Recently, the Second Affiliated Hospital of Xi'an Jiaotong University treated an 11 year old boy. After taking Nimesulide and intramuscular injection of Chaihu antipyretic agent due to fever, 90% of the epidermis in his body peeled off and eroded, and he was diagnosed with toxic epidermal necrolysis (TEN). This case once again sounded the alarm for medication safety in children. According to Zhai Zhifang, Deputy Director of the Dermatology Department at Southwest Hospital of Army Medical University, TEN is a rare but dangerous severe drug eruption with a mortality rate of up to 14.8% -30%. Yin Changlin, director of the Intensive Care Medicine Department at Southwest Hospital of the Army Medical University, told reporters that the typical symptoms of TEN have a stage progression characteristic: prodromal symptoms appear 1-3 days after medication, manifested as fever, fatigue, sore throat, conjunctival congestion and other symptoms similar to upper respiratory tract infections; In the following 1-3 weeks, there may be skin itching or pain, which rapidly develops into polymorphic erythema, forming blisters and bullae. Light pressure on the skin can cause epidermal peeling, and may also be accompanied by erosion of mucosal areas such as the mouth, eyes, and external genitalia; When the condition is severe, systemic symptoms such as high fever, dehydration, electrolyte imbalance, or involvement of internal organs such as the liver, lungs, heart, and kidneys may occur. If secondary infection occurs, it may also lead to life-threatening conditions such as sepsis and multiple organ failure. "Although the incidence rate of TEN in children is low, due to its weak skin barrier and immature immune function, once it occurs, the disease progresses faster and the risk of complications is higher. ”Shen Leilei, assistant director of pediatrics at Southwest Hospital of Army Medical University, said that clinical data shows that 40% of children with TEN will experience liver function damage, 13.3% will experience gastrointestinal bleeding, and the incidence of eye injury can reach 75%. The main factor causing TEN in clinical practice is medication, accounting for over 90% of the causes of the disease. Nimesulide is a common antipyretic drug that may induce TEN in children, and its metabolites may cause liver damage, thereby triggering immune abnormalities in children. ”Yin Changlin said that infants and young children have weaker liver metabolism, which can easily lead to drug accumulation and increase the risk of disease. Therefore, China has banned the use of Nimesulide oral preparations in children under 12 years old. Shen Leilei emphasized that parents should not purchase compound medicines with unknown ingredients on their own, and should carefully check the "prohibited for children" clause in the instruction manual. Acetaminophen (available for children over 2 months old) and ibuprofen (available for children over 6 months old) are the preferred choices for reducing fever. However, they should be used when the axillary temperature is 38.2 ℃ or above and accompanied by discomfort, and the dosage should be strictly calculated according to body weight to avoid repeated use with compound cold medicine. When seeking medical attention, parents should proactively inform the doctor of their child's history of drug allergies and avoid using drugs with known allergies or similar structures. Improper medication or multiple diseases caused by incorrect medication can not only trigger TEN, but may also lead to other diseases in children. Shen Leilei said that according to the expert consensus on rational use of antipyretic and analgesic drugs in symptomatic treatment of fever in children, the following antipyretic drugs can harm children's health. Aspirin and aspirin may cause Reye's syndrome, leading to encephalopathy and hepatic steatosis. Aspirin and aspirin should not be used in infants under 3 months old. Analytica can cause severe allergic reactions and granulocytopenia. The injection variety has been cancelled in China, and tablets are prohibited for children under 18 years old. Aminopyrine and prednisone have multiple and severe adverse reactions, and there is no specialized dosage form for children. Therefore, they are not recommended for use in children. In addition, quinolone and sulfonamide drugs should be prohibited without clear indications for children, or used with caution under strict guidance from a doctor. ”Yin Changlin added that children's medication should also be cautious of compound cold medicines, such as those containing aminopyrine and antihistamines, which may increase the risk of allergies. After medication, it is necessary to observe whether there is a rash. If symptoms such as redness, blisters, and mucosal erosion appear, the medication should be stopped immediately and medical attention should be sought. Yin Changlin suggests that children can be evaluated through methods such as genetic testing and screening for safe medication before taking medication, which can help to more accurately select safe drugs and avoid secondary harm to sick children caused by incorrect medication. (New Society)