Co‐existence of histopathological features is characteristic in drug reaction with eosinophilia and systemic symptoms and correlates with high grades of cutaneous abnormalities

Abstract

The co-existence of three histopathological patterns in a skin specimen is characteristic in DRESS and shows a significant association with clinical severity.

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): An Interplay among Drugs, Viruses, and Immune System

“…Spongiosis is also a commonly seen feature of the histopathological presentation, having been found in 40–80% of the cases in previous studies [74,75,76,77]. In one study, the presence of spongiosis was shown to be associated with a milder severity of the disease [78].…”

“…Interface dermatitis is the most common histopathological presentation, having been found in more than three-fourths of the patients with DRESS syndrome in most previous studies [74,75,76]. It consists of an erythema multiforme-like pattern and/or a lichenoid dermatitis pattern.…”

“…There is no single unique finding that can be used to differentiate DRESS syndrome from other drug eruptions or inflammatory skin disorders. In past years, several commonly encountered histopathological patterns have been identified in the skin specimens of patients with DRESS syndrome (Figure 3), including spongiosis, interface dermatitis, vascular damage, and superficial perivascular infiltration [74]. …”

“…In some cases, subcorneal pustules can be seen even though there are no obvious cutaneous pustules in these patients. In addition, the feature of vascular damage is also prevalent in patients with DRESS syndrome, having been observed in 54–88% of the patients in prior studies [74,76,77,78]. The extent of vascular damage seen in those studies varied largely but at least included findings of prominent endothelial cells, red blood cell extravasations, and a certain degree of vessel wall damage [74].…”

“…In addition, the feature of vascular damage is also prevalent in patients with DRESS syndrome, having been observed in 54–88% of the patients in prior studies [74,76,77,78]. The extent of vascular damage seen in those studies varied largely but at least included findings of prominent endothelial cells, red blood cell extravasations, and a certain degree of vessel wall damage [74]. Otherwise, while vascular damage is prevalent in DRESS syndrome patients, frank leukocytoclastic vasculitis was seldom seen in most previous studies excepting one [78].…”