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RegiSCAR Score for DRESS

Diagnostic scoring system for drug reaction with eosinophilia and systemic symptoms.

RegiSCAR Score for DRESS
Fever ≥38.5°C
Lymphadenopathy ≥2 sites, >1 cm
Eosinophilia
Atypical lymphocytes present
Rash extent >50% body surface area
Rash morphology suggestive of DRESS (≥2 of: facial edema, infiltration, purpura, scaling)
Skin biopsy performed and NOT suggestive of DRESS
Liver involvement
counted toward the organ-involvement subscore
Lung involvement
Kidney involvement
Muscle/heart involvement
Pancreas involvement
Other organ involvement
Resolution ≥15 days
≥3 of the following negative, and none positive: ANA, blood culture, hepatitis A/B/C serology, chlamydia/mycoplasma serology
Result-3 points

No case (excluded) of DRESS.

Organ involvement subscore
0 (0 organs)
Skin subscore
-1
Total score
-3

When to use

  • A patient with suspected drug reaction with eosinophilia and systemic symptoms, to standardize diagnostic certainty for research or complex cases.

Formula

RegiSCAR = fever ≥38.5°C (-1 to 0) + lymphadenopathy (0-1) + eosinophilia (0-2) + atypical lymphocytes (0-1) + skin subscore [rash extent >50% (0-1) + morphology suggestive of DRESS (-1 to 1) + biopsy not suggestive (-1 to 0)] + organ involvement (0 organs=0, 1=1, ≥2=2) + resolution ≥15 days (-1 to 0) + exclusion of other causes (0-1). Range -4 to +9. <2 = excluded, 2-3 = possible, 4-5 = probable, >5 = definite.

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):609-611.