Post-traumatic stress disorder in Stevens-Johnson syndrome and toxic epidermal necrolysis: prevalence and risk factors. A prospective study of 31 patients.

BACKGROUND: Epidermal necrolysis is a rare and severe cutaneous adverse reaction to drugs with long-term somatic consequences and potentially underrecognized psychological complications. OBJECTIVES: To assess the prevalence and risk factors of post-traumatic stress disorder (PTSD) in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in a population of adults undergoing psychiatric evaluation. METHODS: In this prospective study, we included adult patients admitted at the acute phase of SJS/TEN to our dermatology department from June 2009 to February 2013. The main objective was to assess the prevalence of PTSD at 6 months after the acute disease phase, defined by a PTSD Checklist score > 44. Secondary objectives were to investigate risk factors of PTSD in the medical history of patients and characteristics of the disease at the acute phase by the Peritraumatic Dissociative Experience Questionnaire (PDEQ) and Peritraumatic Distress Inventory (PDI) and the degree of impairment on the Sheehan Disability Scale. RESULTS: We initially included 32 of 80 patients admitted during the study period. At 6 months, seven of 30 still followed up had a PTSD Checklist score > 44, suggesting a PTSD prevalence of 23%; 23 (77%) patients had a hydroxyzine prescription at the acute phase. The main risk factors associated with PTSD at 6 months were psychological results at the acute phase. CONCLUSIONS: Despite frequent prescription of hydroxyzine at the acute phase, almost one-quarter of patients with SJS/TEN had PTSD at 6 months. A systematic psychiatric evaluation should be offered regularly for at least 1 year after the acute disease phase.

[Neglected skin tumors. Three cases]. / Tumeurs "historiques": tumeurs négligées. Trois observations.

BACKGROUND: Giant skin tumours are defined as greater than 10 cm in size and are frequently a consequence of neglect. We report three cases of giant skin tumours and discuss possible factors associated with delayed diagnosis and treatment. OBSERVATIONS: Two men and one woman, aged 52, 62 and 78 years, presented with giant skin tumours. One was mentally retarded, one had a borderline personality and another was presenting a major depressive disorder. Pain, smell, bleeding and/or loss of function forced the patients to seek medical care. Tumour sizes were 11 to 30 cm and were present for between six months and 20 years. All patients had hidden their lesion from their doctor and families. In one case, a sebaceous carcinoma of the right shoulder required amputation of the right upper limb. In a second, palliative surgery and medical care was given for a metastatic porocarcinoma. The last patient received neoadjuvant chemotherapy for an undifferentiated carcinoma. DISCUSSION: Neglected skin tumours continue to be encountered even in 2011. Consultation was delayed due to fear of the diagnosis and/or lack of corresponding physicians, resulting in worsening of the prognosis. A larger scale study could help us to identify the factors associated with neglected giant tumours and to improve their management.