Elisa Funck-Brentano1, Tu-Anh Duong1, Sophie Bouvresse2, Martine Bagot3, Pierre Wolkenstein1, Jean-Claude Roujeau1, Olivier Chosidow1, Laurence Valeyrie-Allanore4. 1. Dermatology Department, Assistance Publique-Hõpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Université Paris Est Créteil (UPEC), Créteil, France; Referral Center for Toxic and Autoimmune Diseases, Assistance Publique-Hõpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Université Paris Est Créteil (UPEC), Créteil, France. 2. Dermatology Department, Assistance Publique-Hõpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Université Paris Est Créteil (UPEC), Créteil, France. 3. Department of Dermatology, Hôpital Saint Louis, Assistance Publique-Hõpitaux de Paris (AP-HP), Université Paris VII, Sorbonne Paris Cité, Paris, France. 4. Dermatology Department, Assistance Publique-Hõpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Université Paris Est Créteil (UPEC), Créteil, France; Referral Center for Toxic and Autoimmune Diseases, Assistance Publique-Hõpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Université Paris Est Créteil (UPEC), Créteil, France. Electronic address: laurence.allanore@hmn.aphp.fr.
Abstract
BACKGROUND: There is no consensus regarding treatment for drug reaction with eosinophilia and systemic symptoms (DRESS). OBJECTIVES: We report a single-center observational series of therapeutic management of DRESS. METHODS: We examined data for 50 consecutive patients admitted from March 2005 to June 2009 with a discharge diagnosis of DRESS (RegiSCAR score). RESULTS: For the 38 patients with a DRESS score of 4 or more, topical steroid treatment alone was initiated in 66% of cases. On admission, 13 patients received systemic steroids; in 7 of them, systemic steroid treatment was initiated or maintained for life-threatening organ failure, with kidney, lung, and/or nervous system involvement. Complications of DRESS, such as relapse, viral reactivation, and sepsis, were less frequent with topical steroid than with systemic steroids. None of the patients died during their stay in hospital. LIMITATIONS: Retrospective nonblinded design and dermatologic recruitment are limitations. The variables underlying the choice of treatment study were not analyzed. CONCLUSIONS: Systemic steroids may not be required for the management of mild forms of DRESS, and may thus be reserved for more severe cases. Prospective studies are required to evaluate strategies for treating DRESS.
BACKGROUND: There is no consensus regarding treatment for drug reaction with eosinophilia and systemic symptoms (DRESS). OBJECTIVES: We report a single-center observational series of therapeutic management of DRESS. METHODS: We examined data for 50 consecutive patients admitted from March 2005 to June 2009 with a discharge diagnosis of DRESS (RegiSCAR score). RESULTS: For the 38 patients with a DRESS score of 4 or more, topical steroid treatment alone was initiated in 66% of cases. On admission, 13 patients received systemic steroids; in 7 of them, systemic steroid treatment was initiated or maintained for life-threatening organ failure, with kidney, lung, and/or nervous system involvement. Complications of DRESS, such as relapse, viral reactivation, and sepsis, were less frequent with topical steroid than with systemic steroids. None of the patients died during their stay in hospital. LIMITATIONS: Retrospective nonblinded design and dermatologic recruitment are limitations. The variables underlying the choice of treatment study were not analyzed. CONCLUSIONS: Systemic steroids may not be required for the management of mild forms of DRESS, and may thus be reserved for more severe cases. Prospective studies are required to evaluate strategies for treating DRESS.
Authors: Jonathan Grant Peter; Rannakoe Lehloenya; Sipho Dlamini; Kimberly Risma; Katie D White; Katherine C Konvinse; Elizabeth J Phillips Journal: J Allergy Clin Immunol Pract Date: 2017 May - Jun
Authors: Rebecca Pavlos; Katie D White; Celestine Wanjalla; Simon A Mallal; Elizabeth J Phillips Journal: Immunol Allergy Clin North Am Date: 2017-11 Impact factor: 3.479