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Pathogenesis of drug-induced exanthema
1Clinic for Rheumatology and Clinical Immunology/Allergology, University of Bern, Switzerland.
Background:
In vitro data derived from drug-specific T cell clones have revealed that heterogeneous T cell subsets with distinct phenotypes (CD4+ > CD8+) and cell functions (strong IL-5 production, cytotoxic potential) are generated. The aim of this study was to elaborate the relevance of these findings in vivo.
Methods:
Skin biopsy specimens from drug-induced maculopapular exanthema and normal skin were analyzed for CD4, CD8, CD25, HLA-DR, CD54, perforin, granzyme B, IL-5 and IFN-gamma using immunohistochemistry.
Results:
The majority of infiltrating lymphocytes in maculopapular drug eruptions were CD4+. Both CD4+ and CD8+ T cells expressed perforin and granzyme B and were partly located at the dermoepidermal junction and in the epidermis. In addition, strong immunoreactivity for IL-5 and moderate immunoreactivity for IFN-gamma were observed in the mononuclear cell infiltrate.
Conclusions:
Our data indicate that skin infiltrating T cells with a cytotoxic potential and the ability to produce IL-5 and IFN-gamma may contribute to the damage of keratinocytes and the activation of eosinophils, which are typical features of drug-induced maculopapular exanthema.