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Moreover, subsequently, there may be reactivation of other viruses from the Herpesviridae family, such as HHV7, the Epstein-Barr virus (EBV), and, finally, cytomegalovirus (CMV).27 HHV6 reactivation requires immunosuppression, which is demonstrated by the decrease in serum levels of immunoglobulins, including IgG, IgM and IgA, in addition to circulating B cells at the onset of DRESS syndrome.24 The depletion in circulation and in DRESS skin lesions of pro-inflammatory CD14dimCD16+ monocytes (pMOs) capable of mediating antiviral functions, together with the significant expansion of CD4+FOXP3+ Treg cells in the acute phase of DRESS, aiming to contain the activation of drug-specific effector T cells (Teffs), could play a relevant role in inhibiting antiviral T lymphocytes and favoring the reactivation of latent viruses.12,24 In some patients with DRESS, HH6 and HH7, EBV, and CMV are detected in the blood, and in some human tissues, in addition to, in some cases, Varicella zoster virus (VZV)
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Extra contraindications for SSD-containing products, such as sensitivity to silver, and avoidance of use during pregnancy or lactation unless product guidance and clinical judgement support its use
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