Stevens-Johnson Syndrome in a Patient of Color: A Case Report and an Assessment of Diversity in Medical Education Resources

Abstract

This is a review of a patient encounter that underscores the common trend of insufficient inclusivity and lack of diversity regarding skin of color representation in teaching materials including textbooks in the medical education setup. A Black woman who was treated with carbamazepine for trigeminal neuralgia after a dental procedure presented with upper airway breathing difficulties and facial pain and swelling. After doubling her dose of carbamazepine as advised by her primary care physician, her symptoms continued to worsen, and she was treated in the emergency department for a presumed allergic reaction of unknown etiology. Two days later, her symptoms progressively worsened. She self-admitted to the emergency department, where she required cardiopulmonary resuscitation. Eventually, the formal diagnosis of carbamazepine-induced Stevens-Johnson syndrome (SJS) was made based on history, clinical presentation, and skin biopsy.The nature of the disease progression in this case prompted our investigation into the lack of representation of skin of color in current medical training resources regarding SJS. Our assessment demonstrates that there is a significant underrepresentation of SJS in skin of color in medical educational resources. Increased inclusivity of skin disorders in patients of color is crucial in training healthcare professionals to recognize life-threatening cutaneous disorders quickly and accurately in such patients.

Comparison of visual diagnostic accuracy of dermatologists practicing in Germany in patients with light skin and skin of color

“…Nevertheless, the participants’ rate of only 11% of correct diagnoses of tinea corporis in PoC is worrisome. Of equal concern was the fact that 68.1% of the cohort did not recognize the life-threatening disease of TEN in PoC 28 , 36 , 37 . However, not all cases were better and more confidently diagnosed in patients with Ls than in patients with SoC.…”

Toxic Epidermal Necrolysis in a Critically Ill African American Woman: A Case Report Written With ChatGPT Assistance

“…Medical textbooks and education materials have an inherent lack of skin-of-color representation, which can contribute to delayed recognition by the healthcare team [15]. Dutt et al in 2020 showcased African American patients who were evaluated two to three times for mucocutaneous lesions before being admitted for a diagnosis of SJS [16].…”

“…Medical textbooks and education materials have an inherent lack of skin-of-color representation, which can contribute to delayed recognition by the healthcare team [ 15 ]. Dutt et al.…”

SJS/TEN immune-related dermatologic reaction secondary to immune checkpoint inhibitor pembrolizumab in skin of color

“…SJS/TEN has a variety of possible skin presentations including decentralizing atypical targetoid macules resulting in dusky plaques and subsequent skin-sloughing, macular targetoid lesions, or flaccid bullous lesions ( Diep et al, 2022 ). The percentage of body surface area (BSA) affected in SJS and TEN is what differentiates the two conditions; SJS affects < 10 % BSA, while TEN affects > 30 %BSA, and overlapping SJS/TEN covers between 10 and 30 % BSA ( Barvaliya et al, 2011 ).…”

“…However, majority of the images in medical textbooks and google search images primarily showcase SJS presentations on light and white skin tones as opposed to medium to dark skin tones. Lack of exposure to images of SJS on darker skin tones in medical education can result in delays when caring for minority groups, which could translate to inferior outcomes, especially when associated with new drug classes, such as immune checkpoint inhibitors, like pembrolizumab ( Diep et al, 2022 ).…”