In managing DRESS when organ involvement is present, which therapy is recommended?

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

Answer: (B)

When DRESS involves internal organs, systemic corticosteroids are the treatment of choice. The condition is driven by a severe drug-triggered immune reaction that can affect the liver, kidneys, heart, and other organs; giving steroids helps dampen this rampant immune response, reduces eosinophilia, and protects organ function. Promptly stopping the offending drug is essential, but addressing the systemic inflammation is necessary for organ involvement. Topical steroids manage only skin symptoms and won’t control internal organ disease, and purely supportive care doesn’t halt the immune-driven damage. Dosing is typically around 0.5–2 mg/kg/day of prednisone (or equivalent), followed by a gradual taper over several weeks to months as improvement occurs.