Department of Infectious Diseases, Immunology, Asthma and Allergy Research Institute, Children Medical Center, Medical Sciences/University of Tehran, Tehran, Iran.
Int J Dermatol. 2009 Nov;48(11):1254-61. doi: 10.1111/j.1365-4632.2007.03561.x.
The severe adverse cutaneous reactions of erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare mucocutaneous diseases associated with significant morbidity and mortality. The most common cause is antiepileptic drugs, particularly carbamazepine and lamotrigine, as well as the barbiturates group (phenobarbital and phenytoin). In this article, we present seven children with severe adverse cutaneous reactions caused by barbiturates.
The age of the affected children was between 2 and 11 years and they all had a history of taking barbiturates. Their symptoms started 1-3 weeks after the initiation of barbiturates, including a prodrome characterized by 2-3 days of malaise, fever, cough and anorexia, after which the skin and mucosal lesions appeared and worsened. The skin lesions varied from rash to large bullae, plus different forms of mucous membrane involvement. The offending drugs (barbiturates) were stopped immediately and care was largely supportive.
As a result of the morbidity and/or mortality associated with EM, SJS and TEN, physicians should keep in mind their differential diagnosis when cutaneous reactions are observed in patients undergoing barbiturate therapy. Furthermore, although TEN and SJS are life-threatening diseases, early detection and appropriate care can lead to a decrease in the incidence of death. The strategies described here seem to be successful and safe because, despite the serious conditions, our patients responded well. All survived.
多形红斑（EM）、史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）等严重皮肤不良反应是罕见的黏膜疾病，具有较高的发病率和死亡率。最常见的病因是抗癫痫药物，尤其是卡马西平和拉莫三嗪，以及巴比妥类药物（苯巴比妥和苯妥英）。本文介绍了 7 例由巴比妥类药物引起的严重皮肤不良反应患儿。
受影响儿童的年龄在 2 至 11 岁之间，均有服用巴比妥类药物的病史。他们的症状在开始服用巴比妥类药物后 1-3 周出现，包括以 2-3 天不适、发热、咳嗽和食欲不振为特征的前驱期，随后出现皮肤和黏膜损伤并加重。皮肤损伤从皮疹到大疱不等，伴有不同形式的黏膜受累。立即停用致病药物（巴比妥类），并主要进行支持性治疗。
由于 EM、SJS 和 TEN 与发病率和/或死亡率相关，因此当接受巴比妥类药物治疗的患者出现皮肤反应时，医生应考虑到其鉴别诊断。此外，尽管 TEN 和 SJS 是危及生命的疾病，但早期发现和适当的治疗可以降低死亡率。这里描述的策略似乎是成功和安全的，因为尽管病情严重，但我们的患者反应良好。所有患者均存活。
