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:
- 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
- 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.
- 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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