title: Fixed drug eruptions: evidence for a cytokine-mediated process.
abstract: Fixed drug eruptions (FDE) are immunologic reactions to drugs which produce erythematous plaques or blisters that characteristically recur at the same cutaneous sites with repeated antigenic challenges. While a detailed pathogenesis of these lesions remains obscure, T-lymphocyte infiltration has been documented repeatedly. In this study, we tried to determine if FDE were mediated, at least in part, by cytokines, such as gamma-interferon. We examined biopsies from 6 cases of clinically well-documented FDE with an HLA-DR antibody, LN3, and an antibody to gamma IP-10 (IP-10), a protein expressed by keratinocytes, monocytes, lymphocytes and endothelial cells following exposure to gamma-interferon. We found staining of the dermal lymphocytes with anti-HLA-DR antibody in all 6 cases examined. Keratinocytes and endothelial cells showed only focal staining at the antibody concentrations used. In addition, there was keratinocyte staining with the IP-10 antibody at all levels of the epidermis, with accentuation in areas of blister formation. There was more intense staining of keratinocytes with the IP-10 antibody in cases with accumulations of HLA-DR positive lymphocytes in the dermis. We believe that these findings are consistent with the hypothesis that FDE represent cell-mediated immunologic responses to a variety of antigens, and further, that the histologic alterations can be explained, at least in part, by a cytokine-mediated process.
authors.affiliation: Department of Dermatopathology, New York Hospital, New York.
authors.forename: B R
authors.initials: BR
authors.lastname: Smoller
authors.forename: A D
authors.initials: AD
authors.lastname: Luster
authors.forename: J F
authors.initials: JF
authors.lastname: Krane
authors.forename: J
authors.initials: J
authors.lastname: Krueger
authors.forename: M H
authors.initials: MH
authors.lastname: Gray
authors.forename: N S
authors.initials: NS
authors.lastname: McNutt
authors.forename: A
authors.initials: A
authors.lastname: Hsu
authors.forename: A B
authors.initials: AB
authors.lastname: Gottlieb
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000276:immunology; D016207:Cytokines / Q000276:immunology*; D003875:Drug Eruptions / Q000276:immunology* / Q000473:pathology; D005260:Female; D006684:HLA-DR Antigens / Q000276:immunology; D006801:Humans; D007111:Immunity, Cellular; D007371:Interferon-gamma / Q000276:immunology; D015603:Keratinocytes / Q000276:immunology; D008297:Male
chemical_list: D000911:Antibodies, Monoclonal; D016207:Cytokines; D006684:HLA-DR Antigens; D007371:Interferon-gamma