Topical on par with systemic corticosteroids for DRESS syndrome

A recent study has shown no significant differences in outcomes between initial topical and systemic corticosteroid therapy among patients with drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome.

A team of investigators conducted a multicentre retrospective cohort study involving 359 adults hospitalized for DRESS syndrome at two tertiary centres (2012‒2021). They categorized patients by initial therapy as topical corticosteroids only or systemic corticosteroids.

Thirty-day mortality and discharge were the primary outcomes. The investigators adjusted overlap propensity score weighting for demographics, comorbidities, and baseline severity markers.

Of the hospitalized patients, 124 (35 percent) received initial treatment with topical corticosteroids and 235 with systemic with or without topical corticosteroids. Subsequently, 56 patients (45 percent) in the topical group required escalation to systemic therapy.

The weighted 30-day mortality rate was 2.0 per 1,000 person-days for the topical group and 2.9 per 1,000 person-days for the systemic group (hazard ratio [HR], 1.56, 95 percent confidence interval [CI], 0.19‒12.94), while the 30-day discharges rates were 76.2 and 92.9, respectively (HR, 1.22, 95 percent CI, 0.87‒1.71).

“Of the whole cohort, 19 percent were successfully managed with topical corticosteroids alone, supporting their role as a potential first-line approach with careful monitoring,” the investigators said.

The study was limited by its retrospective design and lack of long-term follow-up.

“DRESS syndrome is a severe cutaneous adverse reaction for which systemic corticosteroids are widely used,” the investigators said. “[H]owever, emerging evidence suggests that topical corticosteroids may be sufficient in selected cases.”