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Lyell's syndrome (toxic epidermal necrolysis) in children
Last reviewed: 07.07.2025

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Lyell's syndrome is one of the most severe drug-induced disorders. It is rare in children.
It develops with the use of several medications (antibiotics, sulfonamides, nonsteroidal anti-inflammatory drugs, anticonvulsants), less often - with blood or plasma transfusions. Hereditary predisposition plays a certain role.
In pathogenesis - development of an allergic reaction of the Arthus phenomenon type - necrosis of all layers of the epidermis, dermis, thrombocapillaritis and thrombovasculitis. Characteristic is the Nikolsky symptom - detachment of the epidermis with minor mechanical impact.
Symptoms of Lyell's syndrome
The onset of the disease is acute. The condition is severe. Hyperthermia. Intoxication and dehydration are expressed. Erythematous painful elements appear on the skin with a rapid transformation into large bullous blisters with subsequent formation of extensive erosive surfaces. Up to 80-90% of the entire skin surface is affected, with the exception of the scalp. Externally, the child resembles a patient with burns. Toxicosis, microcirculation disorders, hypovolemia develop, and DIC syndrome may develop. All these disorders lead to toxic-allergic lesions of the internal organs: heart, kidneys, liver. Skin infection leads to generalization of the infection and the development of hyperergic sepsis and pneumonia.
Mortality is 30-50%. With timely and adequate therapy, improvement in the condition occurs in the 2nd-3rd week, erosions heal by the end of the month from the onset of the disease and pigmentation remains in their place.
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Treatment of Lyell's syndrome
Cancel all medications that the child was receiving. The patient is hospitalized in the resuscitation or intensive care unit, and if possible, in a burn tent. Sterile linen is mandatory! It is important to ensure the "temperature protection" mode. Prescribe parenteral prednisolone at a dose of 5-10 mg / kg per day, infusion therapy, heparin at a dose of 10-15 U / kg per hour intravenously by drip, broad-spectrum antibiotics. In very severe cases, plasmapheresis is indicated in combination with pulse therapy with prednisolone.
Local treatment of Lyell's syndrome is similar to treatment of burns.
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