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June 1985

Toxic Epidermal Necrolysis

Author Affiliations

Departments of Dermatology and Immunohaematology University Medical Centre 2333 AA Leiden, the Netherlands

Arch Dermatol. 1985;121(6):715-716. doi:10.1001/archderm.1985.01660060027011

To the Editor.—  We read with much interest the report of Westly and Wechsler1 on granulocytopenia as a prognostic factor in drug-induced toxic epidermal necrolysis. However, the cause of the granulocytopenia remained obscure. The authors speculated that hypersensitivity immunologic reactions might cause the drug-induced toxic epidermal necrolysis as well as the granulocytopenia; with this respect we would like to report some of our data on drug-induced disorders.In two patients with drug-induced toxic epidermal necrolysis we could demonstrate drug-dependent antibodies that were directed against monocytes.2 Absorption studies revealed that the same drug-dependent antibodies reacted also with epithelial cells of the patients. In one patient, monocytopenia was present just before the drug-induced toxic epidermal necrolysis started. In the total white blood cell counts there was a slight dip up to 4,000, two days after the beginning of the drug-induced toxic epidermal necrolysis.Our data suggest common determinants on