Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Int J Dermatol. 2021 Jan;60(1):44-52. doi: 10.1111/ijd.15054. Epub 2020 Jul 20.
Toxic epidermal necrolysis (TEN) is a life-threatening severe cutaneous adverse reaction. Data on pediatric TEN is limited.
Case records of 44 children, 1 month-12 years with a diagnosis of TEN (>30% body surface area [%BSA] detachment) admitted to a tertiary pediatric intensive care unit (PICU) between 2009 and 2018 were analyzed retrospectively. The primary outcome was mortality, and secondary outcomes were organ dysfunction, length of stay (LOS), and long-term sequelae.
Median (IQR) age was 6.5 (3.6, 8.0) years, and 25 (57%) were boys. Median (IQR) %BSA involved, SCORTEN score, and PRISM-III were 65% (45, 80); 2 (2, 3) and 13 (10, 16), respectively. Antiepileptics (n = 24, 54.6%) and antimicrobials (n = 8, 18.2%) were the most common offending agents. Twenty-four (54.5%) children had culture positive sepsis. Immunomodulatory therapy was provided in 35 (79.5%) and conservative management in nine (20.5%) children. Intravenous immunoglobulin (IVIG) was given in 22 (50%), steroids in three (6.8%), and both IVIG and steroids in 10 (22.7%) children. Respiratory failure (n = 14, 31.8%) was the commonest organ failure. Mortality was 15.9% (n = 7), and median (IQR) PICU-LOS in survivors was 8 (4, 11.75) days. There was no association between IVIG, steroids, or conservative management with mortality or LOS. Ocular sequelae (n = 20, 54.1%) were the most common long-term complication followed by skin (18, 40.1%).
Immunomodulation with IVIG or steroids was not associated with any mortality benefit as compared to conservative management alone. Further research is required to determine the most effective treatment in pediatric TEN.
中毒性表皮坏死松解症（TEN）是一种危及生命的严重皮肤不良反应。儿科 TEN 的数据有限。
回顾性分析了 2009 年至 2018 年间，在一家三级儿科重症监护病房（PICU）住院的 44 例 1 个月至 12 岁儿童 TEN（>30%体表面积[BSA]脱落）的病例记录。主要结局为死亡率，次要结局为器官功能障碍、住院时间（LOS）和长期后遗症。
中位（IQR）年龄为 6.5（3.6，8.0）岁，25 例（57%）为男性。中位（IQR）%BSA 受累、SCORTEN 评分和 PRISM-III 分别为 65%（45，80）；2（2，3）和 13（10，16）。抗癫痫药（n=24，54.6%）和抗菌药（n=8，18.2%）是最常见的致病药物。24 例（54.5%）患儿有培养阳性败血症。35 例（79.5%）患儿接受免疫调节治疗，9 例（20.5%）患儿接受保守治疗。22 例（50%）患儿给予静脉注射免疫球蛋白（IVIG），3 例（6.8%）患儿给予类固醇，10 例（22.7%）患儿给予 IVIG 和类固醇。呼吸衰竭（n=14，31.8%）是最常见的器官衰竭。死亡率为 15.9%（n=7），幸存者的 PICU 住院时间中位数（IQR）为 8（4，11.75）天。IVIG、类固醇或保守治疗与死亡率或 LOS 无相关性。眼部后遗症（n=20，54.1%）是最常见的长期并发症，其次是皮肤（n=18，40.1%）。
与单独保守治疗相比，IVIG 或类固醇的免疫调节治疗并未带来任何生存获益。需要进一步研究以确定儿科 TEN 最有效的治疗方法。
