MACROPHAGES AND TUMOR-NECROSIS-FACTOR-ALPHA IN TOXIC EPIDERMAL NECROLYSIS

Background: We studied the immunopathologic characteristics of five cases of toxic epidermal necrolysis by using a large panel of antibodies. Observations: The pattern and amount of the inflammatory cell infiltrate varied according to the stage of the disease. The main constant feature was the prominent involvement of the monocyte-macrophage lineage, including factor XIIIa(+) HLA-DR(+) dendrocytes and CD68(+) Mac 387(+) macrophages, before and during the epidermal necrosis. The number of CD4(+) and CD8(+) lymphocytes was comparatively small. This was associated with a dense labeling of the epidermis for tumor necrosis factor alpha. Conclusions: Cells of the monocyte-macrophage lineage largely outnumber lymphocytes in the lesions of toxic epidermal necrolysis. Tumor necrosis factor alpha is likely a major cytokine that is responsible for necrosis.