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Treatment Varies and Mortality is Low among Children with Severe Skin Reactions

Published online: May 30, 2018

Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are life threatening skin reactions most commonly caused by medications and infections. Our understanding of the treatments and prognoses of these diseases in children are primarily based on adult studies.

In a recently published article in The Journal of Allergy and Clinical Immunology:In Practice, Antoon and colleagues describe the variation in hospital care among children with severe skin reactions. Using the Pediatric Health Information System, a large pediatric database from the U.S. Children’s Hospital Association, the authors studied the treatment strategies of children hospitalized with SJS and TEN and determined their outcomes including morbidity, mortality, recurrence, readmissions, and costs.  

The study found that, in contrast to adults, deaths and recurrences were rare in children. However, children had a high rate of complications and were commonly readmitted to the hospital after discharge. The authors report that children with SJS and TEN had long and costly hospital stays. The study also identified a wide variation in the medications used to treat children with SJS and TEN and treatment strategies varied by geographic region of the country. Importantly, the authors found that combination drug therapies (e.g. steroids, immunoglobulin) were not associated with a reduction in length of hospital stay or preventing the need for life support as compared to single drug treatment.

These findings help us to better understand the current treatments and prognoses of pediatric SJS and TEN in the United States. The wide variation in treatment likely represents an area to improve the quality of care of children with these severe skin reactions. More research is needed to determine the most optimal and cost-effective treatment for children with SJS and TEN.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

Retrospective Cohort Study of the Management and Outcomes of Children Hospitalized With Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis
By James W. Antoon, Jennifer L. Goldman, Samir S. Shah, Brian Lee