• Pediatric dermatology · Sep 2017

    Case Reports

    Successful Use of Cyclosporin A for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Three Children.

    • Jessica St John, Vladimir Ratushny, Kristina J Liu, Daniel Q Bach, Omar Badri, Lia E Gracey, Allen W Ho, Adam B Raff, Daniel Y Sugai, Peter Schalock, and Daniela Kroshinsky.
    • Department of Dermatology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts.
    • Pediatr Dermatol. 2017 Sep 1; 34 (5): 540-546.

    Background/ObjectivesStevens-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.ObjectiveTo report on the efficacy of cyclosporine A in the treatment of SJS/TEN in three pediatric patients.MethodsWe 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.ResultsThe 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).ConclusionsWe 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.© 2017 Wiley Periodicals, Inc.

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