Stevens-Johnson Syndrome in Thai Children: A 29-Year Study
Srisupalak Singalavanija MD*, Wanida Limpongsanurak MD*
Affiliation : * Dermatology Unit, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok, Thailand
Background : Stevens-Johnson syndrome (SJS) is a rare and severe life-threatening hypersensitivity syndrome. The etiology
is unclear but is associated with drug exposure or infections and frequently high morbidity and mortality.
Objective : To determine etiologies, treatments and complications of Stevens-Johnson syndrome (SJS) in children.
Material and Method: A retrospective descriptive study was performed at Queen Sirikit National Institute of Child Health
during 1979 and 2007 (29-year study). The authors collected and separated data into three phases from 1979 to 1987, 1988
to 1997 and 1998 to 2007. Diagnosis was confirmed by pediatric dermatologists.
Results : There were 189 patients, 56 cases between 1979-1987, 72 cases between 1988-1997 and 61 cases between 1998-
2007. The ratio of male to female was 1.6: 1. The range of age was from 2 months to 15 years old with a mean age of 5.5 years.
One hundred and sixty-five cases (87%) had a history of drug taking before onset of the rash. The most common drugs
exposure were antibiotics in 69 cases (42%), anticonvulsant drugs in 58 cases (35%), non-steroids anti-inflammatory drugs
in 8 cases (5%), antimalarial drugs in 4 cases (2% ) and unknown drugs in 26 cases (16%). Mycoplasma infections were
found in 5 cases (3%). One hundred and nine cases (58%) were treated with systemic corticosteroids. The corticosteroid
treatment was increasing from 18% in the first phase to 64% and 87% in the second and third phase respectively. The overall
complications were found in 38 cases (20%) included bacterial skin infections in 16 cases (8%), eye complications in 12 cases
(6%), hepatitis in 4 cases (2%) and other complications in 6 cases (2%).Ten patients (5%) died from sepsis and underlying
diseases. The mortality rate declined from 9% in the first phase to 1.5% in the third phase
Conclusion : Etiology of SJS in children was associated with drug exposure with the most commonly implicated drug being
antibiotics and anticonvulsants. Corticosteroid may have a role in the treatment of SJS.
Keywords : Stevens-Johnson syndrome, Children
