Topical Corticosteroids and Hospital Length of Stay in Children with Eczema Herpeticum

Authors

  • Paul L. Aronson M.D.,

    1. Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
    2. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Samir S. Shah M.D., M.S.C.E.,

    1. Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
    2. Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
    3. Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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  • Zeinab Mohamad M.S.,

    1. Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
    2. Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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  • Albert C. Yan M.D.

    1. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
    2. Section of Dermatology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
    3. Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
    4. Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Address correspondence to Paul L. Aronson, M.D., Division of Emergency Medicine, 3501 Civic Center Boulevard, CTRB 9th Floor, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, or e-mail: aronsonp@email.chop.edu. Dr. Aronson is currently at the Yale School of Medicine, New Haven, CT, USA.

Abstract

Abstract:  There is concern that the use of topical corticosteroids in patients with eczema herpeticum may facilitate dissemination of herpes simplex virus and worsen disease. Our primary aim therefore was to determine whether topical corticosteroid use in children hospitalized with eczema herpeticum is associated with longer hospital length of stay (LOS). We performed a multicenter retrospective cohort study of 1,331 children ages 2 months to 17 years admitted with a diagnosis of eczema herpeticum between January 1, 2001, and March 31, 2010, to 42 tertiary care children’s hospitals in the Pediatric Health Information System database. Multivariable linear regression models determined the association between receipt of topical corticosteroid therapy on the first day of hospitalization and the main outcome measure: LOS. Receipt of topical corticosteroid therapy on day 1 of hospitalization was not associated with a longer LOS on unadjusted or multivariable analysis (p = 0.75). Receipt of topical calcineurin inhibitors during the hospitalization was also not associated with a longer LOS (p = 0.12). Receipt of systemic corticosteroids was associated with an 18% adjusted longer LOS (95% confidence interval 2%–36%; p = 0.03). Further study is needed to identify which children with eczema herpeticum may benefit from topical corticosteroids, but their use during active infection is not associated with poorer outcomes, although the use of systemic corticosteroids was associated with a longer LOS and should be avoided in patients with eczema herpeticum pending future prospective study.

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