Figure 1. Medical algorithm: Diagnosis and treatment of DRESS.
Suspicious skin rashes with or without eosinophilia should be investigated by comprehensive medical history, examination and lab work. If the results from this investigation are in line with the diagnosis of DRESS and other organ involvement is suspected, a complementary, patient-specific work-up is indicated. This includes individual, symptom-specific examination of liver, lung, heart, kidney, gastrointestinal tract, pancreas, and the nerve system. Based on the extent of organ involvement, mild, moderate and severe DRESS can be differentiated. These are treated by high potent topical steroids or systemic glucocorticoids, respectively. The culprit drug must be stopped. In case of steroid-refractory DRESS, second line therapy is indicated. The first follow up visits shall be scheduled one month after discharge and include clinical and laboratory controls. Patch testing, intracutaneous testing and, if available, lymphocyte transformation test (LTT) or ELISPOT, shall be performed. AP: Alkaline phosphatase, ALT: Alanine transaminase, AST: Aspartate aminotransferase, CNS: Central nervous system, CT: Computed tomography, IVIG: Intravenous immunoglobulins, JAK: janus kinases, MRI: Magnetic resonance imaging, PNS: Peripheral nervous system.
§Severity assessment: According those of the French RCT DRESSCODE https://clinicaltrial.gov NCT01987076.