American Journal of Clinical Dermatology

, Volume 20, Issue 2, pp 217–236 | Cite as

Drug Reaction with Eosinophilia and Systemic Symptoms (DReSS): How Far Have We Come?

  • Sylvia Aide Martínez-Cabriales
  • Fabian Rodríguez-Bolaños
  • Neil H. ShearEmail author
Review Article


Drug reaction with eosinophilia and systemic symptoms (DReSS), also known as drug-induced hypersensitivity syndrome (DiHS), is an uncommon severe adverse reaction to medications. It is important to recognize it as it is potentially fatal and can cause significant morbidity. From the first reports of drug reactions related to certain anticonvulsants characterized by fever, liver enzyme elevation, and skin changes, our continuously growing understanding of this entity has allowed us to describe its physiopathology and clinical features even further. The relationship of genetic factors, viral activation, and specific drug exposure is now known to play a role in this disease. There is still not a widely accepted marker for DReSS/DiHS, but the spectrum of clinical and laboratory features has now been better outlined. The mainstay of treatment is the use of systemic corticosteroids, but other options such as intravenous immunoglobulin, cyclosporine, mycophenolate mofetil, rituximab, and cyclophosphamide have been described. We present a comprehensive review of the literature on DReSS/DiHS, focusing on its history, etiopathogenesis, diagnosis, therapeutic approach, and outcome.


Compliance with Ethical Standards


No funding was received for the preparation of this review.

Conflict of interest

S.A. Martinez-Cabriales, F. Rodriguez-Bolaños, and N.F. Shear declare that they have no conflicts of interest.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sylvia Aide Martínez-Cabriales
    • 1
    • 2
    • 3
  • Fabian Rodríguez-Bolaños
    • 1
    • 3
  • Neil H. Shear
    • 1
    • 3
    Email author
  1. 1.Department of DermatologyUniversity of TorontoTorontoCanada
  2. 2.Department of DermatologyAutonomous University of Nuevo LeonMonterreyMexico
  3. 3.Dermatology DivisionSunnybrook Health Sciences CentreTorontoCanada

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