DRESS syndrome medical therapy: Difference between revisions
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*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. | *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). | *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. | *Patients hospitalized for DRESS syndrome require multidisciplinary care, including consultation by a dermatologist, hepatologist, and liver transplant specialist.<ref name="pmid22541696">{{cite journal| author=Davern TJ| title=Drug-induced liver disease. | journal=Clin Liver Dis | year= 2012 | volume= 16 | issue= 2 | pages= 231-45 | pmid=22541696 | doi=10.1016/j.cld.2012.03.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22541696 }} </ref> | ||
*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''' | ||
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*Referral to liver transplant in cases of severe hepatic injury (> 3x ULN of LFTs) | *Referral to liver transplant in cases of severe hepatic injury (> 3x ULN of LFTs) | ||
'''4. Lung involvement''' | '''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 | *Systemic corticosteroids: [[Prednisone]] 0.5-2 mg/kg/day (or equivalent) IV until clinical improvement {{then}} tapered slowly over 2-3 months<ref name="pmid20713773">{{cite journal| author=Chen YC, Chiu HC, Chu CY| title=Drug reaction with eosinophilia and systemic symptoms: a retrospective study of 60 cases. | journal=Arch Dermatol | year= 2010 | volume= 146 | issue= 12 | pages= 1373-9 | pmid=20713773 | doi=10.1001/archdermatol.2010.198 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20713773 }} </ref> | ||
'''5. Renal involvement''' | '''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 | *Systemic corticosteroids: [[Prednisone]] 0.5-2 mg/kg/day (or equivalent) IV until clinical improvement {{then}} tapered slowly over 2-3 months<ref name="pmid20713773">{{cite journal| author=Chen YC, Chiu HC, Chu CY| title=Drug reaction with eosinophilia and systemic symptoms: a retrospective study of 60 cases. | journal=Arch Dermatol | year= 2010 | volume= 146 | issue= 12 | pages= 1373-9 | pmid=20713773 | doi=10.1001/archdermatol.2010.198 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20713773 }} </ref> | ||
==Other Pharmacologic Agents== | ==Other Pharmacologic Agents== | ||
Other pharmacologic agents that have been used in the management of 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]]<ref name="pmid22508885">{{cite journal| author=Joly P, Janela B, Tetart F, Rogez S, Picard D, D'Incan M et al.| title=Poor benefit/risk balance of intravenous immunoglobulins in DRESS. | journal=Arch Dermatol | year= 2012 | volume= 148 | issue= 4 | pages= 543-4 | pmid=22508885 | doi=10.1001/archderm.148.4.dlt120002-c | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22508885 }} </ref> | ||
*[[N-acetylcysteine]] | *[[N-acetylcysteine]] | ||
Revision as of 20:07, 21 September 2015
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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.[1]
- 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:[2]
- 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[3]
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[3]
Other Pharmacologic Agents
Other pharmacologic agents that have been used in the management of DRESS syndrome are the following:
References
- ↑ Davern TJ (2012). "Drug-induced liver disease". Clin Liver Dis. 16 (2): 231–45. doi:10.1016/j.cld.2012.03.002. PMID 22541696.
- ↑ Roujeau JC (1999). "Treatment of severe drug eruptions". J Dermatol. 26 (11): 718–22. PMID 10635613.
- ↑ 3.0 3.1 Chen YC, Chiu HC, Chu CY (2010). "Drug reaction with eosinophilia and systemic symptoms: a retrospective study of 60 cases". Arch Dermatol. 146 (12): 1373–9. doi:10.1001/archdermatol.2010.198. PMID 20713773.
- ↑ Joly P, Janela B, Tetart F, Rogez S, Picard D, D'Incan M; et al. (2012). "Poor benefit/risk balance of intravenous immunoglobulins in DRESS". Arch Dermatol. 148 (4): 543–4. doi:10.1001/archderm.148.4.dlt120002-c. PMID 22508885.