Topical versus systemic corticosteroids for drug reaction with eosinophilia and systemic symptoms syndrome: Real-world outcomes from a multicenter retrospective cohort.

BACKGROUND

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe cutaneous adverse reaction for which systemic corticosteroids are widely used; however, emerging evidence suggests that topical corticosteroids may be sufficient in selected cases.

OBJECTIVE

To compare outcomes of initial topical corticosteroid versus systemic corticosteroid therapy in hospitalized DRESS patients.

METHODS

We conducted a multicenter retrospective cohort study of adults hospitalized with DRESS at 2 tertiary centers (2012-2021). Patients were categorized by initial therapy as topical corticosteroids only or systemic corticosteroids. Primary outcomes were 30-day mortality and discharge. Overlap propensity score weighting adjusted for demographics, comorbidities, and baseline severity markers.

RESULTS

Among 359 patients, 124 (35%) were initially treated with topical and 235 (65%) with systemic ± topical corticosteroids; 56 (45%) in the topical group subsequently required escalation to systemic therapy. Weighted 30-day mortality rates were 2.0 and 2.9 per 1000 person-days for topical and systemic groups, respectively (hazard ratio: 1.56; 95% confidence interval: 0.19-12.94). Thirty-day discharge rates were 76.2 and 92.8, respectively (hazard ratio: 1.22; 95% confidence interval: 0.87-1.71).

LIMITATIONS: Retrospective design, lack long-term follow-up.

CONCLUSIONS

Outcomes did not differ significantly by initial therapy. Of the whole cohort, 19% were successfully managed with topical corticosteroids alone, supporting their role as a potential first-line approach with careful monitoring.