Survey on Etiology of Stevens-Johnson syndrome and Toxic Epidermal Necrolysis in Pediatric Patients: A Six-Year Study from Iran

Authors

1 Professor of Dermatology, Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

3 MD, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Assistant Professor of Dermatology, Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Background
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are among the most severe dermatologic reactions to the drugs. Data about SJS and TEN among pediatric population especially in Iran is limited. This study aimed to investigate the clinical and para-clinical characteristics of pediatric patients with SJS/TEN.
Materials and Methods
From 2010 to 2016, all SJS and TEN children from three teaching hospitals in Mashhad-Iran with age less than 15 years were included in the study. Patients’ catechistic, history, physical examinations, progress notes, laboratory findings, medical consults, treatments taken and the final outcome were extracted from medical records by researcher. Data were further analyzed by SPSS (version 17.0).
Results
Among 165 records, 48 children (58.3% male; mean age of 9.1 years) were among the SJS and TEN spectrum. Anticonvulsants (50%; including lamotrigine, phenobarbital, phenytoin, carbamazepine, valproate and clobazam) were the most common drugs followed by antibiotics (38.1%; including cefixime, penicillin, azithromycin, co-amoxiclav, cephalexin, co-trimoxazole and ceftriaxone), and analgesics (9.5%; including acetaminophen, ibuprofen and naproxen). Infectious agents were the possible cause of SJS/TEN in two patients. WBC counts, liver function tests, renal and electrolyte tests were significantly different in SJS and TEN groups.
Conclusion
The main suspected medications found in this study were anticonvulsants and antibiotics and the mortality rate was 12.5%. The main suspected medications found in this study were anticonvulsants and antibiotics and the mortality rate was 12.5%. 

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