Toxic Epidermal Necrolysis in Children

Etiology of TEN in Children

Infections are a common cause of TEN in the pediatric population, with up to 50% of cases triggered by infectious agents 2
Mycoplasma pneumoniae is particularly significant, accounting for up to 50% of infection-related cases 2
Herpes simplex virus (HSV) is another important infectious trigger in children 2
Among medications, anticonvulsants and antibiotics are the most commonly implicated drugs in pediatric TEN 3
Other medications that can trigger TEN include NSAIDs, paracetamol, and newer anti-cancer medications 3

TEN must be distinguished from SSSS, which is caused by Staphylococcus aureus exotoxins 4
The key clinical difference is that TEN typically presents with prominent mucosal involvement (eyes, mouth, nose, genitalia), while SSSS characteristically lacks mucosal involvement 4
Histologically, TEN shows subepidermal cleavage, whereas SSSS demonstrates intraepidermal cleavage at the granular layer 4
A skin biopsy or frozen section of a blister roof can definitively distinguish between these conditions 4

TEN exists on a spectrum with Stevens-Johnson Syndrome (SJS), with TEN defined as epidermal detachment greater than 30% BSA 1

Immediate discontinuation of any suspected culprit medication is essential and decreases mortality risk 2
Children with TEN should be managed in age-appropriate specialist units with an appropriate multidisciplinary team 2
More extensive cases require management in a specialized dermatology service PICU or a pediatric burn center with on-site PICU 2

Mortality in pediatric TEN appears to be lower than in adults 5
Recurrence is more common in children (up to 18% of cases), likely because infections, which may recur, are more common triggers than drugs, which can be avoided 5