Background: Toxic epidermal necrolysis (TEN) is a rare but severe adverse drug disease, characterized by extensive skin and mucosal detachment with participation of different immunoinflammatory pathways, in particular with early participation of activated CD8+ T lymphocytes.
Objective: To further study the potential role of T lymphocytes in the early phase of keratinocyte necrosis.
Design: Prospective study.
Setting: University hospitals.
Patients: Thirteen patients with clinical and histopathologic criteria of TEN and 6 patients with second-degree burns.
Main outcome measures: Measurement of soluble interleukin (IL) 2 receptor (sIL-2R) and IL-1alpha in serum samples and fluid of recent blisters.
Results: In the blister fluid of patients with TEN, we found significantly higher levels of sIL-2R than in patients with burns, whereas IL-1alpha levels were higher in the blister fluid of burned patients. No significant differences were found in serum samples of patients with TEN and burns, in either sIL-2R or IL-1alpha. In TEN we also found significantly higher levels of sIL-2R in the blister fluid compared with serum samples, pointing to a predominantly local production contrasting with the low concentration of sIL-2R in the blister fluid of burned patients.
Conclusions: Our findings of elevated sIL-2R levels in blister fluid of patients with TEN are probably related to a local down-regulation of an immunologically mediated cytotoxic reaction and further support the involvement of activated T lymphocytes in the early blisters of TEN.