title: Fixed drug eruption: the dark side of activation of intraepidermal CD8+ T cells uniquely specialized to mediate protective immunity.
abstract: Fixed drug eruption (FDE) is generally regarded as representing the mild end of drug-induced dermatitis, but the clinical importance of recognizing this disease as an abortive, localized variant of toxic epidermal necrolysis has received increasing attention in recent years. FDE often presents with a wide spectrum of clinical manifestations indistinguishable from those of other skin diseases, such as erythema multiforme, Stevens-Johnson syndrome /toxic epidermal necrolysis, cellulitis, paronychia, lichen planus, and parapsoriasis en plaques. These unusual forms of FDE are likely to be overlooked unless the possibility of a drug etiology is routinely considered in the differential diagnosis of any patient with these diseases. Clinical awareness and recognition of these unique forms are essential for avoiding a misdiagnosis. Intraepidermal CD8+ T cells resident in the FDE lesions that have the capacity to rapidly produce large amounts of IFN-γ are likely to have a key role in mediating localized epidermal injury, while they may represent a T cell subset uniquely specialized to mediate protective immunity against various pathogens.
authors.affiliation: Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan. tpshio@ks.kyorin-u.ac.jp
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shiohara
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Mizukawa
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology / Q000378:metabolism*; D003937:Diagnosis, Differential; D003875:Drug Eruptions / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D004817:Epidermis / Q000276:immunology; D006801:Humans; D007371:Interferon-gamma / Q000378:metabolism; D008213:Lymphocyte Activation; D014777:Virus Diseases / Q000150:complications / Q000188:drug therapy / Q000276:immunology
chemical_list: D000998:Antiviral Agents; D007371:Interferon-gamma