[en] BACKGROUND: We studied the immunopathologic characteristics of five cases of toxic epidermal necrolysis by using a large panel of antibodies. OBSERVATIONS: The pattern and amount of the inflammatory cell infiltrate varied according to the stage of the disease. The main constant feature was the prominent involvement of the monocyte-macrophage lineage, including factor XIIIa+HLA-DR+ dendrocytes and CD68+ Mac 387+ macrophages, before and during the epidermal necrosis. The number of CD4+ and CD8+ lymphocytes was comparatively small. This was associated with a dense labeling of the epidermis for tumor necrosis factor alpha. CONCLUSIONS: Cells of the monocyte-macrophage lineage largely outnumber lymphocytes in the lesions of toxic epidermal necrolysis. Tumor necrosis factor alpha is likely a major cytokine that is responsible for necrosis.
Merot Y, Gravallese E, Guillen F, Murphy G. Lymphocyte subsets and Langerhans’ cells in toxic epidermal necrolysis. Arch Dermatol. 1986; 122: 455-458.
Miyauchi H, Hosokawa H, Akaeda T, Iba H, Asada Y. T-cell subsets in drug-induced toxic epidermal necrolysis. Arch Dermatol. 1991; 127: 851-855.
Heng M, Allen S. Efficacy of cyclophosphamide in toxic epidermal necrolysis. J Am Acad Dermatol. 1991; 25: 778-786.
Villada G, Roujeau JC, Clerici T, Bairgault I, Revuz J. Immunopathology of toxic epidermal necrolysis. Arch Dermatol. 1992; 128: 50-53.
Stern R, Chan HL. Usefulness of case report literature in determining drugs responsible for toxic epidermal necrolysis. J Am Acad Dermatol. 1989; 21: 317-322.
Begaud B, Evreux JC, Jouglard J, Lagier G. Imputabilité des effets inattendus ou toxiques des médicaments. Thérapie. 1985; 40: 111-118.
Merot Y, Saurat JH. Clues to pathogenesis of toxic epidermal necrolysis. Int J Dermatol. 1985; 24: 165-168.
Roujeau JC, Dubertret LL, Moritz S, et al. Involvement of macrophages in the pathology of toxic epidermal necrosis. Br J Dermatol. 1985; 113: 425-430.
Headington JT, Cerio R. Dendritic cells and the dermis: 1990. Am J Dermatopathol. 1990; 12: 217-220.
Kock A, Urbanski A, Luger TA. mRNA expression and release of tumor necrosis factor-alpha by human epidermal cells. J Invest Dermatol. 1989; 92: 462.
Engelmann H, Holtmann H, Brakebusch C, et al. Antibodies to a soluble form of tumor necrosis factor (TNF) receptor have TNF-like activity. J Biol Chem. 1990; 265: 14497-14504.
Piguet P, Grau G, Hauser C, Vassalli P. Tumor necrosis factor is a critical mediator in hapten-induced irritant and contact hypersensitivity reactions. J Exp Med. 1991; 173: 673-679.
