We thank Dr Koff for pointing to some differences between the results of several recent studies on the immunopathology of toxic epidermal necrolysis (TEN). As did other investigators, we observed the abnormal expression of HLA-DR by keratinocytes, a dermal infiltrate composed of T lymphocytes, mainly CD4+, and the absence of cells with a phenotype of natural killer cells.1 The main difference concerns the nature of the epidermal infiltrate. We observed a similar number of CD4+ and CD8+ mononuclear cells within the epidermis, while other investigators reported that all or most of the cells in the epidermis were CD8+.2,3We suggest that these divergent findings resulted less from different case definition than from the different timing of the biopsies. We obtained biopsy specimens from "early" erythematous lesions, distinct from the areas of epidermal sloughing. Our pathologic samples exhibited little or no morphologic alteration of epidermal cells, in contrast
Villada G, Roujeau J, Bourgault I, Revuz J, Clerici T. Two Divergent Findings in TEN-Reply. Arch Dermatol. 1992;128(7):991–992. doi:10.1001/archderm.1992.01680170127024
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