Drug Rash with Eosinophilia and Systemic Symptoms (DRESS)- Also known as “hypersensitivity syndrome”; represents serious hypersensitivity reaction to a drug, typically appearing 2–6 weeks after starting offending medication
- Characterized by cutaneous eruption, fever, lymph node enlargement, and internal organ involvement (elevated eosinophils, elevated liver enzymes with possible fulminant hepatitis, interstitial nephritis, etc.)
- Presents with morbilliform eruption which may become more edematous with follicular accentuation; ± vesicles, tense bulla, erythroderma; typically involves upper trunk, extremities and face; hallmark finding is facial edema
- Related drugs: sulfonamides, phenobarbital, carbamazepine, phenytoin, lamotrigine, allopurinol, dapsone, abacavir
- Likely related to the inability to detoxify toxic arene metabolites in anticonvulsant drugs; of note, aromatic anticonvulsants (phenytoin, carbamazepine, phenobarbital) are known to cross-react with one another, and safe alternatives include levetiracetam and valproic acid
- Treatment: topical corticosteroid for cutaneous eruption, systemic corticosteroid if internal organ involvement
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