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Kridin K, Brüggen MC, Walsh S, Bensaid B, Ranki A, Oppel E, Meyersburg D, Chua SL, Seeli C, Sandberg H, French LE, Vorobyev A, Ingen-Housz-Oro S. Management and treatment outcome of DRESS patients in Europe: An international multicentre retrospective study of 141 cases. J Eur Acad Dermatol Venereol 2023; 37:753-762. [PMID: 36479739 DOI: 10.1111/jdv.18808] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
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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Affiliation(s)
- Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Marie-Charlotte Brüggen
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Medical Campus Davos, Davos, Switzerland.,ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-Skin)
| | - Sarah Walsh
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-Skin).,Department of Dermatology, King's College Hospital, London, UK
| | - Benoit Bensaid
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-Skin).,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Department of Dermatology, Edouard Herriot Hospital, Lyon, France
| | - Annamari Ranki
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-Skin).,Department of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Hospital, Inflammation Center, Helsinki, Finland
| | - Eva Oppel
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-Skin).,Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany
| | - Damian Meyersburg
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-Skin).,Department of Dermatology and Allergology, University Hospital Salzburg of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Ser-Ling Chua
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-Skin).,Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Corsin Seeli
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Heidi Sandberg
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Hospital, Inflammation Center, Helsinki, Finland
| | - Lars E French
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-Skin).,Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany.,Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Artem Vorobyev
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-Skin).,Department of Dermatology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Saskia Ingen-Housz-Oro
- ToxiTEN Group, European Reference Network for Rare Skin Diseases (ERN-Skin).,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France.,Univ Paris Est Créteil EpiDermE, Créteil, France
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Anasiewicz N, Seeli C, Brüggen MC, Möhrenschlager M. Coronavirus infection in an unvaccinated atopic dermatitis patient under ongoing dupilumab therapy: eczema flare-up, but moderate COVID-19 symptoms. Allergo J Int 2023; 32:1-2. [PMID: 36748045 PMCID: PMC9891745 DOI: 10.1007/s40629-023-00245-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/02/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Natalie Anasiewicz
- Department of Dermatology, Hochgebirgsklinik, Herman-Burchard-Street 1, 7265 Davos Wolfgang, Switzerland
- Christine Kühne Center for Allergy Research and Education, Davos, Switzerland
- Department of Dermatology, University of Zurich, Zurich, Switzerland
| | - Corsin Seeli
- Department of Dermatology, Hochgebirgsklinik, Herman-Burchard-Street 1, 7265 Davos Wolfgang, Switzerland
- Department of Dermatology, University of Zurich, Zurich, Switzerland
| | - Marie-Charlotte Brüggen
- Department of Dermatology, Hochgebirgsklinik, Herman-Burchard-Street 1, 7265 Davos Wolfgang, Switzerland
- Christine Kühne Center for Allergy Research and Education, Davos, Switzerland
- Department of Dermatology, University of Zurich, Zurich, Switzerland
| | - Matthias Möhrenschlager
- Department of Dermatology, Hochgebirgsklinik, Herman-Burchard-Street 1, 7265 Davos Wolfgang, Switzerland
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Anasiewicz N, Seeli C, Brüggen MC, Möhrenschlager M. Localized eczematous rash affecting left and right regions of breast and shoulder after Ad26.COV2.S vaccine against COVID-19 in a 30-year-old woman with comorbidities. Allergo J Int 2022; 32:93-94. [PMID: 36466142 PMCID: PMC9703396 DOI: 10.1007/s40629-022-00234-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/16/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Natalie Anasiewicz
- Department of Dermatology, Hochgebirgsklinik, Davos, Switzerland
- Christine Kühne Center for Allergy Research and Education, Davos, Switzerland
| | - Corsin Seeli
- Department of Dermatology, Hochgebirgsklinik, Davos, Switzerland
| | - Marie-Charlotte Brüggen
- Department of Dermatology, Hochgebirgsklinik, Davos, Switzerland
- Christine Kühne Center for Allergy Research and Education, Davos, Switzerland
- Department of Dermatology, University of Zurich, Zurich, Switzerland
| | - Matthias Möhrenschlager
- Department of Dermatology, Hochgebirgsklinik, Herman-Burchard-Street 1, 7265 Davos Wolfgang, Switzerland
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Möhrenschlager M, Seeli C, Anasiewicz N. Atopic dermatitis in a population-based cohort from Stockholm, Sweden 24 years after start: new data, new questions. J Eur Acad Dermatol Venereol 2022; 36:634. [PMID: 35416366 DOI: 10.1111/jdv.18085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 11/30/2022]
Affiliation(s)
- M Möhrenschlager
- Department of Dermatology, Hochgebirgsklinik, Davos, Switzerland
| | - C Seeli
- Department of Dermatology, Hochgebirgsklinik, Davos, Switzerland
| | - N Anasiewicz
- Department of Dermatology, Hochgebirgsklinik, Davos, Switzerland.,Christine Kühne Center for Allergy Research and Education, Davos, Switzerland
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Buset CS, Fleischer J, Kluge R, Graf NT, Mosti G, Partsch H, Seeli C, Anzengruber F, Kockaert M, Hübner M, Hafner J. Compression Stocking With 100% Donning and Doffing Success: An Open Label Randomised Controlled Trial. Eur J Vasc Endovasc Surg 2021; 61:137-144. [PMID: 33129680 DOI: 10.1016/j.ejvs.2020.09.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/30/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to test whether an investigational two layer stocking exerting 27-29 mmHg pressure at the medial supramalleolar level, but without compression in the foot and heel, is easier to put on and take off than a standard stocking of the same compression class (23-32 mmHg), and also to assess the prevention of diurnal oedema with both types of stocking. METHODS This was an open label randomised controlled trial, which included 47 patients. All participants were at least 65 years of age and suffered from chronic venous disease class C3 - C6 in one leg. The primary end point was donning success; secondary endpoints were doffing success, prevention of diurnal oedema over one day, and the comfort of wearing the stocking. Patients were randomly allocated to one of two groups. Both types of compression stocking were compared in each group for ease of donning and doffing in the manner of a crossover study. Subsequently, patients wore the stocking type assigned to their group for a whole day to evaluate comfort and the effect on diurnal leg volume. RESULTS All participants were able to don the investigational stocking unaided, compared with 75% for the standard stocking (p < .001). Unaided removal success was 100% with the investigational stocking vs. 66% for the standard stocking (p < .001). There was no significant difference in leg volume reduction between the study groups after a day of wear. The investigational stocking was also rated as being more comfortable than the standard stocking (p < .001). CONCLUSION The investigational stocking, which has no compression in the foot or heel area, is significantly easier to don and doff, with no inferiority in oedema prevention, compared with a standard stocking of the same compression class.
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Affiliation(s)
- Caroline S Buset
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | | | | | | | | | - Hugo Partsch
- Professor Emeritus of Dermatology, Medical Faculty of the University of Vienna, Vienna, Austria
| | - Corsin Seeli
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Florian Anzengruber
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Michaël Kockaert
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Monika Hübner
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Jürg Hafner
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
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