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Research Letter
March 11, 2020

Evaluation of Cyclosporine for the Treatment of DRESS Syndrome

Author Affiliations
  • 1Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
  • 2Stony Brook University School of Medicine, Stony Brook, New York
  • 3Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Dermatol. Published online March 11, 2020. doi:10.1001/jamadermatol.2020.0048

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life-threatening hypersensitivity reaction characterized by skin eruption, fever, hematologic abnormalities, and multiorgan involvement. If unrecognized, this condition may be fatal, with a mortality rate of up to 10%.1 Treatment involves discontinuation of treatment with the culprit drug, supportive care, and in severe eruptions with end-organ dysfunction, systemic immunosuppression with glucocorticoids. However, patients with contraindications to glucocorticoids may benefit from treatment with cyclosporine, a calcineurin inhibitor with anti-apoptotic effects on cytotoxic T cells. Cyclosporine also inhibits production of interleukin-5, which generates eosinophilia and drug-specific T cells that mediate DRESS.2 While cyclosporine represents an alternative treatment for DRESS, little is known about its utility.3,4

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