Soluble Interleukin 2 Receptor and Interleukin 1α in Toxic Epidermal Necrolysis: A Comparative Analysis of Serum and Blister Fluid Samples

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-1α 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-1α 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-1α. 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.Arch Dermatol. 2002;138:29-32-->