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  • Presentation

Great Debates in Medical Dermatology: SJS/TEN - Acute Reaction or Chronic Disease?

Description

The debate surrounding Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) addresses whether it is primarily an acute reaction or a chronic disease, emphasizing the long-term implications for patients. Survivors experience significant long-term health issues, with many reporting persistent cutaneous, ocular, and oral problems, along with mental health challenges like depression and PTSD. Evidence suggests that patients with severe forms of SJS/TEN have an increased risk of chronic sequelae, while the timing of treatment does not correlate with these long-term outcomes. Dermatologists, as specialists in this condition, are urged to play a proactive role in post-discharge care, advocating for patients and ensuring they are informed about their condition and treatment. The creation of a discharge passport is proposed as a tool to guide ongoing care and specialist referrals, highlighting the critical ongoing responsibilities dermatologists have in managing patient health beyond the initial acute phase of SJS/TEN.

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Conclusions

  • Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a lifelong disorder with significant long-term sequelae.
  • Patients experience high rates of long-term physical and psychological complications following SJS/TEN.
  • The majority of SJS/TEN survivors report issues such as long-term cutaneous, ocular, and oral problems.
  • Many survivors screen positive for depression and PTSD, indicating mental health challenges post-illness.
  • SJS/TEN significantly impacts survivors' quality of life, evidenced by decreased mental and physical well-being.
  • Over one-quarter of patients are unable to work post-illness, affecting their economic stability.
  • Lack of education about medication safety persists among SJS/TEN survivors, leading to medication non-adherence.
  • Patients with severe mucosal involvement and higher body surface area involvement are at greater risk of severe long-term sequelae.
  • Timely clinical interventions do not necessarily correlate with improved long-term outcomes for SJS/TEN survivors.
  • Dermatologists play a crucial role in managing long-term care and should ensure follow-up consultations for all SJS/TEN patients post-discharge.
  • Noe MH, Rosenbach M, Hubbard RA, Mostaghimi A, Cardones AR, Chen JK, et al. Development and Validation of a Risk Prediction Model for In-Hospital Mortality Among Patients With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis-ABCD-10. JAMA Dermatol. 2019 Apr 1;155(4):448-454.
  • Mitchell C, Mostaghimi A, Ortega-Loayza AG. Supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults. J Am Acad Dermatol. 2020 Jun;82(6):1553-1567.
  • Hoffman M, Chansky PB, Bashyam AR, Boettler MA, Challa N, Dominguez A, et al. Long-term Physical and Psychological Outcomes of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. JAMA Dermatol. 2021 Jun 1;157(6):712-715.
  • Lifetime risk, life expectancy, loss-of-life expectancy and lifetime healthcare expenditure for Stevens-Johnson syndrome/toxic epidermal necrolysis in Taiwan: follow-up of a nationwide cohort from 2008 to 2019. Br J Dermatol 2023; 189:553-560.