DRESS Syndrome and the 2025 American Academy of Dermatology (AAD) Annual Meeting

From March 7 – 11, dermatologists and non-medical professionals gathered from around the world in

DRESS Syndrome Foundation Executive Director Tasha Tolliver (left) and Communications Director Deanna Lorianni

Orlando, Florida, for the 2025 AAD Annual Meeting. This conference brought over 20,000 people together for learning across an array of medical topics, including DRESS Syndrome.

We were excited to attend and deepen our knowledge around updates into dermatological medical research and new insights into managing severe drug reactions like DRESS.

Here are our top takeaways:

Shout Out to Dermatologists Committed to DRESS Syndrome

First, we were encouraged to see the increased focus on severe, cutaneous, adverse drug reactions (SCARs). There were multiple sessions that either included DRESS Syndrome or focused solely on DRESS.

Thank you to the doctors and researchers who presented about DRESS and SCARs at 2025 AAD, and who are working hard to understand these life-threatening diseases!

Viral Reactivations in DRESS Syndrome

A complex DRESS topic is the role viral reactivations (like HHV-6) may play in reaction severity and whether to test for this factor during diagnosis. According to research presented at 2025 AAD, HHV-6 reactivation occurs between 38- to 80% of DRESS Syndrome cases. And severe reactivations link to more severe illness.

The controversy surrounds whether testing and treating for HHV-6 reactivations early in diagnosis could help patients avoid more severe reactions, including death. We hope for continued conversations and research on this topic to help align best practices for addressing viral reactivations in DRESS.

Source:

“Beyond Skin Deep: Practical Tips on Management of DRESS” (Dr. Maria Aleshin, Dr. Silvinia Pugliese)

“High-Yield Updates in DRESS Syndrome” (Dr. Misha Rosenbach)

Early Onset in DRESS Syndrome – “Rule Breakers”

Typically, DRESS shows itself within 2 to 8 weeks after starting a new drug. However, research has shown that some antibiotics and contrast iodinated media can create symptoms quicker than other drugs. For this reason, it’s important for medical teams to not rule out a potential DRESS diagnosis simply due to patients showing early reaction signs.

Source: “Beyond Skin Deep: Practical Tips on Management of DRESS” (Dr. Maria Aleshin, Dr. Silvinia Pugliese)

Acne and Rosacea Treatment Regarding Antibiotics

Taking antibiotics is a leading cause of developing DRESS Syndrome. And dermatologists prescribe more antibiotics in the U.S. than all other clinicians. We were encouraged to hear a call for better antibiotic stewardship among prescribers to provide patients with safer, more effective treatments and combat antibiotic resistance.

Two traditionally prescribed antibiotics that cause DRESS are minocycline and Bactrim (trimethoprim/ sulfamethoxazole). Today, the AAD does not recommend Bactrim and cephalexin for acne/rosacea treatment per 2024 AAD guidelines. Meanwhile, minocycline is “conditionally” recommended. (And our opinion is that patients should be extremely cautious about, or avoid, taking this drug due to its risk for DRESS and other SCARs like Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN).

Presenters also addressed a "narrow spectrum" antibiotic called Sarecycline, which has shown fewer overall side effects. However, it is currently more expensive than the commonly prescribed antibiotic, doxycycline. Additionally, the AAD presenters highlighted several effective non-antibiotic treatments for acne, such as spironolactone, oral contraceptives, Accutane (isotretinoin), and topical options like clascoterone.

Recently, the FDA approved the drug Emrosi for treatment of rosacea. However, this decision has sparked controversy since it’s a minocycline-based drug that will put more patients at risk for developing SCARs. Current safety and efficacy studies done by the drug manufacturer, Journey Medical, did show that this extended-release minocycline outperformed the currently authorized antibiotic treatment with low-dose doxycycline. However, the studies were not large enough to adequately assess for SCARs occurrence. Emrosi has just been released in the U.S., and we will be following closely.

To learn more about Emrosi, check out this video by dermatologist Dr. John Barbieri.

Read our blog about antibiotics and acne, with Dr. John Barbieri.

Source: Dr. Christopher Buick, Dr. Andrea Zaenglein, Dr. Howa Yeung and Journey Medical representatives and Emrosi literature.

Cancer Therapies Causing DRESS Syndrome

As new cancer therapies emerge, we’re seeing DRESS reactions to these drugs. Biologics are an increasing class of drugs that can cause immune reactions like DRESS, which include:

• bortezomib

• dabrafenib

• enorafenib 

• imatinib

• ipilimumab

• vemurafenib

Some of these cases can present atypically in patients who have previously received immune checkpoint inhibitors (ICIs), when compared to patients who didn’t receive ICI. These symptoms include (but aren’t limited to):

• less noted peripheral eosinophilia

• lack of atypical lymphocytes

• no lymphandopathy

Often, cancer patients are taking multiple drugs at once, and when combined with atypical reactions, DRESS can be more challenging to diagnose. Plus, it complicates treatment for cancer patients who need these drugs for life-saving treatment. As a result, relying on the medically accepted RegiSCAR diagnostic criteria for cancer patients may not be as effective.

Source:

“Cutaneous Side Effects of Immune Checkpoint Inhibitors (ICIs)” (Dr. Jennifer Choi)

“Beyond Skin Deep: Practical Tips on Management of DRESS/DIHS” (Dr. Silvina Pugliese)

Long-Term Complications From DRESS Syndrome

While most patients will recover after their DRESS event, research has uncovered that up to 11.5% of patients will develop long-term complications. These health issues can be immune related, but not always. The most common complications are autoimmune thyroid disease and fulminant type 1 diabetes, which can occur between 2 to 4 months after having DRESS. Long-term health issues can also show after all initial symptoms go away and patients wean off steroids, as long as 5 or more years later.

For this reason, it's essential that medical teams continue monitoring DRESS Syndrome patients for many years after their initial recovery.

Source: “Beyond Skin Deep: Practical Tips on Management of DRESS” (Dr. Maria Aleshin, Dr. Silvinia Pugliese)

DRESS Syndrome Treatment

We heard from several presenters about common and novel (new) treatments. They reinforced the following about steroids:

• Steroids (systemic and topical) are still the main first-line treatment.

• Corticosteroids are not sufficient enough to control symptoms for some patients.

1.Common Treatments

Some other treatments could be more effective for severe DRESS cases:

• Cyclosporine: an immune suppressant used either alone or along with steroids or IVIG in DRESS. This treatment generally showed shorter time to resolve symptoms and shorter hospitalization. However, it’s often not appropriate for patients with kidney involvement.

• Intravenous Immunoglobulin (IVIG): These immune system antibodies may be used alongside of steroids to treat DRESS symptoms that are not controlled by steroids alone. However, it’s not recommended as mono therapy (the only one).

2.Novel Treatments

Researchers are studying some new treatments that may offer a promising future in DRESS Syndrome treatment:

• Janus Kinase Inhibitors (JAKi): These agents reduce inflammation and may help in controlling systemic DRESS symptoms. So far, JAKs have been successful in treating difficult DRESS cases in limited studies, particularly those with severe heart involvement. JAKs include treatments like tofacitnib and upadacitnib.

• Biologics – IL-5 and IL-5R Inhibitors: This treatment plays a crucial role by suppressing eosinophils, which can be greatly elevated in DRESS patients (but not always). So far, they’ve been successfully used in a limited number of difficult and relapsing cases where steroids and cyclosporine didn’t control life-threatening symptoms involving the heart, lungs, and liver. Biologics include treatments like Benralizumab and Mepolizumab.

• Monoclonal Antibody – IL-4 and -13 Inhibitors: In recent studies, these antibodies have proven to successfully treat severe cases and have shown a good overall safety profile. This includes treatments like Dupilumab.

• TNF-a Inhibitors: A limited number of cases have shown success in treating complicated DRESS symptoms, particularly those with HHV-6 viral reactivation.

Source:

“High-Yield Updates in DRESS Syndrome” (Dr. Carolyn Nelson and Dr. Abraham Korman)

“Beyond Skin Deep: Practical Tips on Management of DRESS/DIHS” (Dr. Silvina Pugliese and Dr. Maria Aleshin)

The Role of AI and Machine-Learning Tools

We’re encouraged to see researchers developing new ways for technology to assist in diagnosing and predicting illnesses, like DRESS Syndrome. Drug eruptions can be tricky because they vary — some are mild, while others, like DRESS and Stevens-Johnson syndrome, can be life-threatening. These tools aim to help doctors make critical care decisions. Baylor College of Medicine and Ohio State University Wexner Medical Center are developing mechanisms like:

• Multimodal data prediction: This tool combines the following:

  • images (skin rashes, x-rays, and scans)

  • clinical data (patient medical history)

  • histological data (examining skin samples and genetic biomarkers)

The goal is to predict:

• diagnosis (whether a patient is likely to develop a drug reaction from specific medication)

• prognosis (the potential severity of the eruption, from mild to severe)

• drug attribution (identifying which medication is causing the reaction, particularly in cases where a patient is on many medications)

These tools can scan data across multiple hospitals and clinics to expand its database and arise at more accurate results.

• AI: Researchers are starting to use AI to analyze low-risk morbilliform rashes in comparison to DRESS–induced rashes. This tool is showing a promising direction in how artificial intelligence can help doctors more accurately and efficiently identify DRESS in a patient.

Source:

“Use of augmented intelligence to differentiate DRESS from low-risk morbilliform rash” (Dr. Vamsi Varra)

“High-Yield Updates in DRESS Syndrome” (Dr. Abraham Korman)

Our Takeaway

Overall, we left 2025 AAD with a renewed sense of hope in making real progress in improving how we diagnose and treat DRESS Syndrome patients. While there’s still much more to do to deepen medical understanding, DRESS research seems to be moving in an effective, promising direction.