Toxic epidermal necrolysis: A study of clinical profile and treatment outcome in children

Objectives: The objective of this study is to study the clinical and laboratory profile, risk factors for the development of blood culture positive septicemia and treatment outcome of children admitted with toxic epidermal necrolysis (TEN). Methods: All children admitted with TEN from January 2012 to January 2017 were included in the study. Blood culture, organ functions, and serum electrolytes were sent at admission and repeated as clinically indicated. Children were managed with reverse isolation in workforce limited setting of a Government Medical College Hospital. Outcome measure analyzed were the duration of hospital stay, development of blood culture positive septicemia and death. Children were followed up for a variable period from 2-month to 1-year. Results: A total of 13 children were admitted with TEN in the 5-year study period, aged 7.9±3.2 years. Mean area of skin involvement was 69±19.9%. Drugs were found to be the most common cause of TEN accounting for 12 cases (92%). Evidence of renal injury was seen in 6 cases (46%). Disorders of sodium balance were the most common electrolyte abnormality observed in 11 cases (85%). There was no statistically significant difference in duration of progression of skin lesions in children who received ≥2 g/kg of intravenous immunoglobulin (IVIG) and those who received <2 g/kg of IVIG. The mortality rate was 7.6%. At follow-up, all patients had dyspigmentation and none had scarring. 6 children (46%) had ophthalmic complaints at follow-up. Conclusion: Non-steroidal anti-inflammatory drugs were found to be the most common cause of TEN in children. Furthermore, TEN was found to be a disease causing critical kidney disease in children. Multi-organ dysfunction, hyperglycemia, and need for invasive ventilation were found to be associated with increased risk of developing culture positive sepsis. Low-dose IVIG, parenteral steroids and skin care with normal saline washes and sterile liquid paraffin impregnated gauze are the effective and safe treatment options for children with TEN in resource-limited setting.