SJS TEN, and steroids vs Nothing

Journal Scan / Research · August 08, 2020

Intensive Care Needs and Long-Term Outcome of Pediatric Toxic Epidermal Necrolysis

International Journal of Dermatology

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• The authors report 44 children diagnosed with toxic epidermal necrolysis (TEN) during their study period between 2009 and 2018. Of those who received immunomodulatory therapy, 22 (50%) were treated with intravenous immunoglobulin (IVIG), 3 (6.8%) with systemic steroids, and 10 (22.7%) with both IVIG and steroids. Nine (20.5%) patients were treated with supportive care only. Median duration of PICU stay was 8 days and did not differ significantly between those treated with immunomodulatory therapy and those who received supportive care.

• Overall mortality rate was 15.9% (n=7); 4 (57.1%) of these patients were treated with IVIG. Of those who survived, 18 (48.6%) were treated with IVIG, 3 (8.1%) with steroids, 9 (24.3%) with combination IVIG and steroids, and 7 (18.9%) with supportive care. In addition, there was no survival benefit for those who received IVIG within 5 days of symptom onset versus after 5 days or those who received higher doses of IVIG. Increased mortality was associated with higher body-surface area involvement, lower serum albumin levels, secondary blood stream infection, and presence of organ dysfunction.

– Caitlyn T. Reed, MD

Abstract

BACKGROUND

Toxic epidermal necrolysis (TEN) is a life-threatening severe cutaneous adverse reaction. Data on pediatric TEN is limited.

METHODS

Case records of 44 children, 1 month-12 years with a diagnosis of TEN (>30% body surface area [%BSA] detachment) admitted to a tertiary pediatric intensive care unit (PICU) between 2009 and 2018 were analyzed retrospectively. The primary outcome was mortality, and secondary outcomes were organ dysfunction, length of stay (LOS), and long-term sequelae.

RESULTS

Median (IQR) age was 6.5 (3.6, 8.0) years, and 25 (57%) were boys. Median (IQR) %BSA involved, SCORTEN score, and PRISM-III were 65% (45, 80); 2 (2, 3) and 13 (10, 16), respectively. Antiepileptics (n = 24, 54.6%) and antimicrobials (n = 8, 18.2%) were the most common offending agents. Twenty-four (54.5%) children had culture positive sepsis. Immunomodulatory therapy was provided in 35 (79.5%) and conservative management in nine (20.5%) children. Intravenous immunoglobulin (IVIG) was given in 22 (50%), steroids in three (6.8%), and both IVIG and steroids in 10 (22.7%) children. Respiratory failure (n = 14, 31.8%) was the commonest organ failure. Mortality was 15.9% (n = 7), and median (IQR) PICU-LOS in survivors was 8 (4, 11.75) days. There was no association between IVIG, steroids, or conservative management with mortality or LOS. Ocular sequelae (n = 20, 54.1%) were the most common long-term complication followed by skin (18, 40.1%).

CONCLUSION

Immunomodulation with IVIG or steroids was not associated with any mortality benefit as compared to conservative management alone. Further research is required to determine the most effective treatment in pediatric TEN.

International Journal of Dermatology

Intensive Care Needs and Long-Term Outcome of Pediatric Toxic Epidermal Necrolysis — A 10-Year Experience

Int. J. Dermatol 2020 Jul 20;[EPub Ahead of Print], V Williams, M Reddy, A Bansal, AK Baranwal, K Nallasamy, SK Angurana, S Handa, J Ram, M Jayashree, S Singhi 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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