Pediatric severe cutaneous adverse reactions: causative agents, clinical characteristics, and outcomes from a 10-year single-center retrospective study

Background Severe cutaneous adverse reactions (SCARs), including Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS), are rare but potentially life-threatening pediatric conditions. Data on causative drugs and outcomes in Middle Eastern pediatric populations remain limited. This study aimed to analyze drug-induced SCAR cases in a pediatric hospital in Iran, focusing on causative drugs and patient outcomes over ten years. Methods Retrospective review of 70 pediatric SCAR cases (2011–2021). Data collected included demographics, clinical manifestations, culprit drugs, treatments, complications, and outcomes. Results Among identified culprit drugs, beta-lactam antibiotics (particularly co-amoxiclav) and aromatic antiepileptic drugs, including phenobarbital, carbamazepine, and phenytoin, were the most common. Overall, symptom onset most commonly occurred 1–7 days after drug initiation, whereas DRESS more frequently showed delayed onset (8–28 days, with occasional onset > 28 days). ICU care was required in 24.3%, with an overall mortality of 4.2%, primarily associated with TEN and SJS/TEN overlap. Conclusion Pediatric SCARs are associated with substantial morbidity and measurable mortality, particularly in epidermal necrolysis phenotypes. Pharmacogenomic screening may be considered in selected high-risk populations, although further region-specific evidence is needed. Clinical trial number Not applicable.