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March 1985

Granulocytes, Lymphocytes, and Toxic Epidermal Necrolysis-Reply

Author Affiliations

502 Fifth Ave McKeesport, PA 15132

Arch Dermatol. 1985;121(3):306-307. doi:10.1001/archderm.1985.01660030026006

In Reply.—  The authors of the above letters raise important and valid points that are worthy of consideration. At issue are (1) the nature of the leukopenia, (2) the toxic effect of silver sulfadiazine cream, (3) the influence of silver sulfadiazine cream on the granulocytic leukopenia, (4) the use of broad-spectrum antibiotics, and (5) the role of corticosteroids.Roujeau and associates noted leukopenia in 42% of their patients who had TEN but observed in most of their patients that this was due to a lymphopenia. We do not consider these findings to be in conflict with ours. Lymphopenia may well be present, but what we observed that proved to be of prognostic significance was that in all ten patients there was an accompanying significant granulocytopenia (granulocytopenia in this context referring to mature granulocytes or polymorphonuclear cells). The reconstitution of the white blood cells (WBCs) accompanied with an increase in the number

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