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An international scoping review of epidemiologic studies on severe cutaneous adverse reactions
Jeayoon Lee1, Hee Jung Ha1, Minoh Ko1,2
1College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea.
Background:
Severe cutaneous adverse reactions (SCARs) are rare but potentially life-threatening drug hypersensitivity reactions. Understanding their epidemiology is critical for improving patient management and informing preventive strategies.
Objective:
This scoping analysis aims to systematically examine international epidemiologic studies on SCARs, identify geographic patterns and research gaps, and propose directions for future SCAR epidemiology research.
Methods:
A scoping review of observational studies on SCAR epidemiology published between January 2018 and July 2025 was conducted using PubMed and Embase. Studies were selected based on predefined criteria, with additional hand-searching. Data were extracted on study design, geographic region, data sources, and culprit drug classes.
Results:
A total of 143 studies were included. The Asia-Pacific region accounted for the largest share (55.9%), followed by Europe (20.9%) and North America (16.8%), with limited representation from Africa and South America. Hospital medical records were the most common data source (54.5%), followed by pharmacovigilance databases (23.1%) and registries (13.3%). Most studies focused on general SCAR epidemiology (58.4%), with others addressing drug-specific (28.7%) and pediatric SCAR (13.3%). Traditional high-risk drugs including anticonvulsants, antigout agents, antibiotics, and antipyretics were reported across all regions, while antituberculosis drugs and traditional medicines were more frequent in the Asia-Pacific. Emerging trends include immune checkpoint inhibitor (ICI)-related SCARs, reflecting the expanding use of novel cancer therapies.
Conclusion:
Substantial regional disparities were identified in SCAR epidemiology research. These findings highlight the need for standardized data collection, expanded surveillance infrastructure, and region-specific strategies to improve international drug safety as well as SCAR prevention and management.
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