The psychological impact of Stevens–Johnson syndrome and toxic epidermal necrolysis on patients’ lives: a Critically Appraised Topic*

Abstract

Summary Clinical scenario A 65‐year‐old man presented with a 12‐h history of deteriorating rash. Two weeks previously he had completed a course of neoadjuvant chemotherapy for ductal carcinoma of the breast. On examination there were bullae, widespread atypical targetoid lesions and 15% epidermal detachment. There was no mucosal involvement on presentation, but subsequently it did evolve. Skin biopsy showed subepidermal blistering with epidermal necrosis. This confirmed our clinical diagnosis of overlap Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). On transfer to intensive care he was anxious and fearful. Management question What are the psychological impacts of SJS/TEN on this man's life? Background SJS and TEN have devastating outcomes for those affected. Objectives To conduct a Critically Appraised Topic to (i) analyse existing research related to the psychological impact of SJS and TEN and (ii) apply the results to the clinical scenario. Methods Seven electronic databases were searched for publications focusing on the psychological impact of SJS/TEN on adults over 18 years of age. Results Six studies met the inclusion criteria. Healthcare practitioners’ (HCPs’) lack of information around the disorder was highlighted. Patients experienced undue stress and fear. Some patients had symptoms aligned to post‐traumatic stress disorder (PTSD), anxiety and depression. Discussion and recommendation The evidence suggests that SJS and TEN impact psychologically on patients’ lives. Education of HCPs, to address their lack of awareness and information on SJS/TEN, should facilitate their capacity to provide information and support to patients, thereby reducing patient anxiety. On discharge, a follow‐up appointment with relevant HCPs to reduce the possibility of PTSD occurring should be considered.

Chronic pain: a long‐term sequela of epidermal necrolysis (Stevens–Johnson syndrome/toxic epidermal necrolysis) – prevalence, clinical characteristics and risk factors

“…The psychological impact of SJS/TEN has been rarely studied, although patients experienced intense stress, anxiety and fear during the acute disease phase management. In 2019, one meta‐analysis only retrieved six studies published on this topic 20 . In small series with late follow‐up of SJS/TEN patients, the occurrence of PTSD has been found in one‐third of six patients 21 and two‐thirds of 17 patients 22 .…”

Reactive infectious mucocutaneous eruption: Mycoplasma pneumoniae ‐induced rash and mucositis and other parainfectious eruptions

“…There are currently no guidelines. A comprehensive approach to management includes behavioural, supportive, skin-directed, antimicrobial and immunomodulatory therapies 46,52,[58][59][60] ( Table 8). Patients with MIRM do not generally require specialized care in a burn or intensive care unit.…”

“…Usual tests for Mycoplasma pneumoniae infection a 58,59. Mycoplasma pneumoniae; NP, nasopharyngeal swab, OP, oropharyngeal swab.…”

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

“…Stevens-Johnson syndrome and TEN have an annual incidence of about 1 to 7 cases per million people per year, 3,6,7 with SJS cases outnumbering TEN cases by nearly 3-fold. 6 For unknown reasons, women are more likely than men to suffer from SJS and TEN, 6 and rates are higher in pediatric patients younger than 10 years and adults older than 80 years.…”