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T cell involvement in cutaneous drug eruptions
Y Hari1, K Frutig-Schnyder, M Hurni
1Allergy Division of the Clinic for Rheumatology and Clinical Immunology/Allergology, Inselspital, Bern, Switzerland.
Summary
Drug-induced skin reactions involve T cell activation and drug specificity. Predominant CD8(+) T cell activation is linked to severe reactions like bullous eruptions or liver issues.
Area of Science:
- Immunology
- Dermatology
- Pharmacology
Background:
- Skin eruptions are common side-effects of drug therapy.
- The underlying mechanisms of drug-induced skin reactions are not fully understood.
Purpose of the Study:
- To investigate T cell activation and drug specificity in various forms of drug-induced exanthemas.
- To analyze T cell subsets and their correlation with clinical presentation and severity.
Main Methods:
- Prospective study of 22 patients with drug-induced exanthemas.
- Evaluation of liver parameters and T cell activation markers (CD25, HLA-DR) during acute reactions.
- Skin biopsies and post-recovery drug identification using lymphocyte transformation tests (LTT) and patch tests.
Main Results:
- Maculo-papular exanthema (17/22), bullous exanthema (4/22), and urticaria (1/22) were observed.
- Antibiotics, anti-epileptics, and anti-hypertensives were common causative drugs.
- Upregulation of HLA-DR on T cells (CD4+ and/or CD8+) was detected in 17 patients, particularly in severe reactions.
- Lymphocytic infiltration was present in all skin biopsies; CD8+ T cell dominance correlated with bullous reactions or liver involvement.
Conclusions:
- T cells are activated and specific to the causative drug in drug-induced skin eruptions.
- Predominant CD8+ T cell activation is associated with more severe skin symptoms (bullous) or liver involvement.
- Predominant CD4+ T cell activation is associated with maculo-papular reactions.