Pediatric Pearls: SCARs

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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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Mary C. -

Any pearls for differentiating between this and Scalded Skin Syndrome? Other than a medication history of precipitous medication and excluding blood cultures? Great discussion as always!

ilene c. -

Thanks!
Medication history is key. Also, when looking at something like SJS/TEN compared with SSSS, usually mucous membrane desquamation points toward SJS/TEN. SSSS can cause mucous membrane hyperemia and crusting around the mouth but if areas of the mucous membranes are peeling off, that is typically drug-related. Hope that helps!

Elizabeth D. -

Do DRESS or SJS/TEN usually develop after the first few administrations of a medication, or can they develop at any point after taking one of the trigger meds? Wondering if I should think of this like allergies, which manifest rather quickly after the first few doses, or more like angioedema after lisinopril which can strike after years of uneventful use. Thanks!

ilene c. -

That is a really important point that we should have covered better. Thank you! For DRESS, the exact pathophys is poorly understood, but it typically manifests 2-8 weeks after initiation of the drug. SJS/TEN is usually a bit faster than DRESS- a few days up to a month (2 months for anticonvulsants). So both are later than your typical urticaria or anaphylaxis but still within a finite time window.

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