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May 1994

Macrophages and Tumor Necrosis Factor a in Toxic Epidermal Necrolysis

Author Affiliations

From the Department of Dermatopathology, University of Liège (Belgium) (Drs Paquet, Nikkels, Arrese, and Piérard) and the Center for Burn Patients, Brussels (Belgium) Military Hospital (Dr Vanderkelen).

Arch Dermatol. 1994;130(5):605-608. doi:10.1001/archderm.1994.01690050073012

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 ne- crosis. The number of CD4+ and CD8+ lymphocytes was comparatively small. This was associated with a dense labeling of the epidermis for tumor necrosis factor a.

Conclusions:  Cells of the monocyte-macrophage lineage largely outnumber lymphocytes in the lesions of toxic epidermal necrolysis. Tumor necrosis factor a is likely a major cytokine that is responsible for necrosis.(Arch Dermatol. 1994;130:605-608)