distinguishing the two entities If needed, topical steroids can help provide symptomatic relief of pruritus DRUG HYPERSENSITIVITY REACTION (DHR)/DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS) The cutaneous eruption of DHR, also known as drug reaction with eosinophilia and systemic symptoms (DRESS), is a morbilliform eruption that starts on the face and spreads cephalocaudally Additional clinical findings and systemic involvement distinguish DHR from a skin-limited morbilliform drug eruption Facial edema is present in approximately 76%, fever in 90%, and lymphadenopathy in 54% of patients with DHR In half of patients, there can be mild mucosal involvement, more commonly the oral mucosa Systemic involvement commonly manifests with eosinophilia (95%) or atypical lymphocytosis (67%) on complete blood count Liver involvement is seen in 75% of patients, and often presents as elevation of liver transaminases In cases where patients have a prolonged clinical course or when they appear systemically ill, echocardiogram, renal function tests, and coagulation profiles should be checked for cardiac, renal, and hepatic involvement Thyroid involvement is usually delayed in onset, so thyroid functions should be followed for to months after the DHR