title: Severe Cutaneous Adverse Drug Reactions in Pediatric Patients: A Multicenter Study.
abstract: BACKGROUND
  The severe cutaneous adverse drug reactions (SCARs) are rare but could be life-threatening. These include drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome, toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis.
  
  
  OBJECTIVE
  The purpose of this study was the evaluation of the clinical characteristics of patients with the diagnosis of SCARs.
  
  
  METHODS
  Patients who were diagnosed with SCARs between January 2011 and May 2016 by pediatric allergy clinics in the provinces of Ankara, Trabzon, Izmir, Adana, and Bolu were included in this multicenter study. Clinical and laboratory findings, the time between suspected drug intake and development of clinical findings, treatments they have received, and length of recovery time were recorded.
  
  
  RESULTS
  Fifty-eight patients with SCARs were included in this study. The median age of the patients was 8.2 years (interquartile range, 5.25-13 years) and 50% (n = 29) were males. Diagnosis was Stevens-Johnson syndrome/TEN in 60.4% (n = 35), DRESS in 27.6% (n = 16), and acute generalized exanthematous pustulosis in 12% (n = 7) of the patients. In 93.1% of the patients, drugs were the cause of the reactions. Antibiotics ranked first among the drugs (51.7%) and antiepileptic drugs were the second (31%) most common. A patient who was diagnosed with TEN developed lagophthalmos and a patient who was diagnosed with DRESS developed secondary diabetes mellitus. Only 1 patient with the diagnosis of TEN died.
  
  
  CONCLUSIONS
  SCARs in children are not common but potentially serious. Early diagnosis and appropriate treatment of SCARs will reduce the incidence of morbidity and mortality.
authors.affiliation: Department of Pediatric Allergy and Immunology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: Emine
authors.initials: E
authors.lastname: Dibek Misirlioglu
authors.affiliation: Department of Pediatric Allergy and Immunology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Guvenir
authors.affiliation: Department of Pediatric Allergy and Immunology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey.
authors.forename: Semiha
authors.initials: S
authors.lastname: Bahceci
authors.affiliation: Division of Pediatric Allergy and Immunology, Department of Children's Health and Diseases, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
authors.forename: Mehtap
authors.initials: M
authors.lastname: Haktanir Abul
authors.affiliation: Department of Pediatric Allergy and Immunology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey.
authors.forename: Demet
authors.initials: D
authors.lastname: Can
authors.affiliation: Department of Pediatric Allergy and Immunology, Adana Obstetrics and Pediatrics Hospital, Adana, Turkey.
authors.forename: Belgin Emine
authors.initials: BE
authors.lastname: Usta Guc
authors.affiliation: Division of Pediatric Allergy and Immunology, Department of Children's Health and Diseases, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Erkocoğlu
authors.affiliation: Department of Pediatric Allergy and Immunology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: Muge
authors.initials: M
authors.lastname: Toyran
authors.affiliation: Department of Pediatric Allergy and Immunology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey.
authors.forename: Hikmet Tekin
authors.initials: HT
authors.lastname: Nacaroglu
authors.affiliation: Department of Pediatric Allergy and Immunology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: Ersoy
authors.initials: E
authors.lastname: Civelek
authors.affiliation: Department of Pediatric Allergy and Immunology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: Betul
authors.initials: B
authors.lastname: Buyuktiryaki
authors.affiliation: Department of Pediatric Allergy and Immunology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: Tayfur
authors.initials: T
authors.lastname: Ginis
authors.affiliation: Division of Pediatric Allergy and Immunology, Department of Children's Health and Diseases, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
authors.forename: Fazil
authors.initials: F
authors.lastname: Orhan
authors.affiliation: Division of Pediatric Allergy and Immunology, Department of Children's Health and Diseases, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey. Electronic address: cankocabas@yahoo.com.
authors.forename: Can Naci
authors.initials: CN
authors.lastname: Kocabas
mesh_terms: D056150:Acute Generalized Exanthematous Pustulosis / Q000453:epidemiology*; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D063926:Drug Hypersensitivity Syndrome / Q000453:epidemiology*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000378:metabolism; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012867:Skin / Q000187:drug effects / Q000473:pathology*; D013262:Stevens-Johnson Syndrome / Q000453:epidemiology*; D014421:Turkey / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D000927:Anticonvulsants; D007073:Immunoglobulin E
keywords: Acute generalized exanthematous pustulosis; Children; DRESS; Eosinophilia; Severe cutaneous adverse drug reactions; Stevens-Johnson syndrome; Toxic epidermal necrolysis