Treatments for SCAR

For mild to severe reactions

Find out about our Research

Treatments for SCAR

For mild to severe reactions

Find out about our Research

Key Approaches to Therapeutic Management

Effective management of severe adverse drug reactions begins with prompt identification and elimination of the offending medication. Supportive care, often provided in intensive or burn units, is crucial for addressing complex cases such as SCARs. These general principles are vital for optimizing patient outcomes.

Mild reactions

  • Antihistamines
  • Topical corticosteroids
  • Reassurance and monitoring

SJS/TEN

  • Admission to a specialised unit (burn unit or intensive care unit)
  • Fluid and electrolyte balance
  • Pain management and nutritional support
  • Wound care with non-adhesive dressings
  • Controversial: systemic corticosteroids, IVIG, cyclosporine; very successful use of JAK inhibitors (aproctinib) has recently been reported.

DRESS
Systemic corticosteroids (e.g. prednisone 1 mg/kg/day)
Taper off over 6–8 weeks to avoid relapse
Monitor organ function
In severe cases, biologics that inhibit eosinophils, such as IL5 inhibitors (mepolizumab, reslizumab) or IL-5 receptor inhibitors (benralizumab), can also effectively control severe eosinophilia.

Alternative treatments

  • Desensitisation protocols and drug substitutions may be necessary for TB and HIV
  • Use of alternative ART therapies (e.g. avoidance of nevirapine in case of previous reaction), which are now also widely available in resource-poor areas

 

Strategies to improve the management of SCAR in sub-Saharan Africa

Strengthening pharmacovigilance:

  •  Development of national databases for reporting adverse drug reactions
  • Training of healthcare personnel in the recognition and reporting of CDRs

Capacity building:

  • Training frontline clinicians in dermatological emergencies
  • Use of teledermatology to consult specialists in remote areas

Improvements in diagnostics:

  • Establishment of low-cost skin biopsy services in referral centres or backup by tel-histopathology of the skin
  • Introduction of rapid point-of-care tests for liver/kidney function

Improving access to essential medicines:

  • Ensuring the availability of corticosteroids, cyclosporine and wound dressings
  • Inclusion of essential medicines for the treatment of SCARs in national drug lists and the WHO List of Essential Medicines (EML)

Public and patient education:

  • Raising awareness of the risks of freely available, unregulated remedies, whether commercially manufactured or traditional herbal remedies.
  • Promoting adherence to prescribed therapies and early access to medical care

Research and data collection:

  • Supporting local epidemiological studies
  • Promoting pharmacogenomic studies to identify risk alleles (e.g. HLA-B58:01 for allopurinol, HLA-B15:02 for carbamazepine)
  • Better understanding of the mechanisms leading to SCAR, including at the cellular and immunological level in resource-poor areas. Identification of interactions between parasite infection and drug allergies, both of which are influenced by eosinophilic white blood cells.

Policy and advocacy:

  • Advocacy for the inclusion of dermatology in national health priorities
  • Collaboration with NGOs and international partners for technical support. Connection of centres from LMICs to networks such as