DRESS

Signs and symptoms

DRESS syndrome usually begin 2 to 6 weeks but uncommonly up to 8–16 weeks after exposure to an offending drug. DRESS usually begin with a prodrome (early symptoms) of fever, malaise, sore throat with dysphagia, itching, and skin burning. This quickly progresses to a fever and a morbilliform, often itchy rash. The mobilliform rash in DRESS often begins in the trunk and face and spreads to include more than 50% of the body surface area. The rash in DRESS consist mainly of macules or plaques, facial edema (i.e. swelling, which is a hallmark of the disease), enlarged and sometimes painful lymph nodes and other symptoms due to inflammation of internal organ involvement, most commonly liver damage (and less commonly kidney, lung, heart, and rarely pancreatic damage). Most cases of DRESS have a generalized lymph node swelling, and this can precede the rash. Facial edema is characteristic of the disease and often presents with creases in the earlobes. Inflammation of the mucous membranes in DRESS usually involves the mouth (oropharynx), but 15% of cases have inflammation of multiple mucosal membranes.