Service de dermatologie, AP-HP, hôpitaux universitaires Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
Service de dermatologie, AP-HP, hôpitaux universitaires Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Université Paris Est Créteil, EA7380 Dynamyc, EnvA, USC ANSES, rue du Général-Sarrail, 94010 Créteil cedex, France; Faculté de médecine de Créteil, université Paris-Est Créteil (UPEC), 61, avenue du Général-de-Gaulle, 94000 Créteil, France; Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
Ann Dermatol Venereol. 2021 Sep;148(3):168-171. doi: 10.1016/j.annder.2021.02.002. Epub 2021 Apr 12.
There is no consensus on the treatment of drug reaction with eosinophilia and systemic symptoms (DRESS). At our center, systemic steroids (SS) are used for severe cases while topical steroids (TS) are used for mild and moderate forms.
To investigate the short-term outcome for patients with DRESS receiving SS as first-line therapy before being transferred to our department and then switched to TS after admission.
A retrospective monocenter study in DRESS patients (RegiSCAR score≥4) transferred to our dermatology department from a different setting between 07/2012 and 06/2018 and who had received SS before being transferred. Epidemiological, clinical and laboratory data were collected, as well as details of treatment modalities and outcome.
Twenty patients were included. On admission to our department, 4 were assessed as having severe DRESS and continued on SS, while 16 were assessed as mild/moderate DRESS and were switched to TS. Among these 16 patients, the outcome on TS was favorable for 12 and quickly unfavorable for 4, who had to be switched back to SS. Retrospective analysis of the initial data (before transfer) showed that these 4 patients had previously had a greater number of severity criteria than the other 12.
Caution is needed not only when deciding to initiate SS in DRESS but also on withdrawal of these drugs. Our series suggests that when SS are used as first-line therapy in DRESS patients with initial severity criteria, they should not be withdrawn quickly for a switch to TS, even where progression appears favorable, due to the risk of relapse.
药物反应伴嗜酸性粒细胞增多和全身症状（DRESS）的治疗尚无共识。在我们中心，全身性类固醇（SS）用于严重病例，而局部类固醇（TS）用于轻度和中度病例。
研究在转入我科之前接受 SS 作为一线治疗的 DRESS 患者的短期转归，然后在入院后转为 TS。
对 2012 年 7 月至 2018 年 6 月期间从不同机构转入我皮肤科的 DRESS 患者（RegiSCAR 评分≥4）进行回顾性单中心研究，这些患者在转入前曾接受 SS 治疗。收集了流行病学、临床和实验室数据，以及治疗方式和结果的详细信息。
共纳入 20 例患者。入院时，4 例患者被评估为严重 DRESS 并继续使用 SS，16 例患者被评估为轻度/中度 DRESS 并转为 TS。在这 16 例患者中，12 例 TS 治疗效果良好，4 例迅速恶化，不得不转回 SS。对初始数据（转入前）的回顾性分析显示，这 4 例患者在其他 12 例患者之前有更多的严重程度标准。
不仅在决定启动 DRESS 中 SS 时需要谨慎，而且在停药时也需要谨慎。我们的研究表明，在 DRESS 患者中使用 SS 作为一线治疗，即使在病情看起来有所改善的情况下，也不应因转为 TS 而迅速停药，因为这有复发的风险。
