Paediatric Stevens-Johnson syndrome and toxic epidermal necrolysis: patterns and outcomes in a retrospective Pakistani cohort

Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but severe mucocutaneous reactions in children, often triggered by medications such as antibiotics, anticonvulsants and non-steroidal anti-inflammatory drugs (NSAIDs). Treatment guidelines in paediatric populations remain unclear, particularly in South Asia, where data are scarce. This study aims to describe the clinical profile, triggers, management and outcomes of paediatric SJS/TEN cases from a tertiary care centre in Pakistan. Methods A retrospective cross-sectional study was conducted at Aga Khan University Hospital, Karachi, Pakistan. Medical records of children aged 1month to 15 years diagnosed with SJS or TEN between June 2008 and December 2020 were reviewed. Data on demographics, drug exposure, clinical features, treatment modalities and outcomes were extracted and analysed using Stata V.14. Results Among 124 identified cases, 98 children (79.0%) had TEN with >30%body surface area involvement. Mucosal involvement was seen in 85 (68.5%) cases. Prior drug exposure was documented in 98 (79.0%) patients, with antibiotics (52.0%) and NSAIDs (48.0%) being the most common triggers. Supportive care was the mainstay of treatment. Age was associated with poorer outcomes. Conclusion Paediatric drug-induced SJS/TEN remains a critical concern, particularly due to commonly prescribed antibiotics and NSAIDs. High mortality in TEN cases and predominant use of supportive therapy highlight the need for clear paediatric treatment protocols. Local data on the role of early immunomodulatory therapy are limited, indicating a need for further research on optimal early interventions to improve outcomes.