Published: 3 September 2020


DRESS syndrome – Monitor for long-term sequelae

Published: 3 September 2020
Prescriber Update 41(3): 51
September 2020

Key Messages

  • Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is associated with long-term autoimmune sequelae.
  • Patients require careful monitoring for autoimmune disease following recovery from DRESS syndrome.

DRESS syndrome is a type of SCAR

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a type of severe cutaneous adverse reaction (SCAR).1 It is characterised by a rash, haematologic abnormalities (eosinophilia, atypical lymphocytosis), lymphadenopathy and internal organ involvement, typically 2-8 weeks after exposure to the offending drug.1,2

DRESS symptoms, diagnosis and commonly associated medicines have been described in previous issues of Prescriber Update.3,4

Long-term autoimmune sequelae

Patients are at risk of long-term autoimmune sequelae following recovery from DRESS syndrome.5,6 Retrospective cohort studies have reported autoimmune sequelae such as Graves’ disease, Hashimoto’s thyroiditis, type 1 diabetes mellitus, systemic lupus erythematosus, alopecia areata and autoimmune haemolytic anaemia in patients who have recovered from DRESS syndrome.5,6

The pathogenic mechanism leading to the development of autoimmune disease months to years after the acute drug reaction is not well understood.5,6 Reactivation of human herpes viruses (HHVs) in DRESS syndrome may play a role in the development of autoimmune sequelae.2

Long-term monitoring required following DRESS syndrome

Patients with DRESS syndrome require careful long-term follow-up for symptoms and signs of autoimmune disease.6


  1. Bellón T. 2019. Mechanisms of severe cutaneous adverse reactions: recent advances. Drug Safety 42: 973–92. DOI: (accessed 29 June 2020).
  2. Shiohara T, Mizukawa Y. 2019. Drug-induced hypersensitivity syndrome (DiHS)/drug reaction with eosinophilia and systemic symptoms (DRESS): an update in 2019. Allergology International 68: 301–8. DOI: (accessed 14 July 2020).
  3. Medsafe. 2017. DRESS: a pleat for help. Prescriber Update 38(2): 20–1. URL: (accessed 14 July 2020).
  4. Medsafe. 2011. DRESS syndrome: remember to look under the skin. Prescriber Update 32(2): 12-13. URL: (accessed 14 July 2020).
  5. Chen Y-C, Chang C-Y, Cho Y-T, et al. 2013. Long-term sequelae of drug reaction with eosinophilia and systemic symptoms: a retrospective cohort study from Taiwan. Journal of the American Academy of Dermatology 68(3): 459–65. DOI: (accessed 14 July 2020).
  6. Kano Y, Tohyama M, Aihara M, et al. 2015. Sequelae in 145 patients with drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms: survey conducted by the Asian Research Committee on Severe Cutaneous Adverse Reactions (ASCAR). Journal of Dermatology 42: 276–82. DOI: 10.1111/1346-8138.12770 (accessed 14 July 2020).
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