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In light of suspected TEN&#44; the lamotrigine was suspended immediately and treatment with systemic corticosteroids was instated &#40;1-2&#8239;mg&#47;kg&#47;d&#41;&#46; Skin symptoms continued to progress&#44; however&#44; with the addition of hemodynamic instability requiring vasoactive and respiratory support&#46; In the pediatric intensive care department of our hospital&#44; treatment with intravenous cyclosporin was instated&#44; at a dosage of 4&#8239;mg&#47;kg&#47;d&#46; On day 4 of treatment progress of the disease began to stop&#44; with no new active lesions or denuded areas&#46; When partial re-epithelization of all the lesions had taken place&#44; 6 days later &#40;day 10 of treatment&#41;&#44; the dose of cyclosporin was gradually reduced with no new signs of activity of the disease&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In the treatment of patients with TEN&#44; priority measures are based on suspension of any suspected drugs and ensuring fluid&#44; electrolyte&#44; nutritional and respiratory support&#46; Due to the lack of randomized studies&#44; insufficient evidence exists on the efficacy of the different treatments in the pediatric population suffering from TEN&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The literature available to date is scarce and published studies focus on the debate surrounding the use of corticosteroids and IVIg&#44; most of them in the adult population&#46; Several authors argue that survival and speed of re-epithelization are increased in patients treated with corticosteroids or IVIg compared to those who receive supportive treatment alone&#46; These results&#44; however&#44; contrast with other studies&#44; in which increased morbidity has been shown with the use of corticosteroids and IVIg&#46; Several studies have recently been published on SJS&#47;TEN in adults who were treated satisfactorily with cyclosporin &#40;3-5&#8239;mg&#47;kg&#47;d&#44; por un minimum of 14 days&#41;&#59; the studies show that the results appear to be superior to the use of IVIg in terms of survival&#44; speed of re-epithelization&#44; and reduction of length of stay in hospital&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">To date&#44; only 4 pediatric cases of SJS&#47;TEN treated with cyclosporin have been published<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; All of them show the utility of the drug in stabilizing the disease&#44; re-epithelization of the lesions&#44; and reducing mortality in comparison to supportive treatment&#46; One of the most noteworthy findings&#44; which is constantly reported in the literature&#44; is the speed of the drug at halting progression of the disease&#44; with a response time that ranges from hours to a maximum of 3 days from start of treatment&#44; regardless of the delay between onset of the disease and admission to hospital&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4&#44;6&#44;8</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Moreover&#44; based on results in the adult population&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> only 1 case of a pediatric patient treated with etanercept &#40;2 doses of 25&#8239;mg subcutaneously&#41; has been reported&#44; showing comparable results to cyclosporin in terms of re-epithelization and halting the progression of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> This drug appears to be of particular utility in cases with kidney failure or a history of malignant disease&#44; situations in which cyclosporin is contraindicated&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;6&#44;11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">This case supports the previously published results obtained in 4 other pediatric patients and contributes additional evidence on the use of cyclosporin in single-drug therapy in patients with SJS&#47;TEN&#46; Cyclosporin may be considered a good therapeutic option with a reasonable safety profile in a situation such as this&#44; which may severely threaten the patient&#8217;s life&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Quintana-Castanedo L&#44; Nieto-Rodr&#237;guez D&#44; Rodr&#237;guez-&#193;lvarez D&#44; Feito-Rodr&#237;guez M&#44; de Lucas-Laguna R&#46; Necr&#243;lisis epid&#233;rmica t&#243;xica en un ni&#241;o tratada de forma satisfactoria con ciclosporina A&#46; Actas Dermosifiliogr&#46; 2021&#59;112&#58;468&#8211;470&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Trigger&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CsA Dosage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Other Treatments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duration of CsA Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">St&#46; John et al &#40;2017&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Phenytoin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 mg&#47;kg&#47;d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Systemic corticosteroids prior to CsA &#40;1&#46;5&#8239;mg&#47;kg&#47;d&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">St&#46; John et al &#40;2017&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">M pneumoniae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 mg&#47;kg&#47;d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">St&#46; John et al &#40;2017&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">M pneumoniae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 mg&#47;kg&#47;d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aihara et al &#40;2007&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paracetamol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 mg&#47;kg&#47;d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Systemic corticosteroids adjuvant to CsA &#40;30&#8239;mg&#47;kg&#8239;&#215;&#8239;3 d&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Quintana et al &#40;2019&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lamotrigine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 mg&#47;kg&#47;d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prior systemic corticosteroids &#40;1-2&#8239;mg&#47;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  "contribucion" => array:1 [
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                          "etal" => false
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                            0 => "M&#46;G&#46; Kirchhof"
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                            2 => "S&#46; Sikora"
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                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2014.07.016"
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Case and Research Letters
Toxic Epidermal Necrolysis in a Boy: Successful Treatment With Cyclosporine A
Necrólisis epidérmica tóxica en un niño tratada de forma satisfactoria con ciclosporina A
L. Quintana-Castanedoa,
Corresponding author
luciaquintana.e@gmail.com

Corresponding author.
, D. Nieto-Rodrígueza, D. Rodríguez-Álvarezb, M. Feito-Rodrígueza, R. de Lucas-Lagunaa
a Servicio de Dermatología, Hospital Universitario La Paz, Madrid, Spain
b Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario La Paz, Madrid, Spain
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    "titulo" => "Toxic Epidermal Necrolysis in a Boy&#58; Successful Treatment With Cyclosporine A"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Toxic epidermal necrolysis &#40;TEN&#41;&#44; together with Stevens-Johnson syndrome &#40;SJS&#41;&#44; forms part of a spectrum of medical emergencies characterized by peeling of the epidermis and risk of hemodynamic instability and sepsis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Mortality is approximately 35&#37; and&#44; while survival is greater in children&#44; it has been linked to higher rates of long-term complications&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In most cases&#44; TEN is secondary to an idiosyncratic drug reaction&#44; most commonly triggered by antiepileptic drugs&#44; antibiotics&#44; and nonsteroidal anti-inflammatory drugs&#46; No standardized guidelines exist and traditionally&#44; both systemic corticosteroid therapy and intravenous immunoglobulins &#40;IVIg&#41; have been used&#44; with questionable results&#46; New therapeutic options&#44; including classic immunosuppressants such as cyclosporin and anti-TNF-&#945; drugs&#44; have recently been tried&#46; Considering the scarcity of current cases in the literature&#44; we believe that the report of a new case of pediatric TEN treated satisfactorily with cyclosporin is of interest&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Three weeks after beginning treatment&#44; a 10-year-old boy with a history of multifocal epilepsy undergoing treatment with lamotrigine&#44; developed a fever of 39&#8239;&#176;C&#44; blisters on the face&#44; torso&#44; and extremities&#44; and areas of denuded skin with positive Nikolsky sign&#44; which&#44; in total&#44; covered approximately 40&#37; of the total body surface and was associated with major involvement of the ocular&#44; oral&#44; and genital mucosa &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; In light of suspected TEN&#44; the lamotrigine was suspended immediately and treatment with systemic corticosteroids was instated &#40;1-2&#8239;mg&#47;kg&#47;d&#41;&#46; Skin symptoms continued to progress&#44; however&#44; with the addition of hemodynamic instability requiring vasoactive and respiratory support&#46; In the pediatric intensive care department of our hospital&#44; treatment with intravenous cyclosporin was instated&#44; at a dosage of 4&#8239;mg&#47;kg&#47;d&#46; On day 4 of treatment progress of the disease began to stop&#44; with no new active lesions or denuded areas&#46; When partial re-epithelization of all the lesions had taken place&#44; 6 days later &#40;day 10 of treatment&#41;&#44; the dose of cyclosporin was gradually reduced with no new signs of activity of the disease&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In the treatment of patients with TEN&#44; priority measures are based on suspension of any suspected drugs and ensuring fluid&#44; electrolyte&#44; nutritional and respiratory support&#46; Due to the lack of randomized studies&#44; insufficient evidence exists on the efficacy of the different treatments in the pediatric population suffering from TEN&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The literature available to date is scarce and published studies focus on the debate surrounding the use of corticosteroids and IVIg&#44; most of them in the adult population&#46; Several authors argue that survival and speed of re-epithelization are increased in patients treated with corticosteroids or IVIg compared to those who receive supportive treatment alone&#46; These results&#44; however&#44; contrast with other studies&#44; in which increased morbidity has been shown with the use of corticosteroids and IVIg&#46; Several studies have recently been published on SJS&#47;TEN in adults who were treated satisfactorily with cyclosporin &#40;3-5&#8239;mg&#47;kg&#47;d&#44; por un minimum of 14 days&#41;&#59; the studies show that the results appear to be superior to the use of IVIg in terms of survival&#44; speed of re-epithelization&#44; and reduction of length of stay in hospital&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">To date&#44; only 4 pediatric cases of SJS&#47;TEN treated with cyclosporin have been published<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; All of them show the utility of the drug in stabilizing the disease&#44; re-epithelization of the lesions&#44; and reducing mortality in comparison to supportive treatment&#46; One of the most noteworthy findings&#44; which is constantly reported in the literature&#44; is the speed of the drug at halting progression of the disease&#44; with a response time that ranges from hours to a maximum of 3 days from start of treatment&#44; regardless of the delay between onset of the disease and admission to hospital&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4&#44;6&#44;8</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Moreover&#44; based on results in the adult population&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> only 1 case of a pediatric patient treated with etanercept &#40;2 doses of 25&#8239;mg subcutaneously&#41; has been reported&#44; showing comparable results to cyclosporin in terms of re-epithelization and halting the progression of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> This drug appears to be of particular utility in cases with kidney failure or a history of malignant disease&#44; situations in which cyclosporin is contraindicated&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;6&#44;11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">This case supports the previously published results obtained in 4 other pediatric patients and contributes additional evidence on the use of cyclosporin in single-drug therapy in patients with SJS&#47;TEN&#46; Cyclosporin may be considered a good therapeutic option with a reasonable safety profile in a situation such as this&#44; which may severely threaten the patient&#8217;s life&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Quintana-Castanedo L&#44; Nieto-Rodr&#237;guez D&#44; Rodr&#237;guez-&#193;lvarez D&#44; Feito-Rodr&#237;guez M&#44; de Lucas-Laguna R&#46; Necr&#243;lisis epid&#233;rmica t&#243;xica en un ni&#241;o tratada de forma satisfactoria con ciclosporina A&#46; Actas Dermosifiliogr&#46; 2021&#59;112&#58;468&#8211;470&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CsA Dosage&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Other Treatments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duration of CsA Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">St&#46; John et al &#40;2017&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17 mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Phenytoin&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 mg&#47;kg&#47;d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Systemic corticosteroids prior to CsA &#40;1&#46;5&#8239;mg&#47;kg&#47;d&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">St&#46; John et al &#40;2017&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">5 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">M pneumoniae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 mg&#47;kg&#47;d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">St&#46; John et al &#40;2017&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">8 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">M pneumoniae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 mg&#47;kg&#47;d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">21 d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Aihara et al &#40;2007&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Paracetamol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 mg&#47;kg&#47;d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Systemic corticosteroids adjuvant to CsA &#40;30&#8239;mg&#47;kg&#8239;&#215;&#8239;3 d&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Quintana et al &#40;2019&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lamotrigine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 mg&#47;kg&#47;d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prior systemic corticosteroids &#40;1-2&#8239;mg&#47;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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