Treatments for Pediatric Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis: A Systematic Review

Figure S1 presents the PRISMA flow diagram to illustrate the study selection process from the initial search to the final inclusion of studies.Data from the included studies were independently extracted and reviewed by two authors to ensure accuracy and consistency. The extracted data are summarized in Table 1 and include demographic characteristics and clinical characteristics, such as diagnosis type (SJS, SJS/TEN overlap, or TEN), trigger factors, treatment modalities, and outcome measures. If the studies provided detailed information on the treatment modalities, specific regimens and related outcomes were extracted (Table 2). The systemic treatments shown in Table 2 were categorized into the following groups: steroid alone, IVIG alone, combination of steroid and IVIG, supportive care alone, TNF-α inhibitors, and other treatments used alone or in combination. Discrepancies between reviewers were resolved through discussion or consultation with a third reviewer. The findings were synthesized and analyzed to provide insights into the treatment and outcomes of SJS/TEN in pediatric populations.The quality appraisal identified a moderate risk of bias in terms of confounding and selection due to inadequate adjustment for confounding factors and the retrospective nature of many studies (Table S1). Deviations from the intended interventions were also rated as moderate risk because treatments such as IVIG and steroids were often used together. Selective reporting bias was noted due to the absence of preregistered protocols. Despite these limitations, the other methodological domains exhibited a low risk of bias across the included studies, indicating a reasonable overall quality of evidence. Table S2 presents the appraisal of the 27 case series and reports, all of which met the key quality criteria. However, only 18.5% reported systemic treatment side effects, whereas 70.4% did not mention them. Furthermore, two case reports did not present details on treatment specifics, and three were unable to assess side effects due to patient outcomes.