Universal cutaneous depigmentation following phenytoin-induced toxic epidermal necrolysis

A 10-year-old black girl with a severe hypersensitivity reaction to phenytoin is described. Adverse effects included interstitial nephritis, hepatitis, and toxic epidermal necrolysis. An apparently permanent sequela of universal cutaneous depigmentation developed. Although the presence of clear cells in the basal layer of the epidermis suggested that melanocytes might still be present, these clear cells were shown, by electron microscopy, to be Langerhans cells and not melanocytes. This patient demonstrates a unique outcome, not previously described in the literature.