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Practice Gaps
December 20, 2010

Failure to Recognize and Manage Patients With DRESS: Comment on “Drug Reaction With Eosinophilia and Systemic Symptoms” Failure to Recognize Patients With DRESS

Author Affiliations

Author Affiliations: Departments of Medicine, Divisions of Dermatology, University of Louisville, Kentucky (Dr England Owen); and Marshfield Clinic, Marshfield, Wisconsin (Dr Stratman).

Arch Dermatol. 2010;146(12):1379. doi:10.1001/archdermatol.2010.361

As with all SCARs, early recognition and prompt drug withdrawal is an essential part of the management of DRESS. In contrast to the other SCARs, however, DRESS lacks pathognomonic, or even highly suggestive, clinical morphologic characteristics. It often presents with an exanthem identical to the more common, but relatively benign, morbilliform drug reaction.1 In addition, the biopsy findings also lack signature histopathologic findings.2 To diagnose DRESS, the dermatologist must appraise the clinical scenario in its gestalt; then pursue suggestive laboratory findings, identify the common offending medications, and assess the timing of the cutaneous reaction following drug initiation. DRESS, then, is a condition vulnerable to knowledge and performance gaps.

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