosed with delayed-type CADR (2013-2024).
• Review of demographics, culprit drugs, clinical signs, lab/histopathology, treatments, and outcomes.
• Application of RegiSCAR, EuroSCAR, and SCORTEN criteria for classification and severity assessment.

Main Results:

• Maculopapular exanthema (MPE) was the most frequent diagnosis (54.5%), followed by DRESS (15.1%) and SJS/TEN (9.1%).
• Antibiotics and antiepileptic drugs were the most common drug classes implicated.
• Systemic corticosteroids and IVIG were used for severe cases; no CADR-related mortality was observed, though four patients died from primary diseases.

Conclusions:

• Delayed-type CADRs in children exhibit a heterogeneous clinical spectrum.
• MPE is the most common phenotype, with antibiotics and antiepileptic drugs as frequent culprits.
• Comorbidities like immunosuppression and polypharmacy are common and necessitate multidisciplinary management for severe reactions.