We read with interest the article by Mertz et al1 concerning Staphylococcus aureus virulence factors associated with infected skin lesions. The main issue of this study was the significantly lower white blood cell (WBC) counts in skin lesions infected by exfoliative toxin (ET)-positive strains, in comparison with infections associated with Panton-Valentine leukocidin (PVL)-positive strains. The authors then hypothesized that exfoliative toxins could either eliminate WBCs or prevent their accumulation in skin lesions. In our opinion, these hypotheses are not supported by the current knowledge concerning skin infections and the mechanisms of action of staphylococcal toxins.
Durupt F, Thomas L, Etienne J. Panton-Valentine Leukocidin, Exfoliative Toxins, and Skin Infections. Arch Dermatol. 2008;144(8):1069-1070. doi:10.1001/archderm.144.8.1069