Management and treatment outcome of DRESS patients in Europe: An international multicentre retrospective study of 141 cases

J Eur Acad Dermatol Venereol. 2023 Apr;37(4):753-762. doi: 10.1111/jdv.18808. Epub 2022 Dec 19.


Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but potentially fatal drug hypersensitivity reaction.

Objective: To explore treatment approaches across Europe and their impact on the disease course, as well as prognostic factors and culprit drugs.

Methods: In this retrospective European multicentric study, we included patients with probable or certain DRESS (RegiSCAR score ≥ 4) between January 2016 and December 2020. Independent associations between clinical parameters and the risk of intensive care unit admission and mortality at three months were assessed using a multivariable-adjusted logistic regression model.

Results: A total of 141 patients from 8 tertiary centres were included. Morbilliform exanthem was the most frequent cutaneous manifestation (78.0%). The mean affected body surface area (BSA) was 67%, 42% of the patients presented with erythroderma, and 24.8% had mucosal involvement. Based on systemic involvement, 31.9% of the patients had a severe DRESS. Anticonvulsants (24.1%) and sulphonamides (22.0%) were the most frequent causative agents. In all, 73% of the patients were treated with systemic glucocorticoids, and 25.5% received topical corticosteroids as monotherapy. Few patients received antiviral drugs or anti-IL5. No patients received intravenous immunoglobulins. The overall mortality was 7.1%. Independent predictors of mortality were older age (≥57.0 years; fully adjusted OR, 9.80; 95% CI, 1.20-79.93; p = 0.033), kidney involvement (fully adjusted OR, 4.70; 95% CI, 1.00-24.12; p = 0.049), and admission in intensive care unit (fully adjusted OR, 8.12; 95% CI, 1.90-34.67; p = 0.005). Relapse of DRESS and delayed autoimmune sequelae occurred in 8.5% and 12.1% of patients, respectively.

Conclusions: This study underlines the need for diagnostic and prognostic scores/markers as well as for prospective clinical trials of drugs with the potential to reduce mortality and complications of DRESS.

Publication types

  • Multicenter Study

MeSH terms

  • Drug Hypersensitivity Syndrome* / diagnosis
  • Drug Hypersensitivity Syndrome* / drug therapy
  • Drug Hypersensitivity Syndrome* / etiology
  • Eosinophilia* / complications
  • Glucocorticoids / therapeutic use
  • Humans
  • Prospective Studies
  • Retrospective Studies
  • Treatment Outcome


  • Glucocorticoids