Published: 3 September 2020

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DRESS syndrome – Monitor for long-term sequelae

Published: 3 September 2020
Prescriber Update 41(3): 51
September 2020

DRESS syndrome is a type of SCAR

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a type of severe cutaneous adverse reaction (SCAR).¹ It is characterised by a rash, haematologic abnormalities (eosinophilia, atypical lymphocytosis), lymphadenopathy and internal organ involvement, typically 2-8 weeks after exposure to the offending drug.^1,2

DRESS symptoms, diagnosis and commonly associated medicines have been described in previous issues of Prescriber Update.^3,4

Long-term autoimmune sequelae

Patients are at risk of long-term autoimmune sequelae following recovery from DRESS syndrome.^5,6 Retrospective cohort studies have reported autoimmune sequelae such as Graves’ disease, Hashimoto’s thyroiditis, type 1 diabetes mellitus, systemic lupus erythematosus, alopecia areata and autoimmune haemolytic anaemia in patients who have recovered from DRESS syndrome.^5,6

The pathogenic mechanism leading to the development of autoimmune disease months to years after the acute drug reaction is not well understood.^5,6 Reactivation of human herpes viruses (HHVs) in DRESS syndrome may play a role in the development of autoimmune sequelae.²

Long-term monitoring required following DRESS syndrome

Patients with DRESS syndrome require careful long-term follow-up for symptoms and signs of autoimmune disease.⁶

References

1. Bellón T. 2019. Mechanisms of severe cutaneous adverse reactions: recent advances. Drug Safety 42: 973–92. DOI: https://doi.org/10.1007/s40264-019-00825-2 (accessed 29 June 2020).
2. Shiohara T, Mizukawa Y. 2019. Drug-induced hypersensitivity syndrome (DiHS)/drug reaction with eosinophilia and systemic symptoms (DRESS): an update in 2019. Allergology International 68: 301–8. DOI: https://doi.org/10.1016/j.alit.2019.03.006 (accessed 14 July 2020).
3. Medsafe. 2017. DRESS: a pleat for help. Prescriber Update 38(2): 20–1. URL: medsafe.govt.nz/profs/PUArticles/June2017/DRESS.htm (accessed 14 July 2020).
4. Medsafe. 2011. DRESS syndrome: remember to look under the skin. Prescriber Update 32(2): 12-13. URL: medsafe.govt.nz/profs/PUArticles/DRESSsyndromeJune2011.htm (accessed 14 July 2020).
5. Chen Y-C, Chang C-Y, Cho Y-T, et al. 2013. Long-term sequelae of drug reaction with eosinophilia and systemic symptoms: a retrospective cohort study from Taiwan. Journal of the American Academy of Dermatology 68(3): 459–65. DOI: http://dx.doi.org/10.1016/j.jaad.2012.08.009 (accessed 14 July 2020).
6. Kano Y, Tohyama M, Aihara M, et al. 2015. Sequelae in 145 patients with drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms: survey conducted by the Asian Research Committee on Severe Cutaneous Adverse Reactions (ASCAR). Journal of Dermatology 42: 276–82. DOI: 10.1111/1346-8138.12770 (accessed 14 July 2020).