Systemic Versus Topical Corticosteroids in the Treatment of DRESS: A Retrospective Cohort Study Followed by a Meta-Analysis

Am J Clin Dermatol. 2023 Jul;24(4):637-647. doi: 10.1007/s40257-023-00776-6. Epub 2023 May 3.


Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe systemic drug hypersensitivity syndrome with significant risks of mortality and long-term sequelae. Management is challenging; whilst systemic corticosteroids are generally regarded as standard of care, there is a suggestion that topical corticosteroids may be a safe alternative.

Objective: We aimed to compare the clinical outcomes of patients with DRESS treated with systemic corticosteroids and topical corticosteroids in an academic medical center.

Methods: The medical records of patients diagnosed with DRESS at the Singapore General Hospital between 2009 and 2017 were retrospectively reviewed. A secondary systematic review and meta-analysis were performed to further clarify the outcomes.

Results: Out of 94 patients with DRESS, 41 (44%) were treated with topical corticosteroids and 53 (56%) were treated with systemic corticosteroids. Patients receiving systemic corticosteroids were more likely to develop infective complications (32.1 vs 12.2%, p = 0.02). One-month and 12-month mortality, length of hospital stay, flares of DRESS, and viral reactivation were similar between the two groups. In our meta-analysis (six studies, n = 292), there were no significant differences in mortality or length of stay between patients treated with systemic or topical corticosteroids.

Limitations: This study was a non-controlled retrospective cohort study and the allocation of treatment may have been influenced by the severity of disease. Results of the secondary meta-analysis are limited by the quality of included studies.

Conclusions: Topical corticosteroids may be a safe and efficacious alternative to systemic corticosteroids in the treatment of mild-to-moderate DRESS.

Clinical trial registration: PROSPERO registration CRD42021285691.

Publication types

  • Meta-Analysis

MeSH terms

  • Adrenal Cortex Hormones / adverse effects
  • Dermatologic Agents*
  • Drug Hypersensitivity Syndrome* / diagnosis
  • Drug Hypersensitivity Syndrome* / drug therapy
  • Drug Hypersensitivity Syndrome* / etiology
  • Eosinophilia*
  • Humans
  • Retrospective Studies


  • Adrenal Cortex Hormones
  • Dermatologic Agents