Toxic epidermal necrolysis (TEN) is a rare but severe adverse drug disease,
characterized by extensive skin and mucosal detachment with participation
of different immunoinflammatory pathways, in particular with early participation
of activated CD8+ T lymphocytes.
To further study the potential role of T lymphocytes in the early phase
of keratinocyte necrosis.
Thirteen patients with clinical and histopathologic criteria of TEN
and 6 patients with second-degree burns.
Main Outcome Measures
Measurement of soluble interleukin (IL) 2 receptor (sIL-2R) and IL-1α
in serum samples and fluid of recent blisters.
In the blister fluid of patients with TEN, we found significantly higher
levels of sIL-2R than in patients with burns, whereas IL-1α levels were
higher in the blister fluid of burned patients. No significant differences
were found in serum samples of patients with TEN and burns, in either sIL-2R
or IL-1α. In TEN we also found significantly higher levels of sIL-2R
in the blister fluid compared with serum samples, pointing to a predominantly
local production contrasting with the low concentration of sIL-2R in the blister
fluid of burned patients.
Our findings of elevated sIL-2R levels in blister fluid of patients
with TEN are probably related to a local down-regulation of an immunologically
mediated cytotoxic reaction and further support the involvement of activated
T lymphocytes in the early blisters of TEN.