Analysis: Topical Corticosteroids Effective for Select Patients With DRESS Syndrome
Key Takeaways
- Initial treatment with topical corticosteroids was associated with similar 30-day mortality and hospital discharge outcomes compared with systemic corticosteroids in hospitalized patients with DRESS syndrome.
- Nearly one in five patients in the overall cohort (19%) were successfully managed with topical corticosteroids alone, although 45% of patients initially treated topically ultimately required escalation to systemic therapy.
- The findings suggest topical corticosteroids may be a reasonable first-line option for carefully selected patients with close monitoring, but prospective studies are needed.
Topical corticosteroids may offer comparable short-term outcomes to systemic corticosteroids for selected hospitalized patients with drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, according to a multicenter retrospective cohort study published in the Journal of the American Academy of Dermatology.
Researchers evaluated 359 adults hospitalized with DRESS at two tertiary care centers between 2012 and 2021. Patients were grouped by initial treatment strategy, receiving either topical corticosteroids alone (n = 124) or systemic corticosteroids with or without topical therapy (n = 235). To account for differences in baseline characteristics and disease severity, investigators used overlap propensity score weighting.
Real-World Data Suggest Similar Short-Term Outcomes
Almost half (45%) of patients initially managed with topical corticosteroids required escalation to systemic therapy, although 19% of the study population was successfully treated with topical corticosteroids alone. Thirty-day mortality and hospital discharge rates did not differ between treatment groups. Weighted 30-day mortality rates were 2.0 and 2.9 per 1,000 person-days for the topical and systemic corticosteroid groups, respectively (hazard ratio [HR], 1.56; 95% CI, 0.19 to 12.94). Likewise, 30-day discharge rates were similar (HR, 1.22; 95% CI, 0.87 to 1.71). The authors cited the retrospective study design and lack of long-term follow-up as limitations on the data.
"Outcomes did not differ significantly by initial therapy," the investigators concluded. "Of the whole cohort, 19% were successfully managed with topical corticosteroids alone, supporting their role as a potential first-line approach with careful monitoring."
Source
Salciccioli I, et al. JAAD. 2026. Doi:10.1016/j.jaad.2026.04.1928