Clinical and Epidemiological Features of Patients with Drug-Induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Iran: Different Points of Children from Adults.

Bahareh Abtahi-Naeini,Tooba Momen,Ali Mohammad Sabzghabaee,Gita Faghihi,Zabihollah Shahmoradi,Mahdi Hadian,Fatemeh Paknazar,Mojtaba Akbari,Mohammad-Sadegh Dehghan,Samuel Menahem

doi:10.1155/2022/8163588

Abstract

Background Different epidemiologic aspects of drug-induced Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in children are scarce. Aim To compare the clinical and epidemiological features of patients with drug-induced SJS and TEN in children and adults. Method This retrospective study was conducted at two academic referral centers (Isfahan, Iran) over 5 years. SJS and TEN were clinically diagnosed and confirmed by skin biopsy as needed. Results One hundred one patients (31 children and 70 adults) with a female to male ratio of 1.1 : 1 was identified in the present study. SJS was more commonly diagnosed in both pediatric and adult patients. The most frequent reason for drug administration identified was the infection (45.2%) and seizure (45.2%) in children and infection (34.3%) and psychiatry disorder (27.1%) in adults (P = 0.001). The most common culprit drugs in the pediatric were phenobarbital (9/31), cotrimoxazole (4/31), and amoxicillin (4/31); however, in the adult group, the most common drugs were carbamazepine (11/70) and lamotrigine (9/70). Fever was significantly more common in adults (44.3%) compared to pediatric patients (22.6%) (P = 0.03). Multiple logistic regression models showed that pediatric patients had significantly lower odds of hospitalization (OR [odds ratio]: 0.14; 95% CI 0.02, 0.67). In addition, patients with SCORTEN 1 had significantly higher odds of hospitalization (OR: 6.3; 95% CI: 1.68, 23.79) compared to patients with SCORTEN 0. Conclusions The present study showed several differences between the pediatric and adult patients with SJS and TEN, including the reason for drug administration, culprit drugs, length of hospital stay, presence of fever, and final diagnosis of disease.

Highlights

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and severe cutaneous adverse drug reactions (ADR) that are potentially considered life-threatening eruptions [1, 2]. They are a spectrum of the same disease, and SJS/TEN overlap syndrome occurs between the two entities according to the extent of total body surface area
This was a retrospective study of children and adult patients with the diagnosis of SJS, TEN, or SJS/TEN overlap at the referral Imam Hossein Children’s Hospital and Dermatology Tertiary Referral Center of AlZahra Hospital affiliated to Isfahan University of Medical Sciences, Isfahan during 2014-2018
Eligible patients were identified by searching the electronic database at the hospital using International Classification of Diseases (ICD) codes containing the following phrases: Stevens-Johnson syndrome, toxic epidermal necrolysis, SJS, or TEN ICD-9 or ICD-10

Summary

Introduction

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and severe cutaneous adverse drug reactions (ADR) that are potentially considered life-threatening eruptions [1, 2]. They are a spectrum of the same disease, and SJS/TEN overlap syndrome occurs between the two entities according to the extent of total body surface area. Aim. To compare the clinical and epidemiological features of patients with drug-induced SJS and TEN in children and adults. The present study showed several differences between the pediatric and adult patients with SJS and TEN, including the reason for drug administration, culprit drugs, length of hospital stay, presence of fever, and final diagnosis of disease

Methods

Results

Conclusion