RegiSCAR Score for Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)

RegiSCAR Calculator

Fever ≥38.5°C

Enlarged Lymph Nodes (≥2 sites, ≥1 cm)

Eosinophilia

Atypical Lymphocytes

Skin Involvement

Organ Involvement

Resolution ≥15 Days

RegiSCAR Score: –

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Diagnoses drug reaction with eosinophilia and systemic symptoms (DRESS).

Why Use

DRESS is often difficult to diagnose due to significant variability in clinical presentations, and signs/symptoms frequently do not present concurrently. This tool may help facilitate diagnosis and appropriate treatment. Useful for research or clinical trials requiring uniform diagnostic criteria for DRESS.

When to Use

Can be used to confirm or exclude DRESS in patients presenting with symptoms of a cutaneous drug reaction.

Formula

Addition of the selected points: Variable Points Fever (≥38.5 °C) No/Unknown -1 Yes 0 Enlarged lymph nodes (≥2 sites, >1 cm) No/Unknown 0 Yes 1 Atypical lymphocytes No/Unknown 0 Yes 1 Eosinophilia 0-699 cells or <10% (no eosinophilia) 0 700-1,499 cells or 10-19.9% 1 ≥1,500 cells or ≥20% 2 Skin rash extent >50% No/Unknown 0 Yes 1 At least two of: edema, infiltration, purpura, scaling No -1 Yes 1 Unknown 0 Biopsy suggesting DRESS No -1 Yes/Unknown 0 Internal organ involved 0 0 1 1 ≥2 2 Resolution in ≥15 days No/Unknown -1 Yes 0 Alternative diagnoses excluded (by ≥3 biological investigations) No/Unknown 0 Yes 1

Pearls / Pitfalls

Some variables may not be available upon presentation, which may alter the tool’s utility as diagnostic criteria.

Management

If DRESS is suspected or confirmed: Discontinue all potential causative medications immediately. Avoid introducing new medications. Initiate supportive care (e.g., fluids, emollients), as appropriate. Monitor laboratory studies. Use the extent of organ involvement to guide severity grading (e.g., Delphi method has been proposed ), which determines the aggressiveness of management, including: Outpatient versus inpatient treatment (including medical ward versus ICU). Topical or systemic corticosteroids. Advanced organ support and closer monitoring. Specialist consultations. If DRESS is excluded: Evaluate for alternative diagnoses. Monitor for new or progressive signs and symptoms. Repeat the score if new data is available and DRESS remains on the differential.

Critical Actions

If known, record the suspected offending drug in the patient's medical record to avoid future exposure.

Advice

Many conditions can mimic DRESS. A thorough history, physical examination, and clinical evaluation are necessary to rule out alternative diagnoses.

More Information

Interpretation: RegiSCAR-Group Score Likelihood of DRESS Diagnosis <2 No case 2-3 Possible case 4-5 Probable case >5 Definite case