If no organ involvement in DRESS, what treatment is recommended?

• A. High potency topical steroid 2-3x/day for 1 week
• B. Systemic steroids 0.5-2 mg/kg/day
• C. Supportive care
• D. Stop offending agent

Answer: (A)

When DRESS affects only the skin without organ involvement, the goal is to tame the local inflammation with topical therapy rather than systemic treatment. A high-potency topical corticosteroid applied to the affected areas several times daily provides strong local anti-inflammatory effects, helping to control the rash and itching while minimizing systemic exposure. This approach is preferred because systemic steroids carry more risk and are not needed if no organs are involved.

Stopping the offending drug is essential in all DRESS cases, but for skin-only disease, the topical corticosteroid is the primary treatment for the rash, with supportive care as needed. If systemic signs develop, then systemic therapy would be reconsidered.