dermatology pharmacology

RegiSCAR Score for DRESS

Validates a suspected case of drug reaction with eosinophilia and systemic symptoms (DRESS) with the RegiSCAR scoring system (Kardaun 2007): total −4 to 9; < 2 no case, 2–3 possible, 4–5 probable, > 5 definite.

Fever ≥ 38.5 °C*

Enlarged lymph nodes (≥ 2 sites, > 1 cm)*

Eosinophilia*

Atypical lymphocytes*

Skin rash extent > 50 % of body surface area*

Rash suggesting DRESS (≥ 2 of: facial oedema, infiltration, purpura, scaling)*

Skin biopsy suggesting DRESS*

Internal organ involvement (liver, kidney, lung, muscle/heart, pancreas, other)*

Resolution in 15 days or more*

Other causes excluded: ANA, blood culture, hepatitis A/B/C serology, Chlamydia/Mycoplasma — none positive and at least 3 negative*

Score interpretation

No Case (RegiSCAR < 2) -4–1

Score below 2: not a DRESS case by RegiSCAR.

→ DRESS unlikely; consider alternative diagnosis; monitor drug reaction; review causative agent

Possible DRESS (score 2–3) 2–3

RegiSCAR 2–3: possible DRESS.

→ Stop causative drug; specialist dermatology review; monitor FBC, LFTs, renal function, CXR; avoid re-exposure; consider systemic steroids if progressing

Probable DRESS (score 4–5) 4–5

RegiSCAR 4–5: probable DRESS.

→ Emergency admission; stop causative drug immediately; systemic corticosteroids (Adults: prednisolone 1mg/kg/day. Children: use a children's formulary.); ophthalmology (eye involvement); dermatology, hepatology, nephrology involvement; ICU if multiorgan failure

Definite DRESS (score > 5) 6–9

RegiSCAR above 5: definite DRESS.

Interpretation bands for the RegiSCAR (DRESS). Apply clinical judgement and local guidance.

References

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

Related