title: Increased interleukin 10, tumor necrosis factor alpha, and interleukin 6 levels in blister fluid of toxic epidermal necrolysis.
abstract: BACKGROUND
  Toxic epidermal necrolysis is a severe, usually drug-induced disease that shares clinical, histologic, and immunologic similarities with the severe forms of cutaneous acute graft-versus-host disease.
  
  
  OBJECTIVE
  Our purpose was to further characterize common immune-inflammatory pathways in these skin disorders by measurement of different cytokines.
  
  
  METHODS
  Evaluation of serum levels of interleukin 10 (IL-10), tumor necrosis factor alpha, IL-6, and soluble IL-6 receptor in the early phase of both diseases and in blister fluid of toxic epidermal necrolysis.
  
  
  RESULTS
  Serum levels of IL-10 and IL-6 were significantly higher in patients with toxic epidermal necrolysis (P =.0001) and acute graft-versus-host disease (P =.001) compared with those of blood donors. We found an increase in IL-6 levels in blister fluid and significantly higher levels of IL-10 (P =.018) and tumor necrosis factor alpha (P =.028) in blister fluid compared with serum in patients with toxic epidermal necrolysis.
  
  
  CONCLUSIONS
  A similar serum cytokine profile of toxic epidermal necrolysis and acute graft-versus-host disease further emphasizes common immunologic mechanisms. The presence of inflammatory cytokines, IL-6 and tumor necrosis factor alpha, in the blister fluid of patients with toxic epidermal necrolysis is associated with significantly higher levels of IL-10, which through its down-regulatory role, may be involved in limitation of the disease extension.
authors.affiliation: Department of Dermatology, Instituto Português Oncologia, 4200 Porto, Portugal. osvaldo.correia@netc.pt
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Correia
authors.forename: Luís
authors.initials: L
authors.lastname: Delgado
authors.forename: Isabel Leal
authors.initials: IL
authors.lastname: Barbosa
authors.forename: Fernando
authors.initials: F
authors.lastname: Campilho
authors.forename: José
authors.initials: J
authors.lastname: Fleming-Torrinha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D001768:Blister / Q000378:metabolism; D005260:Female; D006086:Graft vs Host Disease / Q000503:physiopathology*; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis*; D016753:Interleukin-10 / Q000032:analysis* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013262:Stevens-Johnson Syndrome / Q000503:physiopathology*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis* / Q000378:metabolism
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10