What Does D.R.E.S.S. Look Like?
D.R.E.S.S. Syndrome isn't pretty but it's important to know what it looks like. Most patients (not all!) present with a maculopapular, pruritic rash of the face, upper trunk and extremeties. The rash can begin on trunk and move down the body and eventually develop into severe exfoliative dermatitis. Parts of the skin may become purple and bruised looking during the course of illness. Edema of the face and extremities will often present in the acute phase of DRESS, and jaundice (yellowing of the skin) is often seen due to liver injury.
While these are the visual cues for DRESS, the most dangerous damage is done internally where it can't be seen. Even after the medication is stopped and rash and edema subside, the organs can progressively get worse. We must look beneath the skin to evaluate for these signs.
DRESS is a progressive and varied condition. Not all symptoms will appear at once and not all patients will experience every symptom.
An early sign of DRESS, rashes are often very itchy, may vary in presentation and progress through the course of illness. Not every DRESS patient will have a severe rash.
Facial Edema (Swelling)
Facial edema is a hallmark sign of DRESS that typically presents within the first few weeks of illness. Some patients will have a facial rash along with swelling, others will not.
Skin exfoliation may occur post rash and involve any part of the body. Some may have "sheets" of skin peel off at times.
Additional Images of DRESS
Swelling of hands
Swelling of legs
Swelling of feet/ankles
Hair loss many months into recovery
Stages of facial rash, edema, and peeling.
Monitoring DRESS patient in hospital.
Hospitalized with skin injury due to DRESS