RegiSCAR DRESS Score

RegiSCAR scoring system for DRESS — Kardaun et al., 2007 · validated in Kardaun et al., 2013

Purpose
Case-validation score for drug reaction with eosinophilia and systemic symptoms (DRESS / DIHS): grades a suspected case from "no case" to "definite" from clinical, laboratory and evolution criteria.
Population
Hospitalised patients with a drug-related acute rash plus at least one of: fever ≥ 38 °C, lymphadenopathy (≥ 2 sites), internal organ involvement, blood count abnormalities (RegiSCAR inclusion criteria). Score once the episode has evolved (resolution item).
Formula
Sum of 8 items weighted −1 to +2; range −4 to +9.
Final score
< 2 no case · 2–3 possible · 4–5 probable · ≥ 6 definite (Kardaun 2007).
🧪 Scoring items

"Unknown" = not assessed or not available. Points are shown on each option.

📋 Organ involvement — reference

Count an organ only after exclusion of other explanations. Organs listed by RegiSCAR: liver, kidney, lung, muscle/heart, pancreas, other. Commonly used thresholds (Kardaun 2013):

  • Liver — ALT > 2× ULN on ≥ 2 consecutive days, and/or raised alkaline phosphatase / bilirubin.
  • Kidney — creatinine > 1.5× baseline, proteinuria or haematuria.
  • Lung — interstitial pneumonitis, pleural effusion, hypoxaemia without alternative cause.
  • Heart / muscle — myocarditis, pericarditis, raised CK/troponin.
  • Pancreas / other — raised lipase/amylase; thyroiditis, encephalitis, colitis, etc.
ℹ️ Typical latency 2–8 weeks after drug start; HHV-6 reactivation supports the diagnosis (Japanese DIHS criteria) but is not part of the RegiSCAR score.
📚 References
  1. Kardaun SH, Sidoroff A, Valeyrie-Allanore L, et al. Variability in the clinical pattern of cutaneous side-effects of drugs with systemic symptoms: does a DRESS syndrome really exist? Br J Dermatol. 2007;156(3):609–11.
  2. Kardaun SH, Sekula P, Valeyrie-Allanore L, et al. Drug reaction with eosinophilia and systemic symptoms (DRESS): an original multisystem adverse drug reaction. Results from the prospective RegiSCAR study. Br J Dermatol. 2013;169(5):1071–80.
  3. Shiohara T, Iijima M, Ikezawa Z, Hashimoto K. The diagnosis of a DRESS syndrome has been sufficiently established on the basis of typical clinical features and viral reactivations. Br J Dermatol. 2007;156(5):1083–4.
  4. Brüggen MC, Walsh S, Ameri MM, et al. Management of adult patients with drug reaction with eosinophilia and systemic symptoms: a Delphi-based international consensus. JAMA Dermatol. 2024;160(1):37–44.
Clinical decision support only. This tool is intended to assist clinical assessment and does not replace professional judgment. Always interpret results in the context of the individual patient.