Immunopathology of toxic epidermal necrolysis. Keratinocytes, HLA-DR expression, Langerhans cells, and mononuclear cells: an immunopathologic study of five cases.
BACKGROUND
Toxic epidermal necrolysis is a potentially severe mucocutaneous affliction whose cause is usually drug related. To further characterize the nature of the dermal mononuclear infiltrate as well as the epidermal alterations observed by standard microscopy, we studied five cases of toxic epidermal necrolysis using labeled monoclonal antibodies.


RESULTS
On clinically involved areas of skin, the following occurs: (1) the dermal infiltrate is composed mainly of activated T lymphocytes, with a predominant helper phenotype; (2) the number of Langerhans cells is decreased; and (3) keratinocytes express HLA-DR molecules, normally absent on their surface.


CONCLUSIONS
These findings, although not specific, are consistent with an immune cellular reaction, but they could also be linked to an inflammatory reaction initiated by epidermal damages whatever its primary mechanism.
Villada
G
G
Department of Dermatology, Hôpital Henri Mondor, University Paris Val-de-Marne, Créteil, France.
Roujeau
J C
JC
Clérici
T
T
Bourgault
I
I
Revuz
J
J
D000328:Adult; D001706:Biopsy; D005260:Female; D005455:Fluorescent Antibody Technique; D006684:HLA-DR Antigens / Q000032:analysis*; D006801:Humans; D007150:Immunohistochemistry; D015603:Keratinocytes / Q000276:immunology* / Q000473:pathology; D007801:Langerhans Cells / Q000276:immunology* / Q000473:pathology; D007963:Leukocytes, Mononuclear / Q000276:immunology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000276:immunology / Q000473:pathology; D013262:Stevens-Johnson Syndrome / Q000276:immunology* / Q000473:pathology
D006684:HLA-DR Antigens