Article
Diagnosis, classification, and management of erythema multiforme
and Stevens-Johnson syndrome
C Léauté-Labrèzea, T Lamireaub, D Chawkib, J Malevillea, A Taïeba
a Unité
de Dermatologie Pédiatrique, Hôpital Pellegrin-Enfants, Place
Amélie Raba-Leon, 33 076 Bordeaux Cedex, France, b Service de Pédiatrie, Hôpital
Pellegrin-Enfants
Correspondence to: Prof. Taïeb email: alain.taieb{at}u-bordeaux2.fr
Accepted 24 May 2000
BACKGROUND
In adults, erythema
multiforme (EM) is thought to be mainly related to herpes infection and
Stevens-Johnson syndrome (SJS) to drug reactions.
AIMSTo investigate this hypothesis
in children, and to review our experience in the management of these patients.
METHODSA retrospective analysis of
77 paediatric cases of EM or SJS admitted to the Children's Hospital
in Bordeaux between 1974 and 1998.
RESULTSThirty five cases,
inadequately documented or misdiagnosed mostly as urticarias or non-EM
drug reactions were excluded. Among the remaining 42 patients (14 girls
and 28 boys), 22 had EM (11 EM minor and 11 EM major), 17 had SJS, and
three had isolated mucous membrane involvement and were classified
separately. Childhood EM was mostly related to herpes infection and SJS
to infectious agents, especially Mycoplasma
pneumoniae. Only two cases were firmly attributed to drugs
(antibiotics). No patient died. EM and SJS sequelae were minor and
steroids were of no overall benefit.
CONCLUSIONIn paediatric practice
EM is frequently misdiagnosed. The proposal that SJS is drug related in
adults does not apply to children, and in our recruitment EM and SJS
are mostly triggered by infectious agents. The course of both diseases,
even though dramatic at onset, leads to low morbidity and mortality
when appropriate symptomatic treatment is given.
Keywords: erythema multiforme; Stevens-Johnson syndrome
© 2000 by Archives of Disease in Childhood
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