Stevens–Johnson syndrome and toxic epidermal necrolysis associated with increased risk of developing psychiatric disorders: A retrospective population‐based cohort study in Taiwan

Abstract

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life‐threatening adverse reactions to drugs and psychological sequelae are also observed to follow the trauma of widespread epidermal necrolysis. To delineate the association between SJS and TEN, and psychiatric disorders, we conducted a retrospective population‐based cohort study by including 212 patients diagnosed with first‐time SJS or TEN in Taiwan between 2000 and 2013 and 669 population controls. Adjusted hazard ratios were calculated after adjusting for sex, age, comorbidity in the form of Charlson comorbidity index, and facility level of care. Overall, SJS or TEN was associated with an increased risk of developing psychiatric disorders including schizophrenia, major depressive disorder, mania, anxiety, and bipolar with an adjusted hazard ratio of 1.392 (95% CI, 1.192–1.625; p < 0.001). Particularly, the adjusted hazard ratios of psychiatric disorders were 1.290 (95% CI, 1.105–1.506; p < 0.001) for SJS and 1.855 (95% CI, 1.587–2.167; p < 0.001) for TEN.

Classification of psychodermatological disorders: Proposal of a new international classification

“…62 These primary dermatoses are also associated with secondary psychiatric comorbidities which is a relevant aspect in other primary dermatoses that do not seem to present a pathophysiological link with stress, such as some examples of autoimmune bullous dermatoses (dermatitis herpetiformis, IgA bullous dermatosis), androgenetic alopecia, hidradenitis suppurativa, lichen sclerosus, toxic epidermal necrolysis, Stevens-Johnson syndrome, genodermatoses and cicatricial alopecias, particularly, primary neutrophilic cicatricial alopecias, such as folliculitis decalvans and dissecting cellulitis of the scalp. [63][64][65][66] In lymphocytic primary cicatricial alopecias, including chronic cutaneous lupus erythematosus, lichen planopilaris and frontal fibrosing alopecia, a pathophysiological link with stress could be possible, but studies are required on these dermatoses. 67,68 In the subgroup 'functional skin disorders', psychological stress can also contribute to the pathophysiology of the disorders, within a multifactorial etiopathogenesis.…”

“…In the main group ‘primary skin disorders linked with mental health’, the pathophysiological link with psychological stress was documented in the following disorders: some autoimmune bullous dermatoses (pemphigus vulgaris), 46 acne, 47 alopecia areata, 48 atopic dermatitis, 49 chronic spontaneous urticaria, 50 dermatomyositis, 51 hyperhidrosis, 52 infectious diseases (herpesviruses and warts), 53,54 lichen planus, 55 lupus erythematosus, 56 psoriasis, 57 rosacea, 58 systemic sclerosis, 59 seborrheic dermatitis, 60 telogen effluvium 61 and vitiligo 62 . These primary dermatoses are also associated with secondary psychiatric comorbidities which is a relevant aspect in other primary dermatoses that do not seem to present a pathophysiological link with stress, such as some examples of autoimmune bullous dermatoses (dermatitis herpetiformis, IgA bullous dermatosis), androgenetic alopecia, hidradenitis suppurativa, lichen sclerosus, toxic epidermal necrolysis, Stevens–Johnson syndrome, genodermatoses and cicatricial alopecias, particularly, primary neutrophilic cicatricial alopecias, such as folliculitis decalvans and dissecting cellulitis of the scalp 63–66 . In lymphocytic primary cicatricial alopecias, including chronic cutaneous lupus erythematosus, lichen planopilaris and frontal fibrosing alopecia, a pathophysiological link with stress could be possible, but studies are required on these dermatoses 67,68 …”

Psychiatric comorbidities on an inpatient dermatology consultation service: A cross‐sectional analysis

“…Although the association between psychiatric illness and all drug reactions has not been previously reported, prior studies have demonstrated connections between psychiatric disease and specific drug reactions, including after Stevens‐Johnson syndrome/toxic epidermal necrolysis. 3 The lack of association between psoriasis/dermatitis and psychiatric illness could be partially explained by aggregating multiple diseases to form this group. Nationally, the prevalence of comorbid psychiatric illness is 38.7% for psoriasis 4 versus 16.36% for atopic dermatitis.…”