Pediatric Drug-Induced Epidermal Necrolysis: Insights from Real-World Evidence in Türkiye.

Abstract

Background: Drug-induced epidermal necrolysis is a recently proposed entity designed to clearly differentiate medication-triggered Stevens-Johnson syndrome and toxic epidermal necrolysis from infection-related and idiopathic disease, particularly in pediatric patients.

Objectives: This study aims to characterize the clinical features of pediatric drug-induced epidermal necrolysis, a condition with relatively limited data in the literature.

Methods: This retrospective study analyzed the the electronic medical records of pediatric patients diagnosed with Stevens-Johnson syndrome and toxic epidermal necrolysis in Türkiye between 2018 and 2024. Cases were identified using ICD-10 codes from a national database, and only those with a confirmed drug-related etiology were included. Clinical characteristics, suspected causative drugs, disease severity, in-hospital complications, and treatment approaches were evaluated. Statistical analyses were performed to assess differences in clinical outcomes based on drug type and disease severity.

Results: A total of 33 pediatric patients were included. Antibiotics (39.4%) and antiepileptic drugs (36.4%) were the most commonly implicated medications. In-hospital complications occurred in 66.7% of cases, with septicemia being the most frequent. The patients with toxic epidermal necrolysis had significantly longer hospital stays. Statistical analyses revealed differences in clinical presentation and disease course based mainly on the causative drug, with antiepileptic-induced cases exhibiting a later onset and fewer in-hospital complications.

Conclusions: This study highlights the distinct clinical characteristics of pediatric drug-induced epidermal necrolysis, emphasizing the impact of causative drugs on disease course and outcomes, which may aid in improving diagnosis and treatment strategies.