UMEM Educational Pearls

Category: Toxicology

Title: Drug Rash with Eosinophilia and Systemic Symptoms (DRESS)

Keywords: DRESS, anticonvulsant, eosinophilia, phenytoin, carbamazepine (PubMed Search)

Posted: 2/7/2012 by Bryan Hayes, PharmD (Emailed: 2/9/2012) (Updated: 2/19/2012)
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  • Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome, previously named “anticonvulsant hypersensitivity syndrome,” is a severe adverse drug reaction which occurs in approximately 1 of every 1,000–10,000 uses of anticonvulsants.

  • Characterized by triad of fever, rash, and internal organ involvement.

  • Usually involves aromatic anticonvulsants such as phenytoin, carbamazepine, phenobarbital, primidone, lamotrigine, and possibly oxcarbazepine.

  • DRESS occurs most frequently within the first 2 months of therapy and is not related to dose or serum concentration.

  • Treatment includes prompt discontinuation of the offending agent. Patients should be admitted to the hospital and receive methylprednisolone 0.5–1 mg/kg/d divided in four doses. Other promising therapies include use of IVIG.


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