Perspective
I read with great interest the excellent review on minocycline-associated DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) recently published by Pan and Wu in Frontiers in Pharmacology (Pan and Wu, 2025).
DRESS is classified as a type IV hypersensitivity reaction. Interestingly, for certain drugs, the risk of developing this severe cutaneous adverse reaction appears to be linked to the initial dosage at the start of treatment (Blumenthal et al., 2025). This is well documented for antiepileptic drugs, allopurinol, and sulfasalazine. For these medications, a gradual dose escalation is recommended when initiating therapy, which significantly reduces the incidence of DRESS.
It would be of particular interest to have data on the initial dosing of minocycline in reported cases of DRESS. Demographic data from existing reports indicate that most cases involve young women, whose average body weight may be lower than the general population. However, it is not standard clinical practice to adjust minocycline dosing according to body weight, and doses of 100 mg/day or even 200 mg/day are frequently prescribed.
Furthermore, minocycline is a lipophilic drug that tends to accumulate in adipose tissue—a characteristic that could potentially increase exposure and risk in women.
It would therefore be valuable to analyze the dosage-to-body weight ratio in minocycline-associated DRESS cases, especially in female patients. Such data could inform future guidelines and support the adoption of lower starting doses—similar to current recommendations for many antiepileptic drugs and allopurinol—to minimize the risk of DRESS.
Statements
Author contributions
VD: Conceptualization, Data curation, Formal Analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review and editing.
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References
1
Blumenthal K. G. Cardones A. R. G. Kroshinsky D. (2025). Drug reaction with Eosinophilia and systemic Symptoms. Reply. N. Engl. J. Med.392 (9), 935. 10.1056/NEJMc2500319
2
Pan Y. Wu Q. (2025). Clinical manifestations, diagnostic criteria, and treatment outcomes of minocycline-associated DRESS syndrome: a comprehensive exploration of published cases. Front. Pharmacol.16, 1515000. 10.3389/fphar.2025.1515000
Summary
Keywords
adverse drug reaction, DRESS (drug reaction with eosinophilia and systemic symptoms), minocyclin, weight adjustable, risk factor
Citation
Descamps V (2025) Minocycline-induced DRESS: could dosage in relation to body fat mass be a contributing factor?. Front. Pharmacol. 16:1681474. doi: 10.3389/fphar.2025.1681474
Received
07 August 2025
Accepted
11 September 2025
Published
25 September 2025
Volume
16 - 2025
Edited by
Monika Batke, University of Applied Sciences Emden Leer, Germany
Reviewed by
Ursula Gundert-Remy, Charité University Medicine Berlin, Germany
Lennart T. Anger, Genentech Inc., United States
Updates
Copyright
© 2025 Descamps.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Vincent Descamps, vincent.descamps@aphp.fr
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.