Topical vs Systemic Corticosteroids for DRESS Syndrome: Real-World Outcomes from a Multi-Center Retrospective Cohort.

Abstract

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. To compare outcomes of initial topical corticosteroid versus systemic corticosteroid therapy in hospitalized DRESS patients. We conducted a multi-center retrospective cohort study of adults hospitalized with DRESS at two 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. 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 (HR 1.56; 95% CI 0.19-12.94). Thirty-day discharge rates were 76.2 and 92.8, respectively (HR 1.22; 95% CI 0.87-1.71). Retrospective design, lack long-term follow up. 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.