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Successful Use of Cyclosporin A for Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis in Three Children
Author(s) -
St. John Jessica,
Ratushny Vladimir,
Liu Kristina J.,
Bach Daniel Q.,
Badri Omar,
Gracey Lia E.,
Ho Allen W.,
Raff Adam B.,
Sugai Daniel Y.,
Schalock Peter,
Kroshinsky Daniela
Publication year - 2017
Publication title -
pediatric dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.542
H-Index - 73
eISSN - 1525-1470
pISSN - 0736-8046
DOI - 10.1111/pde.13236
Subject(s) - medicine , toxic epidermal necrolysis , observational study , lesion , disease , clinical trial , dermatology , surgery , pediatrics
Abstract Background/Objectives Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are medical emergencies. Mainstays of treatment include removal of the offending agent, supportive care, and wound care. The use of immunosuppressive agents such as corticosteroids and intravenous immunoglobulin (IVIg) is controversial. Some case reports and small studies report the successful use of cyclosporin A (CsA) for SJS/TEN in halting disease progression, fostering reepithelialization, and reducing mortality. Objective To report on the efficacy of cyclosporine A in the treatment of SJS/TEN in three pediatric patients. Methods We describe three pediatric patients seen at a tertiary care hospital in Boston, Massachusetts, diagnosed with SJS/TEN confirmed by skin biopsy who were successfully treated with CsA with improvements seen in time to cessation of disease progression or new lesion formation, reepithelialization, and duration of hospital stay. Results The average time cessation of disease progression or new lesion formation after CsA administration was 2.2 days (range 1.5–3 days) and average time to remission or reepithelialization was 13 days (range 10–15 days). The average length of hospital stay was 11.7 days (range 4–19 days). Conclusions We describe three pediatric patients treated successfully with CsA and provide evidence for the use of cyclosporine in children with SJS/TEN. These results further support previous observations that CsA use for SJS/TEN produces consistently favorable outcomes. The results in this case series are limited by their observational nature. Additional trials are needed to evaluate the safety and efficacy of CsA use in children.