Drugs & Bugs

Skin reactions to infections in children can be difficult to distinguish from reactions to medications. Children are different from adults in 2 important ways, meaning that we can’t rely on what is known about these reactions in adults without interpretation and further study. #1: Children are exposed to more infections (think of daycare) and have evolving immune responses to these bugs. #2. Adults take more medications and possibly different medications for their health conditions than children do. These differences are important because if the triggers for the reactions are different, then the treatment/management should be different and specific to children too.

In the last 5-7 years, there has been increasing recognition of the entity now preferentially referred to as RIME – reactive infectious mucocutaneous eruption – that was previously called Stevens Johnson syndrome (SJS) from infection or Mycoplasma pneumoniae-induced rash and mucositis (MIRM). This condition, a ‘bug’-related one, is triggered by many different respiratory infections but is still poorly understood. Drug-induced reactions also need further study – not only those that are blistering (toxic/drug-induced epidermal necrolysis) but other types of severe cutaneous reactions too.