Many different drugs may cause DRESS syndrome. One of them is Lamictal (lamotrigine), a medication used to treat epilepsy and bipolar disorder. Some drugs are more likely to cause symptoms than others; it is difficult to predict which patients will be affected and which will be spared.

What is DRESS Syndrome?

The acronym “DRESS” stands for Drug Rash with Eosinophilia and Systemic Symptoms. This is an allergic reaction that can occur with almost any type of medication; however, most drugs that cause DRESS Syndrome are anti-seizure medications, antibiotics and anti-inflammatories, such as allopurinol.

What Are the Symptoms?

The most common visible symptom of DRESS Syndrome is a red rash that usually starts on the face and upper body. Another outward sign is facial swelling. Internally, the victim may suffer from enlarged lymph nodes and kidney or liver injuries.

Eosinophilia is an overabundance of white blood cells (eosinophils), which are part of the immune system. This condition, which can only be diagnosed with a blood test, is usually the result of a parasite infestation or the presence of some types of cancer. However, they can also be the result of an allergic reaction. Untreated, eosinophilia can cause severe organ damage.

Symptoms due to a drug allergy generally become apparent approximately two to six weeks after the patient has begun taking the medication; those who have been on their prescription(s) for 12 weeks or longer are unlikely to develop DRESS syndrome.

Which Specific Medications Have Been Linked to DRESS Syndrome?

Prescription drugs that have most often been associated with DRESS are:

Abacavir (Ziogen)
Allopurinol (Aloprim, Zyloprim)
Carbamazepine (Carbatrol, Tegretol)
Dapsone (Aczone)
Lamotrigne (Lamictal)
Nevirapine (Viramune)
Phenytoin (Dilantin)
Vancomycin (Vancocin)

What Else Can Cause DRESS Syndrome?

Aside from medications and infections, there is no other known cause of DRESS Syndrome. There is however evidence to indicate that genetics may play a role in how certain people develop the condition in response to specific medications. For example, people of Han Chinese ancestry appear to have a greater risk of experiencing DRESS Syndrome when taking phenytoin.

Are There Treatments for DRESS Syndrome?

In drug-related DRESS, the first-line treatment is to discontinue the medication immediately. In some cases, this is enough; however, most of the time, topical ointments are needed for the skin rash and steroids are required in order to prevent serious organ injury.

What Are the Differences Between DRESS Syndrome and Stevens Johnson Syndrome?

Another condition which is essentially an allergic reaction to a drug is Stevens Johnson Syndrome (SJS). According to a separate National Institutes of Health article, both DRESS and SJS are most commonly caused first by antibiotics—ranging between 35 percent and 40 percent–and then by anticonvulsants like Lamictal—ranging between 25 percent and 35 percent. Both conditions have been brought on by non-steroidal anti-inflammatory drugs (NSAIDS) as well. The ailments share symptoms of fever, itching, and general malaise in common.

SJS and DRESS also will appear within a window of two to six weeks of starting a new drug regimen.  In DRESS, blood tests will likely show liver or other internal organ involvement and medical examination might reveal swollen lymph nodes. SJS will not have this, but will upon physical observation, affect mucous membranes of the body such as mouth, eyes, and genitals in 90 percent of cases with ten percent of the body involved in the rash.

This involvement with mucous tissue and the measurement of surface area of skin involved is a key way to avoid misdiagnosis between the two syndromes. It is the first line of differentiation before running blood tests. Patient records over a four-year period between 2004 and 2008 were reviewed, as indicated by the NIH report, of 11 adults with DRESS and 20 adults with SJS.

It was noted with this group that DRESS patients always had higher-than-normal liver enzymes and some kidney side effects. With SJS, only two patients had elevated white blood cells characteristic of eosinophils while several had liver enzyme upset.

If I Suffered DRESS from Taking a Medication, Can I Sue?

There actually have been lawsuit investigations into Lamictal side effects. The medication was developed by UK pharmaceutical company GlaxoSmithKline and first approved as an anti-seizure medication in the US in December of 1994. In June of 2003, Lamictal gained FDA approval for the treatment of bipolar disorder.

It was not until 2018 that the FDA issued a safety warning about the link to DRESS Syndrome and required the drug maker to include this information on the label.

Current lawsuits claim that GlaxoSmithKline knew of the possible danger prior to that time, so if you suffered DRESS as a result of taking Lamictal, you may have grounds for legal action.