Severe cutaneous adverse drug reactions: incidence, clinical characteristics, treatment, and outcome in pediatric patients.

IF 2.3 4区医学 Q3 ALLERGY

Asian Pacific journal of allergy and immunology Pub Date : 2024-01-06 DOI:10.12932/AP-200623-1640

Patawee Na Bangxang, Wanee Wisuthsarewong, Rattanavalai Nitiyarom

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引用次数: 0

Abstract

Background: Severe cutaneous adverse drug reactions (SCARs) can cause significant morbidity and mortality. Clinical data regarding such conditions is still limited in the pediatric population.

Objective: To investigate the incidence, clinical characteristics, treatment, and outcome of SCARs in Thai pediatric patients.

Methods: This retrospective study enrolled 52 patients aged less than 18 years who were diagnosed with acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), or SJS/TEN overlap during January 2005 to August 2021 at Siriraj Hospital.

Results: SCARs were slightly more prevalent in females than in males (51.9% vs. 48.1%). Median age at diagnosis was 97 months, and median length of hospital stay was 11 days. DRESS, SJS, TEN, AGEP, and SJS/TEN overlap was found in 44.2%, 36.5%, 9.6%, 5.8%, and 3.8%, respectively. The most common etiologies were antimicrobial agents (40.3%) and anticonvulsants (35.5%). Target lesions, vesicobullous lesions, purpura, positive Nikolsky's sign, and skin tenderness were significant in blistering SCARs. Hematologic (84.6%) and hepatic (65.5%) manifestations were common. Treatment varied according to the clinical features of each condition. Systemic corticosteroids showed some benefit in SJS/TEN. One patient diagnosed with TEN died for an overall SCARs mortality rate of 1.9%.

Conclusion: The unique characteristics of SCARs described herein can lead to timely and accurate diagnosis and proper management.

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严重皮肤药物不良反应：儿科患者的发病率、临床特征、治疗和结果。

背景：严重皮肤药物不良反应（SCARs）可导致严重的发病率和死亡率。在儿科人群中，有关此类病症的临床数据仍然有限：调查泰国儿科患者 SCAR 的发病率、临床特征、治疗和结果：这项回顾性研究纳入了 2005 年 1 月至 2021 年 8 月期间在 Siriraj 医院确诊为急性全身性大疱性脓疱病（AGEP）、伴有嗜酸性粒细胞增多和全身症状的药物反应（DRESS）、史蒂文斯-约翰逊综合征（SJS）、中毒性表皮坏死（TEN）或 SJS/TEN 重叠的 52 名 18 岁以下患者：女性SCAR发病率略高于男性（51.9%对48.1%）。确诊时的中位年龄为 97 个月，中位住院时间为 11 天。DRESS、SJS、TEN、AGEP和SJS/TEN重叠率分别为44.2%、36.5%、9.6%、5.8%和3.8%。最常见的病因是抗菌药物（40.3%）和抗惊厥药物（35.5%）。在水疱型 SCAR 中，靶区病变、膀胱脓肿病变、紫癜、尼克尔斯基征阳性和皮肤触痛均很重要。血液学（84.6%）和肝脏（65.5%）表现也很常见。根据每种病症的临床特征，治疗方法也有所不同。全身性皮质类固醇对SJS/TEN有一定疗效。一名确诊为 TEN 的患者死亡，SCARs 的总死亡率为 1.9%：结论：本文描述的 SCARs 的独特特征可有助于及时、准确地诊断和适当的治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Asian Pacific journal of allergy and immunology 医学-过敏

CiteScore

12.80

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： The Asian Pacific Journal of Allergy and Immunology (APJAI) is an online open access journal with the recent impact factor (2018) 1.747 APJAI published 4 times per annum (March, June, September, December). Four issues constitute one volume. APJAI publishes original research articles of basic science, clinical science and reviews on various aspects of allergy and immunology. This journal is an official journal of and published by the Allergy, Asthma and Immunology Association, Thailand. The scopes include mechanism, pathogenesis, host-pathogen interaction, host-environment interaction, allergic diseases, immune-mediated diseases, epidemiology, diagnosis, treatment and prevention, immunotherapy, and vaccine. All papers are published in English and are refereed to international standards.