Mental health and psychosocial outcomes in survivors of severe cutaneous adverse reactions: a scoping review.

Abstract

Severe cutaneous adverse reactions (SCARs) are rare drug-induced eruptions, most notably Stevens-Johnson syndrome-toxic epidermal necrolysis (SJS-TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS). Their psychological impact is increasingly recognized, with UK guidelines for SJS-TEN recommending psychological evaluation, and a continuing medical education review for DRESS recommending monitoring for anxiety, depression and post-traumatic stress disorder (PTSD) for 1 year. However, monitoring for adverse psychosocial outcomes has not been standardized. This scoping review aims to characterize the existing literature on psychosocial outcomes in survivors of SCARs and highlight gaps in knowledge. Following the Joanna Briggs Institute guidelines, we searched MEDLINE, Embase and PsycInfo for primary literature using terms related to SCARs and psychosocial outcomes. After screening 865 records, 24 studies were included. Of these studies, 88% investigated SJS-TEN and 21% addressed DRESS. In total, 44-54% and 21-44% of survivors of SJS-TEN and 36-63% and 50% of survivors of DRESS screened positive for anxiety and depression, respectively, on the Hospital Anxiety and Depression Scale. Overall, 17-51% of survivors of SJS-TEN and 50% of survivors of DRESS had scores indicating PTSD using variations of the Impact of Events Scale. Quality of life, fear of medications and altered relationships with medical providers were also frequently identified. The heterogeneity in outcome measures underscores the need for a specific, standardized tool to assess for psychosocial complications in survivors of SCARs. This review highlights needs for improved psychosocial support in survivors of SJS-TEN and DRESS, as well as research into psychosocial outcomes in unexplored SCARs such as acute generalized exanthematous pustulosis and generalized bullous fixed drug eruption.