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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

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.

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. 2020. The psychological impact of Stevens-Johnson syndrome and toxic epidermal necrolysis on patients' lives: a critically appraised topic. British journal of dermatology [online], 183(3), pages 452-461. Available from: https://doi.org/10.1111/bjd.18746

Journal Article Type Article
Acceptance Date Nov 27, 2019
Online Publication Date Jan 11, 2020
Publication Date Sep 30, 2020
Deposit Date Dec 18, 2019
Publicly Available Date Dec 18, 2019
Journal British journal of dermatology
Print ISSN 0007-0963
Electronic ISSN 1365-2133
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 183
Issue 3
Pages 452-461
DOI https://doi.org/10.1111/bjd.18746
Keywords Stevens-Johnson syndrome (SJS); Toxic epidermal necrolysis (TEN); Patients; Psychological impact; Health care practitioners
Public URL https://rgu-repository.worktribe.com/output/782625

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