Original articleTherapeutic management of DRESS: A retrospective study of 38 cases
Section snippets
Patients
We retrospectively screened all consecutive patients admitted to our department from March 2005 to June 2009 who received steroids and had a discharge diagnosis of DRESS. The final diagnosis was validated by a review committee (J-C. R., L. V-A., S. B.), using the RegiSCAR DRESS score,6 with blinding to any risk factors. Each case was scored (4-5 = probable case; >5 = definite case); we considered only cases with a score of 4 or more.
We collected clinical and epidemiologic data, including
Description of the population
We analyzed data for 50 consecutive patients with a discharge diagnosis of DRESS; 38 patients had a RegiSCAR score of 4 or more, indicating probable DRESS, and were included in the study (Fig 1). The patients treated with topical and systemic steroids did not differ in age (median age: 49 ± 22 years [range: 16-87 years] vs 54 ± 22 years [range: 20-88 years], respectively, P = .66) or sex (number of female: n = 14/25 [56%] vs n = 5/13 [38%], respectively, P = .2) (data not shown).
The drugs
Discussion
Published guidelines for the treatment of DRESS are currently lacking. Only a few observational series have focused on the therapeutic management of this syndrome.14, 17 Systemic corticosteroids have long been considered the mainstay treatment for DRESS.8 Intravenous and oral pulse strategies are currently proposed.18, 19, 20, 21 Topical corticosteroids are effective alternative treatments for dermatologic diseases, such as bullous pemphigoid,22 decreasing the number of severe adverse events.
References (34)
Clinical heterogeneity of drug hypersensitivity
Toxicology
(2005)- et al.
Long-term sequelae of drug reaction with eosinophilia and systemic symptoms: a retrospective cohort study from Taiwan
J Am Acad Dermatol
(2013) - et al.
DRESS syndrome, part II: management and therapeutics
J Am Acad Dermatol
(2013) - et al.
Short- and long-term outcomes of 34 patients with drug-induced hypersensitivity syndrome in a single institution
J Am Acad Dermatol
(2013) - et al.
Management of drug reaction with eosinophilia and systemic symptoms (DRESS) [in French]
Ann Dermatol Venereol
(2010) - et al.
Virus reactivation and intravenous immunoglobulin (IVIG) therapy of drug-induced hypersensitivity syndrome
Toxicology
(2005) - et al.
Successful treatment of lamotrigine-associated drug hypersensitivity syndrome with intravenous IgG
J Am Acad Dermatol
(2012) - et al.
Drug-induced pseudolymphoma and drug hypersensitivity syndrome (drug rash with eosinophilia and systemic symptoms: DRESS)
Semin Cutan Med Surg
(1996) - et al.
Anticonvulsant hypersensitivity syndrome
Arch Intern Med
(1995) - et al.
Risk of serious cutaneous disorders after initiation of use of phenytoin, carbamazepine, or sodium valproate: a record linkage study
Neurology
(1997)
The diagnosis of a DRESS syndrome has been sufficiently established on the basis of typical clinical features and viral reactivations
Br J Dermatol
Variability in the clinical pattern of cutaneous side-effects of drugs with systemic symptoms: does a DRESS syndrome really exist?
Br J Dermatol
Drug reaction with eosinophilia and systemic symptoms (DRESS): an original multisystem adverse drug reaction. Results from the prospective RegiSCAR study
Br J Dermatol
Severe adverse cutaneous reactions to drugs
N Engl J Med
Drug rash with eosinophilia and systemic symptoms induced by valproate and carbamazepine: formation of circulating auto-antibody against 190-kDa antigen
Acta Derm Venereol
Minocycline hypersensitivity syndrome with hypotension mimicking septic shock
Pediatr Dermatol
Drug-induced hepatitis with autoimmune features during minocycline therapy
Intern Med
Cited by (107)
Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. Part II diagnosis and management
2024, Journal of the American Academy of DermatologyDrug-Induced Hypersensitivity Syndrome/Drug Reaction With Eosinophilia and Systemic Symptoms: Predictive Score and Outcomes
2023, Journal of Allergy and Clinical Immunology: In PracticeClinical features and prognostic factors of severe cutaneous adverse drug reactions: A single-center retrospective study of 209 cases in China
2023, International ImmunopharmacologyCitation Excerpt :For DRESS, allopurinol, TCM, NSAIDs, and sulfasalazine were the most common causative drugs in our and other studies [8,17]. The difference is that antiepileptic drugs (carbamazepine, oxcarbazepine, and phenobarbital) are relatively infrequent in our study compared to other studies [27–30]. For SJS/TEN, antibiotics and anticonvulsants were the most frequent causative drugs in our study, which was similar to multicenter studies in European [23,31]and research in China [32,33].
Clinical aspects and therapeutic approach of drug-induced adverse skin reactions in a quaternary hospital: a retrospective study with 219 cases
2022, Anais Brasileiros de DermatologiaDrug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Series of 49 French Pediatric Cases
2022, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Furthermore, the rash appears to resolve more rapidly (16 vs 23.5 days). These results are consistent with those of Funck-Brentano et al33 and Uhara et al,34 who suggested that TS can be used in patients with nonsevere DRESS. Treatment with SC might favor relapse30; it is often prolonged and carries an infection risk.35,36
Successful treatment of corticosteroid-dependent drug reaction with eosinophilia and systemic symptoms with cyclosporine
2021, Annals of Allergy, Asthma and Immunology
Dr Funck-Brentano is currently affiliated with the Department of Dermatology, Hôpital Ambroise Paré, Boulogne-Billancourt, France.
Funding sources: None.
Conflicts of interest: None declared.