Severe cutaneous reactions caused by barbiturates in seven Iranian children.
BACKGROUND
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.


METHODS
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.


CONCLUSIONS
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.
Mamishi
Setareh
S
Department of Infectious Diseases, Immunology, Asthma and Allergy Research Institute, Children Medical Center, Medical Sciences/University of Tehran, Tehran, Iran.
Fattahi
Fatemeh
F
Pourpak
Zahra
Z
Aghaee
Farzaneh Mirza
FM
Moinfar
Zeinab
Z
Mohammadi
Mahmoud
M
Ashrafi
Mahmoud
M
Moin
Mostafa
M
D000927:Anticonvulsants / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004827:Epilepsy / Q000188:drug therapy; D005260:Female; D006801:Humans; D007223:Infant; D007492:Iran; D008297:Male; D010634:Phenobarbital / Q000009:adverse effects*; D012720:Severity of Illness Index; D013262:Stevens-Johnson Syndrome / Q000139:chemically induced* / Q000473:pathology*
D000927:Anticonvulsants; D010634:Phenobarbital