title: Immunohistochemical evaluation of toxic epidermal necrolysis treated with human intravenous immunoglobulin.
abstract: OBJECTIVE
  Toxic epidermal necrolysis (TEN) is a severe drug reaction characterized by massive epidermal cell death. The authors of the current study and others have noted improved outcomes in TEN patients treated with human intravenous immunoglobulin (IVIG), purportedly due to its ability to inhibit the fas/fas-ligand (Fas-L) apoptotic pathway, but published case series evaluating TEN through the use of immunohistochemical antibody stains for Fas and Fas-L before and after IVIG treatment are lacking. The authors hypothesized that due to IVIG's ability to arrest the evolution of TEN, expression of Fas/Fas-L on keratinocytes would be decreased or absent following IVIG treatment.
  
  
  METHODS
  Ten patients diagnosed with TEN underwent biopsies of their lesions prior to and five days after treatment with IVIG. Seven post-treatment biopsies were of sufficient quality to undergo evaluation.
  
  
  RESULTS
  All ten pretreatment biopsies had Fas and Fas-L expression by immunohistochemistry, while six out of seven (85.7%) post-treatment biopsies failed to demonstrate Fas or Fas-L expression. One of seven post-treatment biopsies stained positive for Fas and Fas-L.
  
  
  CONCLUSIONS
  This reduced immunohistochemical expression of apoptotic markers may represent IVIG inhibition of the pathogenic mechanism of TEN. Alternatively reduced Fas and Fas-L may be a feature of reepithelialization in TEN, or characteristic of rapidly proliferating epidermis.
authors.affiliation: Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA. Promanelli@med.miami.edu
authors.forename: P
authors.initials: P
authors.lastname: Romanelli
authors.forename: E
authors.initials: E
authors.lastname: Schlam
authors.forename: J B
authors.initials: JB
authors.lastname: Green
authors.forename: J T
authors.initials: JT
authors.lastname: Trent
authors.forename: C
authors.initials: C
authors.lastname: Ricotti
authors.forename: G W
authors.initials: GW
authors.lastname: Elgart
authors.forename: R S
authors.initials: RS
authors.lastname: Kirsner
authors.forename: F A
authors.initials: FA
authors.lastname: Kerdel
mesh_terms: D000328:Adult; D017209:Apoptosis / Q000187:drug effects; D001706:Biopsy; D053222:Fas Ligand Protein / Q000187:drug effects*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007150:Immunohistochemistry; D007155:Immunologic Factors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015398:Signal Transduction / Q000187:drug effects; D013262:Stevens-Johnson Syndrome / Q000276:immunology / Q000473:pathology* / Q000628:therapy*; D016896:Treatment Outcome; D019014:fas Receptor / Q000187:drug effects*
chemical_list: C491901:FAS protein, human; D053222:Fas Ligand Protein; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D019014:fas Receptor