Prospective longitudinal study of psychological sequelae, self-perception of body image, and quality of life in severe cutaneous adverse drug reactions: a case-control study

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Background Severe cutaneous adverse drug reactions (SCARs) are associated with mental health sequelae and reduced quality of life. However, existing research is limited by small retrospective cohorts, overrepresentation of high-income countries, lighter skin tones, inadequate controls, and a paucity of prospective longitudinal case-control studies assessing the psychological sequelae in SCAR. Objective This study aimed to prospectively determine and compare the longitudinal trajectories of psychological sequelae in patients with SCAR and controls. Methods Between June 2020 and October 2023, SCAR cases and matched controls were recruited. The following validated instruments were used for assessments: (1) the MINI International Neuropsychiatric Interview to assess depression and suicide risk; (2) the Kessler Psychological Distress Scale (K10) to determine pre-existing depression; (3) the Cutaneous Body Image (CBI) scale to measure self-perception of body image; and (4) the Dermatology quality life index (DQLI) to measure the impact of SCAR on health-related quality of life (QoL). Assessments were conducted at admission (baseline or t 0 ), 6 months ( t 1 ), and 12 months ( t 2 ) after the development of SCARs. Results Total of 47 SCAR cases (8 SJS/TEN, 35 DRESS, and 4 GBFDE) and 30 controls were recruited. All had Fitzpatrick skin types ≥III. Cases had significantly higher prevalence of depression [21/47 (45%) vs. 4/30 (13.3′%), p = 0.006] and suicide risk [12/21 (57%) vs. 1/4 (25%), p = 0.012] compared to controls at t 0. This was maintained at t 1 and t 2 . Of 45 cases, 36 (80%) had severe negative self-perception, significantly more than in controls [10/18 (56%), p = 0.023] at t 0 . Among the cases, 20% continued to experience this negative self-perception, while 9% experienced a deterioration over time. Only one showed persistent negative self-perception among controls. At t 0, cases had significantly impaired QoL compared to controls , with a median (IQR) DLQI score of [9.3 (4–15) vs. 1.5 (0–3), p < 0.001]. However, this effect was lost over time. A major limitation of the study was the high rate of loss-to-follow-up due to coronavirus disease 2019 (COVID-19). Conclusion SCARs were found to be associated with a high risk of depression, suicide, impaired QoL, and severe negative self-perception compared to controls. SCAR patients demonstrated persistent or worsening impairments at 6 months and relapses at 12 months. These findings highlight the ongoing psychosocial burden of SCARs and the need for integrated mental health support.

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