Topical Corticosteroids May Be Effective in Treating DRESS

For patients with mild-to-moderate drug reaction with eosinophilia and systemic symptoms (DRESS), topical corticosteroids may be a safe and effective alternative to systemic corticosteroids, according to study results published in American Journal of Clinical Dermatology.

Researchers combined a retrospective cohort study with a meta-analysis to evaluate the potential utility of topical corticosteroids in DRESS. Data for the retrospective study were sourced at the Singapore General Hospital. Patients (n=94) diagnosed with DRESS between 2009 and 2017 were evaluated for outcomes on the basis of corticosteroids received. The meta-analysis included 6 relevant studies comprising 292 participants that were conducted between 2004 and 2017.

In the retrospective study, 53 participants received systemic corticosteroids and 41 participants received topical corticosteroids. They were median ages 60 and 61 years, 30.2% and 53.7% were men (P =.034), 66.0% and 63.4% were Chinese, and 52.8% and 41.5% had 2 or more organs involved, respectively. The most commonly involved organs included liver (72.3%), kidney (42.6%), and other (30.9%).

Outcomes were similar among those in the systemic and topical steroid groups. Overall, the median hospital stay was 10 (IQR, 6-21) days, 17.0% of participants were admitted to the intensive care unit, 31.9% were readmitted for a DRESS-related reason, 24.5% had a flare, 38.3% had viral reactivation, 18.1% experienced cytomegalovirus reactivation, 8.5% died within 1 month, and 19.1% died within 12 months. The only significant group difference observed was that more systemic corticosteroid recipients had an infection than topical recipients (32.1% vs 12.2%; P =.020).

Mortality at 12 months was associated with 2 or more organs involved compared with 1 or none (odds ratio [OR], 5.50; 95% CI, 1.62-18.68; P =.006) and was not associated with corticosteroid treatment (OR, 0.58; 95% CI, 0.19-1.73; P =.329).

In the meta-analysis, no significant differences between systemic and topical corticosteroids were observed for the outcomes of hospital length of stay (standardized mean difference, 10.03; 95% CI, -5.87 to 25.92; I², 80.3%; P =.216) and mortality (risk difference, -0.01; 95% CI, -0.07 to 0.05; I2, 0.0%; P =.798).

The major limitation of this study was that it was not a randomized trial.

The study authors conclude, “There is growing evidence suggesting the safety and efficacy of topical corticosteroids as alternatives to systemic corticosteroids particularly in the treatment of mild-to-moderate DRESS. However, such observations need to be prospectively evaluated to better establish the role of topical corticosteroids in severe DRESS.”