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The psychological impact of Stevens-Johnson syndrome and toxic epidermal necrolysis on patients' lives: a critically appraised topic.

O'Reilly, P.; Kennedy, C.; Meskell, P.; Coffey, A.; Delaunois, I.; Dore, L.; Howard, S.; Ramsay, B.; Scanlon, C.; Wilson, D. M.; Whelan, B.; Ryan, S.

Authors

P. O'Reilly

P. Meskell

A. Coffey

I. Delaunois

L. Dore

S. Howard

B. Ramsay

C. Scanlon

D. M. Wilson

B. Whelan

S. Ryan



Abstract

A 65 year-old male presented with a 12 hour history of deteriorating rash. Two weeks previously, he had completed a course of neo-adjuvant 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 sub-epidermal blistering with epidermal necrosis. This confirmed our clinical diagnosis of overlap SJS-TEN. On transfer to ICU, he was anxious and fearful. What are the psychological impacts of SJS/TEN on this man’s life? SJS and TEN have devastating outcomes for those affected. The aim of this study was to conduct a critically-appraised topic (CAT), in order to: (1) analyse existing research related to the psychological impact of SJS and TEN; and (2) apply the results to the clinical scenario. Seven electronic databases were searched for publications, focusing on the psychological impact of SJS TEN on adults over eighteen years of age. Six studies met inclusion criteria. Health care 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. The evidence suggests that SJS and TEN impact psychologically on patients' lives. Education of HCPs - in order 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.

Journal Article Type Article
Journal British journal of dermatology
Print ISSN 0007-0963
Electronic ISSN 1365-2133
Publisher Wiley Open Access
Peer Reviewed Peer Reviewed
Institution Citation O'REILLY, P., KENNEDY, C., MESKELL, P., COFFEY, A., DELAUNOIS, I., DORE, L., HOWARD, S., RAMSAY, B., SCANLON, C., WILSON, D.M., WHELAN, B. and RYAN, S. 2019. The psychological impact of Stevens-Johnson syndrome and toxic epidermal necrolysis on patients' lives: a critically appraised topic. British journal of dermatology [online], Early View. Available from: https://doi.org/10.1111/bjd.18746
DOI https://doi.org/10.1111/bjd.18746
Keywords Stevens-Johnson syndrome (SJS); Toxic epidermal necrolysis (TEN); Patients; Psychological impact; Health care practitioners
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