Diagnosis, classification, and management of erythema multiforme and Stevens-Johnson syndrome

Background-In adults, erythema multiforme (EM) is thought to be mainly rela ted to herpes infection and Stevens-Johnson syndrome (SJS) to drug reaction s. Aims-To investigate this hypothesis in children, and to review our experien ce in the management of these patients. Methods-A retrospective analysis of 77 paediatric cases of EM or SJS admitt ed to the Children's Hospital in Bordeaux between 1974 and 1998. Results-Thirty five cases, inadequately documented or misdiagnosed mostly a s urticarias or non-EM, drug reactions were excluded. Among the remaining 4 2 patients (14 girls and 28 boys), 22 had EM (11 EM minor and Il EM major), 17 had SJS, and three had isolated mucous membrane involvement and were cl assified separately. Childhood EM was mostly related to herpes infection an d SJS to infectious agents, especially Mycoplasma pneumoniae. Only two case s were firmly attributed to drugs (antibiotics). No patient died. EM and SJ S sequelae were minor and steroids were of no overall benefit. Conclusion-In paediatric practice EM is frequently misdiagnosed. The propos al that SJS is drug related in adults does not apply to children, and in ou r recruitment EM, and SJS are mostly triggered by infectious agents. The co urse of both diseases, even though dramatic at onset, leads to low morbidit y and mortality when appropriate symptomatic treatment is given.