Pediatric Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in the US

MedicalResearch.com Interview with:

Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois

Dr. Jonathan Silverberg

Dr. Jonathan L. Silverberg MD PhD MPH
Assistant Professor in Dermatology
Medical Social Sciences and Preventive Medicine
Northwestern University, Chicago, Illinois

MedicalResearch.com: What is the background for this study?

Response: Stevens-Johnson syndrome and Toxic Epidermal Necrolysis (SJS/TEN) are relatively rare and potentially life-threatening disorders. There have been some recent advances in our understanding of the epidemiology and risk factors of SJS/TEN in adults.

However, little is known about the epidemiology of pediatric SJS/TEN.

MedicalResearch.com: What are the main findings?

Response: The incidences of SJS, SJS-TEN and TEN were a mean 5.3, 0.8, and 0.4 cases per million children per year, respectively. These incidences are similar to prior estimates of pediatric SJS-TEN. However, they are considerably lower than previous incidence estimates of adult SJS-TEN. Childhood SJS, SJS-TEN, and TEN caused a significant healthcare burden, with a mean cost of hospitalization of >$20,000, >$50,000 and >$100,000, respectively, and a total 4-year cost of $63,001,951 (mean $16.3 million per year). Children with SJS-TEN also had up to a 4-fold longer duration and 9-fold higher mean cost of hospitalization in comparison to other pediatric admissions. Mortality was 0% for SJS, 4% for SJS/TEN, and 16% for TEN, suggesting that increasing body surface area of involvement may be a mortality risk factor in children. Other major predictors of mortality in pediatric SJS/TEN, included renal failure (>300 fold odds), malignancy (>50-fold odds), septicemia (>30-fold odds), bacterial infection (>20-fold odds), and epilepsy (>50-fold odds).

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: This study suggests that renal failure, septicemia, bacterial infections, and body surface area of involvement >30% — not just >10% — are mortality risk factors in pediatric SJS/TEN. Recognizing these risk factors may be useful for prognostication.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Future research is needed to determine optimal strategies aimed at reducing the incidence and mortality of pediatric SJS/Ten.

No relevant disclosures for this research.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

J Am Acad Dermatol. 2017 Mar 9. pii: S0190-9622(16)31285-3. doi: 10.1016/j.jaad.2016.12.024. [Epub ahead of print]
Pediatric Stevens-Johnson syndrome and toxic epidermal necrolysis in the United States.
Hsu DY1, Brieva J1, Silverberg NB2, Paller AS3, Silverberg JI

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Last Updated on March 26, 2017 by Marie Benz MD FAAD