Allergy Asthma Immunol Res.  2019 Mar;11(2):241-253. 10.4168/aair.2019.11.2.241.

Severe Cutaneous Adverse Reactions in Korean Pediatric Patients: A Study From the Korea SCAR Registry

• Oh HL
• Kang DY
• Kang HR
• Kim S
• Koh YI
• Kim SH
• Kim MH
• Suh DI
• the Korean Severe Cutaneous Adverse Reactions Consortium

• KMID: 2431856
• DOI: http://doi.org/10.4168/aair.2019.11.2.241

Abstract

PURPOSE
Although severe cutaneous adverse drug reactions (SCARs) are rare, they are associated with high morbidity and mortality, and thus early diagnosis and treatment are critical for improving prognoses. However, few studies have reported the characteristics of SCARs in children. Thus, we aimed to evaluate the clinical characteristics, current management and prognosis of pediatric SCARs.
METHODS
We analyzed pediatric data in the Korean SCARs registry, which was built retrospectively in 2016 with SCAR cases treated in 34 tertiary referral university hospitals during 2010-2015. Using these cases, we descriptively analyzed detailed data regarding etiology, clinical and laboratory features, treatment strategies, and prognosis.
RESULTS
Forty-seven pediatric SCAR cases from 15 tertiary referral hospitals were included. The median patient age was 10 (interquartile range, 3-15.5) years and 68.1% (n = 32) were males. The culprit drug was identified in 95.7% (n = 45) of the patients; antibiotics (44.7%) and antiepileptic drugs (19.1%) were the most common and second most common culprits, respectively. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) cases presented with the largest area of skin involvement without permanent sequelae. Stevens-Johnson syndrome (SJS) cases involved relatively small areas of skin but serious sequelae in two children. Of 4 patients with toxic epidermal necrolysis (TEN), 1 died. Of all patients assessed, 36 (76.6%) received systemic steroids and 21 (44.7%) received intravenous immunoglobulin (IVIG). Thirteen (27.7%) received both systemic steroids and IVIG. Cyclosporine was administered to only 1 patient along with a systemic steroid.
CONCLUSIONS
In patients with pediatric SCARs, including those with DRESS, SJS and TEN, clinical presentations were variable. Thus, there was no clear continuous disease spectrum. Although the mortality rate was low (2.1%), clinical suspicion may be the best tool for proactive SCAR management.

Keyword

Drug-related side effects and adverse reactions; children; Drug eruptions

MeSH Terms

Anti-Bacterial Agents
Anticonvulsants
Child
Cicatrix*
Cyclosporine
Drug Eruptions
Drug Hypersensitivity Syndrome
Drug-Related Side Effects and Adverse Reactions
Early Diagnosis
Hospitals, University
Humans
Immunoglobulins
Immunoglobulins, Intravenous
Korea*
Male
Mortality
Prognosis
Referral and Consultation
Retrospective Studies
Skin
Steroids
Stevens-Johnson Syndrome
Tertiary Care Centers
Anti-Bacterial Agents
Anticonvulsants
Cyclosporine
Immunoglobulins
Immunoglobulins, Intravenous
Steroids

Figure

• 

  Figure Flow diagram of pediatric SCAR cases analyzed. SCAR, severe cutaneous adverse reaction.

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