DRESS syndrome medical therapy: Difference between revisions
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*The following drugs have been used in the management of DRESS syndrome: | *The following drugs have been used in the management of DRESS syndrome: | ||
'''1. Symptomatic relief''' | '''1. Symptomatic relief''' | ||
*''Pruritus'': Topical | *''Pruritus'': Topical [[corticosteroid]]s preferred over systemic steroids {{and}} [[antihistamine]]s | ||
*''Fever'': [[Antipyretics|Antipyretic therapy]] | *''Fever'': [[Antipyretics|Antipyretic therapy]] | ||
:*Note: Avoid antipyretic drugs that are cleared by the liver (e.g. | :*Note: Avoid antipyretic drugs that are cleared by the liver (e.g. [[Acetaminophen]]) if liver injury is suspected and drugs cleared by the kidney (e.g. [[NSAID]]s) if renal injury is suspected | ||
'''2. Exfoliative dermatitis''' | '''2. Exfoliative dermatitis''' | ||
*Management of exfoliative dermatitis is similar to management of burns:<ref name="pmid10635613">{{cite journal| author=Roujeau JC| title=Treatment of severe drug eruptions. | journal=J Dermatol | year= 1999 | volume= 26 | issue= 11 | pages= 718-22 | pmid=10635613 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635613 }} </ref> | *Management of exfoliative dermatitis is similar to management of burns:<ref name="pmid10635613">{{cite journal| author=Roujeau JC| title=Treatment of severe drug eruptions. | journal=J Dermatol | year= 1999 | volume= 26 | issue= 11 | pages= 718-22 | pmid=10635613 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10635613 }} </ref> | ||
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==Other Pharmacologic Agents== | ==Other Pharmacologic Agents== | ||
Other pharmacologic agents that have been used in DRESS syndrome are the following: | Other pharmacologic agents that have been used in the management of DRESS syndrome are the following: | ||
*[[Cyclosporin]] | *[[Cyclosporin]] | ||
*[[Intravenous immunoglobulin]] | *[[Intravenous immunoglobulin]] | ||
Revision as of 19:57, 21 September 2015
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DRESS syndrome Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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DRESS syndrome On the Web |
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American Roentgen Ray Society Images of DRESS syndrome |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Medical Therapy
- Drug withdrawal is the first step in the management of DRESS syndrome.
- Patients with severe skin eruptions are usually admitted to the hospital for close monitoring and fluid/electrolyte management.
- Supportive care is considered the mainstay of therapy, and administration of pharmacologic agents is usually necessary. Data from randomized clinical trials regarding the efficacy of immunosuppressive therapy in the management of DRESS syndrome is not yet available.
- Persistent DRESS syndrome often requires prolonged therapy (possible beyond 1 year).
- Patients hospitalized for DRESS syndrome require multidisciplinary care, including consultation by a dermatologist, hepatologist, and liver transplant specialist.
- The following drugs have been used in the management of DRESS syndrome:
1. Symptomatic relief
- Pruritus: Topical corticosteroids preferred over systemic steroids AND antihistamines
- Fever: Antipyretic therapy
- Note: Avoid antipyretic drugs that are cleared by the liver (e.g. Acetaminophen) if liver injury is suspected and drugs cleared by the kidney (e.g. NSAIDs) if renal injury is suspected
2. Exfoliative dermatitis
- Management of exfoliative dermatitis is similar to management of burns:[1]
- Warming
- Management of electrolyte derangements
- Intake of high-caloric diet
- Sepsis prevention
3. Liver involvement
- Unknown benefit of systemic corticosteroids
- Referral to liver transplant in cases of severe hepatic injury (> 3x ULN of LFTs)
4. Lung involvement
- Systemic corticosteroids: Prednisone 0.5-2 mg/kg/day (or equivalent) IV until clinical improvement THEN tapered slowly over 2-3 months
5. Renal involvement
- Systemic corticosteroids: Prednisone 0.5-2 mg/kg/day (or equivalent) IV until clinical improvement THEN tapered slowly over 2-3 months
Other Pharmacologic Agents
Other pharmacologic agents that have been used in the management of DRESS syndrome are the following:
References
- ↑ Roujeau JC (1999). "Treatment of severe drug eruptions". J Dermatol. 26 (11): 718–22. PMID 10635613.