Beyond Skin Deep: Practical Tips on Management of DRESS/DIHS

The presentation discusses the management and complications of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) and Drug-Induced Hypersensitivity Syndrome (DISH), highlighting the importance of an accurate diagnosis and tailored treatment strategies. A case study of a 19-year-old female who developed DRESS after starting lamotrigine illustrates the clinical evaluation process, emphasizing the significance of initiating treatment promptly upon suspicion. The presentation recommends categorizing DRESS severity (mild, moderate, severe) to guide therapy, which may include stopping the offending agent, topical steroids for mild cases, and systemic steroids for more severe reactions. The talk also addresses the potential for viral reactivation (e.g., HHV-6, EBV) in DRESS patients, highlighting the need for monitoring and possibly treating viral infections in severe scenarios. A second case describes a 39-year-old woman with severe DRESS symptoms and hospitalization; it underscores the complexities of managing acute severe cases, particularly when facing challenges like cardiac involvement and the necessity for additional immunosuppressive treatments, including cyclosporine and tofacitinib. Lastly, the discussion touches on potential long-term autoimmune sequelae post-DRESS resolution, recommending providers maintain vigilance in monitoring and addressing complications, particularly autoimmune conditions like thyroiditis. The session emphasizes ongoing patient support and education as essential in the long-term care of individuals affected by DRESS.