Abstract
<h3>Background:</h3> We studied the immunopathologic characteristics of five cases of toxic epidermal necrolysis by using a large panel of antibodies. <h3>Observations:</h3> 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<sup>+</sup>HLA-DR<sup>+</sup>dendrocytes and CD68<sup>+</sup>Mac 387<sup>+</sup>macrophages, before and during the epidermal ne- crosis. The number of CD4<sup>+</sup>and CD8<sup>+</sup>lymphocytes was comparatively small. This was associated with a dense labeling of the epidermis for tumor necrosis factor a. <h3>Conclusions:</h3> Cells of the monocyte-macrophage lineage largely outnumber lymphocytes in the lesions of toxic epidermal necrolysis. Tumor necrosis factor a is likely a major cytokine that is responsible for necrosis. (Arch Dermatol. 1994;130:605-608)
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