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June 1978

Columnar Epidermal Necrosis: A Special Form of Toxic Epidermal Reaction?

Author Affiliations

From the Department of Dermatology, Hamamatsu University School of Medicine (Drs Tagami, Yamada, and Aoshima), and the Department of Dermatology, Kansai Medical College (Dr Uragami), Japan.

Arch Dermatol. 1978;114(6):925-928. doi:10.1001/archderm.1978.01640180059014

• A bizzare erythematosquamous, partially verrucose, crusty or eroded eruption developed in a 6-year-old boy one week after his first measles vaccination. The eruption regressed completely after a two-year clinical course. Histologically, the epidermis showed unique columnar eosinophilic degeneration. There was a dense, mononuclear cell infiltration in the upper part of the dermis. To our knowledge these clinical and histologic features have not been reported in the literature, although they resemble, in some aspects, Kyrle's disease, Mucha-Haberman's disease, or lichen planus verrucosus.

Regarding the pathomechanisms underlying the development of this unique epidermal change, a postulate was made that it represented a special form of toxic epidermal reaction, probably resulting from autoaggressive lymphoid cell response to epidermal cells. Furthermore, relationship of measles vaccination to this special response is suggested.

(Arch Dermatol 114:925-928, 1978)