Traitement des toxidermies graves

Ingen‐Housz‐Oro, Saskia; Duong, Tu-Anh; Prost, Nicolas de; Colin, A.; Fardet, L.; Lebrun‐Vignes, Bénédicte; Barbaud, A.; Chosidow, Olivier; Wolkenstein, Pierre

doi:10.1016/j.annder.2018.02.014

Cited by 11 publications

(13 citation statements)

References 56 publications

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“…1,12,13 In the most severe forms of DRESS and in corticosteroids-refractory cases, intravenous immunoglobulins (IVIg), immunosuppressive agents such as cyclosporine, antivirals (especially in case of high CMV load) and anti-IL5 /anti-IL5R antibodies may be considered as secondline treatment. [1][2][3][13][14][15] The reported mortality rate of DRESS ranges between 5% and 10%, and beyond the potentially fatal outcome in the acute phase, around 11% of DRESS patients experience auto-immune sequelae such as thyroiditis and diabetes mellitus, or chronic renal failure. 1,16 There are many open questions in the pathophysiology and management of DRESS patients.…”

Section: Introductionmentioning

confidence: 99%

Management and treatment outcome of DRESS patients in Europe: An international multicentre retrospective study of 141 cases

Kridin

Brüggen

Walsh

et al. 2022

Acad Dermatol Venereol

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Background Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but potentially fatal drug hypersensitivity reaction. Objective To explore treatment approaches across Europe and their impact on the disease course, as well as prognostic factors and culprit drugs. Methods In this retrospective European multicentric study, we included patients with probable or certain DRESS (RegiSCAR score ≥ 4) between January 2016 and December 2020. Independent associations between clinical parameters and the risk of intensive care unit admission and mortality at three months were assessed using a multivariable‐adjusted logistic regression model. Results A total of 141 patients from 8 tertiary centres were included. Morbilliform exanthem was the most frequent cutaneous manifestation (78.0%). The mean affected body surface area (BSA) was 67%, 42% of the patients presented with erythroderma, and 24.8% had mucosal involvement. Based on systemic involvement, 31.9% of the patients had a severe DRESS. Anticonvulsants (24.1%) and sulphonamides (22.0%) were the most frequent causative agents. In all, 73% of the patients were treated with systemic glucocorticoids, and 25.5% received topical corticosteroids as monotherapy. Few patients received antiviral drugs or anti‐IL5. No patients received intravenous immunoglobulins. The overall mortality was 7.1%. Independent predictors of mortality were older age (≥57.0 years; fully adjusted OR, 9.80; 95% CI, 1.20–79.93; p = 0.033), kidney involvement (fully adjusted OR, 4.70; 95% CI, 1.00–24.12; p = 0.049), and admission in intensive care unit (fully adjusted OR, 8.12; 95% CI, 1.90–34.67; p = 0.005). Relapse of DRESS and delayed autoimmune sequelae occurred in 8.5% and 12.1% of patients, respectively. Conclusions This study underlines the need for diagnostic and prognostic scores/markers as well as for prospective clinical trials of drugs with the potential to reduce mortality and complications of DRESS.

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Section: Introductionmentioning

confidence: 99%

Management and treatment outcome of DRESS patients in Europe: An international multicentre retrospective study of 141 cases

Kridin

Brüggen

Walsh

et al. 2022

Acad Dermatol Venereol

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“…Corticosteroids, either topically or systemic, are the current mainstay of DRESS treatment. Since DRESS relapses in about 10% to 15% of patients, it is current practice to slowly taper corticosteroids, usually over several months . To our knowledge, there is no consensus on corticosteroid dose tapering or the appropriate treatment regimen, including the dose and length of administration.…”

Section: Introductionmentioning

confidence: 99%

“…In patients with evidence of robust human herpes virus (HHV) replication, especially cytomegalovirus (CMV), antiviral agents may be considered, but little guidance exists to date . Furthermore, in severe corticosteroid-refractory cases, additional treatment approaches have been proposed, including immunosuppressants or, more recently, targeted treatments (anti–IL-5/anti–IL-5R antibodies or Janus kinase inhibitors) . Lastly, very little data and guidance are available to clinicians concerning follow-up care in DRESS, a matter of importance given the risk of relapse, and uncertain the optimal allergy workup.…”

Section: Introductionmentioning

confidence: 99%

Management of Adult Patients With Drug Reaction With Eosinophilia and Systemic Symptoms

Brüggen,

Walsh,

Ameri

et al. 2024

JAMA Dermatol

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ImportanceDrug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but potentially fatal drug hypersensitivity reaction. To our knowledge, there is no international consensus on its severity assessment and treatment.ObjectiveTo reach an international, Delphi-based multinational expert consensus on the diagnostic workup, severity assessment, and treatment of patients with DRESS.Design, Setting, and ParticipantsThe Delphi method was used to assess 100 statements related to baseline workup, evaluation of severity, acute phase, and postacute management of DRESS. Fifty-seven international experts in DRESS were invited, and 54 participated in the survey, which took place from July to September 2022.Main Outcomes/MeasuresThe degree of agreement was calculated with the RAND-UCLA Appropriateness Method. Consensus was defined as a statement with a median appropriateness value of 7 or higher (appropriate) and a disagreement index of lower than 1.ResultsIn the first Delphi round, consensus was reached on 82 statements. Thirteen statements were revised and assessed in a second round. A consensus was reached for 93 statements overall. The experts agreed on a set of basic diagnostic workup procedures as well as severity- and organ-specific further investigations. They reached a consensus on severity assessment (mild, moderate, and severe) based on the extent of liver, kidney, and blood involvement and the damage of other organs. The panel agreed on the main lines of DRESS management according to these severity grades. General recommendations were generated on the postacute phase follow-up of patients with DRESS and the allergological workup.Conclusions and RelevanceThis Delphi exercise represents, to our knowledge, the first international expert consensus on diagnostic workup, severity assessment, and management of DRESS. This should support clinicians in the diagnosis and management of DRESS and constitute the basis for development of future guidelines.

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“…La prise en charge, centrée sur la prévention de la morbi-mortalité aiguë comme chronique, consiste, en plus de l'éviction du/des médicaments(s) suspecté(s), en des soins locaux et un support symptomatique proches (d'autant plus pour la nécrolyse épidermique (NE)) de ceux administrés aux grands brûlés. Dans certains cas, le recours à une immunomodulation sera nécessaire après discussion avec un spécialiste [5].…”

Section: Introductionunclassified

Toxidermies graves en réanimation

Gaillet

Ingen‐Housz‐Oro

Chosidow

et al. 2023

Méd. Intensive Réa.

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Les toxidermies graves (nécrolyse épidermique, drug reaction with eosinophilia and systemic symptoms (DRESS) et pustulose exanthémathique aiguë généralisée (PEAG)) sont des situations complexes, tant dans leur approche diagnostique que thérapeutique, justifiant une prise en charge multidisciplinaire en centre spécialisé. En plus de l’atteinte cutanéo-muqueuse, des complications viscérales peuvent advenir, engageant le pronostic vital à court terme. La prise en charge initiale, essentiellement symptomatique, a, par ailleurs, pour but de prévenir d’éventuelles séquelles à long-terme. Les médecins doivent être conscients du rôle potentiel des médicaments à haut risque dans le déclenchement de toxidermies graves, en particulier lorsque des facteurs prédisposants sont présents. Toutes les toxidermies graves doivent être déclarées en pharmacovigilance. A distance, les tests allergologiques peuvent aider à confirmer le médicament coupable et à décider des alternatives possibles.

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Traitement des toxidermies graves

Cited by 11 publications

References 56 publications

Management and treatment outcome of DRESS patients in Europe: An international multicentre retrospective study of 141 cases

Management and treatment outcome of DRESS patients in Europe: An international multicentre retrospective study of 141 cases

Management of Adult Patients With Drug Reaction With Eosinophilia and Systemic Symptoms

Toxidermies graves en réanimation

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