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

• Published in: Allergy, asthma & immunology research Vol. 11; no. 2; pp. 241 - 253
• Main Authors: Oh, Hea Lin, Kang, Dong Yoon, Kang, Hye Ryun, Kim, Sujeong, Koh, Young Il, Kim, Sae Hoon, Kim, Min Hye, Suh, Dong In
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Academy of Asthma, Allergy and Clinical Immunology 01.03.2019; The Korean Academy of Asthma, Allergy and Clinical Immunology; The Korean Academy of Pediatric Allergy and Respiratory Disease; 대한천식알레르기학회
• Subjects: Antibiotics; Antiepileptic agents; Children; Complications; Cyclosporins; Data analysis; Data processing; Eosinophilia; Etiology; Hospitals; Immunoglobulins; Intravenous administration; Males; Morbidity; Mortality; Original; Patients; Pediatrics; Prognosis; Scars; Side effects; Signs and symptoms; Skin; Steroid hormones; Steroids; Stevens-Johnson syndrome; Toxic epidermal necrolysis; 내과학; Drug eruptions; children; Drug-related side effects and adverse reactions
• ISSN: 2092-7355; 2092-7363
• DOI: 10.4168/aair.2019.11.2.241

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. 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. 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. 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.