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  • Chronic ocular issues due to SJS or TEN are worse for children than adults

    Pediatric Ophth/Strabismus

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    Review of: Ocular manifestations and outcomes in children with Stevens-Johnson syndrome and toxic epidermal necrolysis: A comparison with adult patients

    Chen Y-L, Tsai T-Y, Pan L-Y, et al. American Journal of Ophthalmology, in press 2023

    Investigators sought to determine whether ocular symptoms of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) present differently in children than in adults.

    Study design

    This was a retrospective review of 35 children and 105 adults diagnosed with SJS or TEN at a single hospital in Taiwan between 2010 and 2020. Both acute and chronic ocular symptoms were scored. Primary outcomes were BCVA and severity of dry eye; the secondary outcome was the need for medical and/or surgical treatment.

    Outcomes

    In the pediatric group, the most common etiologies of SJS/TEN were nonsteroidal anti-inflammatory drug treatment and mycoplasma infection; in adults, the most common etiology was antiepileptic drug treatment. Children and adults had similar rates of severe dry eye, but more children underwent amniotic membrane grafts and oral mucosal transplantations than adults. Seventy-five percent of children and 64% of adults showed a BCVA of 20/40 or better at final follow-up. While acute ocular scores were not different between pediatric and adult patients, the children had a significantly higher average chronic score (6.5, vs 3.2 for adults); a significantly higher proportion of children than adults had severe chronic ocular complications (15.9% vs 3.8%, respectively).

    Limitations

    This was a retrospective study that included more adults than children. In addition, some of the patients were enrolled in an ongoing clinical trial of etanercept treatment for SJS/TEN and received that intervention.

    Clinical significance

    While SJS and TEN are rare occurrences, children can be affected. While children had worse chronic ocular symptoms than adults and more commonly required surgery, following treatment most of them maintained a VA of 20/40 or better. As the HLA-B*51.01 allele was more common in children with SJS/TEN than in adults, the authors recommend additional studies to see if having this allele is a risk factor for pediatric SJS/TEN.

    Financial Disclosures: Dr. Brenda Bohnsack discloses no financial relationships.