Here’s Dr. Bart with today’s Morning Report!

 

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS)

 

PRESENTATION:

  • ­Typical onset 2­6 weeks (within 2 months)
  • ­Most common inciting drugs:
    • Aromatic Anticonvulsants: Phenytoin, phenobarbital, allopurinol, sulfa
    • NSAIDS, antiretroviral medications, ACE inhibitors, calcium channel blockers, antibiotics
  • ­Fever and rash then systemic symptoms which may present as malaise
  • Eosinophilia (30%)
  • Hepatic and renal dysfunction
  • High mortality rate ­ 8­10%

 

APPEARANCE:

  • ­Variable, symmetric generally on trunk and extremities
  • Erythematous and scaly to blistering (exfoliative erythroderma to SJS)
  • Morbilliform eruption similar to exanthematous drug eruption which may progress to exfolitiative dermatitis/erythroderma → purpura and sterile pustules.
  • Scaling and/or desquamation possible with healing
  • Facial edema

 

TREATMENT:

  • ­STOP inciting medication
  • Steroids
  • Supportive care: antipyretics and antipruritics
  • Admission
  • Genetics counseling ­ may be genetic disposition in ability to metabolize certain drugs

 

References:

  1. Thomas J, Perron AD, Brady WJ. Chapter 245. Serious Generalized Skin Disorders. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, CydulkaRK, Meckler GD, T. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7e. New York, NY: McGraw­Hill; 2011.

    http://accessmedicine.mhmedical.com.newproxy.downstate.edu/content.aspx?bookid=348&Sectionid=40381732

  2. Velez NF, Saavedra AP. Chapter 142. Adverse Cutaneous Drug Reactions. In: McKean SC, Ross JJ, Dressler DD, Brotman DJ, Ginsberg JS. eds. Principles and Practice of Hospital Medicine. New York, NY: McGraw­Hill; 2012. http://accessmedicine.mhmedical.com.newproxy.downstate.edu/content.aspx?bookid=496&Sectionid=41304123.
  3. Wolff K, Johnson R, Saavedra AP. Section 23. Adverse Cutaneous Drug Reactions1. In: Wolff K, Johnson R, Saavedra AP. eds. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 7e. New York, NY: McGraw­Hill; 2013. http://accessmedicine.mhmedical.com.newproxy.downstate.edu/content.aspx?bookid=682&Sectionid=45130155.
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Jay Khadpe MD

  • Editor in Chief of "The Original Kings of County"
  • Assistant Professor of Emergency Medicine
  • Assistant Residency Director
  • SUNY Downstate / Kings County Hospital

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Categories: Immune/Inflammatory

Jay Khadpe MD

  • Editor in Chief of “The Original Kings of County”
  • Assistant Professor of Emergency Medicine
  • Assistant Residency Director
  • SUNY Downstate / Kings County Hospital

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