In DRESS with organ involvement, which treatment is recommended?

• A. Systemic steroids
• B. High potency topical steroids
• C. Supportive care
• D. Stop offending agent

Answer: (A)

DRESS with organ involvement is a systemic inflammatory reaction, so addressing the whole body response is required. Stopping the offending drug is essential, but it isn’t enough when organs are affected. Systemic corticosteroids dampen the widespread immune activation, reduce eosinophilic and lymphocytic damage, and help reverse hepatic, renal, or other organ injuries that can occur in DRESS. Local or topical steroids won’t reach the systemic inflammation, and supportive care alone doesn’t control the underlying immune process. Therefore, systemic steroids are the recommended treatment in this scenario, often started at about 1 mg/kg/day of prednisone (or equivalent) and tapered as the patient improves, with close monitoring of organ function.