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Community sources variously attribute it to dose, to the DMSO carrier in transdermal use, or to vascular effects, with no way to confirm cause in self-reports

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Currently, DRESS is considered a serious, idiosyncratic adverse drug reaction, mediated especially by T-cells, classified as a type IVb hypersensitivity reaction (sometimes IVc), according to the Gel & Coombs classification, expanded by Pichler.21 Thus, the current concept is that DRESS is the result of the complex interaction between exposure to medications (or immunizing vaccines, or immunobiologicals), genetic predisposition, and reactivation of latent viruses, particularly from the Herpesviridae family.20 The reason why some individuals develop this adverse reaction, while others do not, despite being exposed to the same medication, seems to result from the cumulative effect of the conjunction of risks, which are aligned through a single successive causal model, where the final result, in a straight line, is DRESS (Fig