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Macrophages and tumor necrosis factor alpha in toxic epidermal necrolysis
P Paquet1, A Nikkels, J E Arrese
1Department of Dermatopathology, University of Liège, Belgium.
Background:
We studied the immunopathologic characteristics of five cases of toxic epidermal necrolysis by using a large panel of antibodies.
Observations:
The pattern and amount of the inflammatory cell infiltrate varied according to the stage of the disease. The main constant feature was the prominent involvement of the monocyte-macrophage lineage, including factor XIIIa+HLA-DR+ dendrocytes and CD68+ Mac 387+ macrophages, before and during the epidermal necrosis. The number of CD4+ and CD8+ lymphocytes was comparatively small. This was associated with a dense labeling of the epidermis for tumor necrosis factor alpha.
Conclusions:
Cells of the monocyte-macrophage lineage largely outnumber lymphocytes in the lesions of toxic epidermal necrolysis. Tumor necrosis factor alpha is likely a major cytokine that is responsible for necrosis.