Management of Psychotropic Drug-Induced DRESS Syndrome: A Systematic Review

Mayo Clin Proc. 2016 Jun;91(6):787-801. doi: 10.1016/j.mayocp.2016.03.006. Epub 2016 Apr 25.


Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous eruption that has been linked to several common drugs and drug categories, including antiepileptics, allopurinol, sulfonamides, and various antibiotics; however, because of a number of recent case reports linking psychotropic medications to this condition, DRESS is increasingly recognized among psychiatrists. We systematically reviewed all psychotropic drugs linked to DRESS syndrome, and this article summarizes the clinical management relevant to psychiatric professionals. A comprehensive search was performed using Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Database of Systematic Reviews, Web of Science, Scopus, and Litt's Drug Eruption and Reaction Database for articles published in English during the past 20 years (1996-2015) using the search terms (1) psychotropic drugs OR serotonin uptake inhibitors AND DRESS or (2) psychotropic drugs AND drug reaction (or rash) eosinophilia systemic syndrome, and all article abstracts were screened for inclusion and exclusion criteria by 3 reviewers. Two independent reviewers examined the full text of 163 articles, of which 96 (25 original articles, 12 review articles, 55 case reports, and 4 letters to the editor) were included in the systematic review. We identified 1072 cases of psychotropic drug-induced DRESS, with carbamazepine, lamotrigine, phenytoin, valproate, and phenobarbital being the most implicated drugs. Based on our review of the literature, we outline management principles that include prompt withdrawal of the causative drug, hospitalization, corticosteroid therapy, and novel treatments, including intravenous immunoglobulin, cyclophosphamide, and cyclosporine, for corticosteroid-resistant DRESS. Finally, we outline strategies for treating comorbid psychiatric illness after a DRESS reaction to the psychotropic medication.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Administration, Intravenous
  • Adrenal Cortex Hormones / therapeutic use*
  • Comorbidity
  • Cyclophosphamide / therapeutic use
  • Cyclosporine / administration & dosage
  • Cyclosporine / therapeutic use
  • Dermatologic Agents / administration & dosage
  • Dermatologic Agents / therapeutic use*
  • Diagnosis, Differential
  • Drug Hypersensitivity Syndrome / diagnosis*
  • Drug Hypersensitivity Syndrome / epidemiology
  • Drug Hypersensitivity Syndrome / etiology
  • Drug Hypersensitivity Syndrome / therapy
  • Exanthema Subitum
  • Humans
  • Immunoglobulins / administration & dosage
  • Immunoglobulins / therapeutic use*
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / therapeutic use*
  • Mental Disorders / drug therapy*
  • Mental Disorders / epidemiology
  • Plasma Exchange*
  • Psychotropic Drugs / adverse effects*
  • Psychotropic Drugs / therapeutic use


  • Adrenal Cortex Hormones
  • Dermatologic Agents
  • Immunoglobulins
  • Immunosuppressive Agents
  • Psychotropic Drugs
  • Cyclosporine
  • Cyclophosphamide