Medline ® Abstract for Reference 31
of 'Stevens-Johnson syndrome and toxic epidermal necrolysis: Pathogenesis, clinical manifestations, and diagnosis'
31
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HIV infection predisposes skin to toxic epidermal necrolysis via depletion of skin-directed CD4⁺T cells.
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Yang C, Mosam A, Mankahla A, Dlova N, Saavedra A
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J Am Acad Dermatol. 2014;70(6):1096.
BACKGROUND:
A greater incidence of adverse cutaneous drug eruptions, including toxic epidermal necrolysis (TEN), occurs among HIV-infected patients.
OBJECTIVE:
We sought to determine if immunophenotypical differences exist in the inflammatory infiltrates of TEN lesions from HIV-infected individuals versus noninfected individuals.
METHODS:
The inflammatory infiltrates in 12 cases of TEN from HIV-positive patients were characterized and compared with the infiltrates present in 12 cases of TEN from HIV-negative patients.
RESULTS:
TEN infiltrates consisted of CD3, CD4, and CD8 immunoreactive T lymphocytes in both the dermis and epidermis. HIV infection was associated with an 8-fold increase in the ratio of CD8(+) to CD4(+) T cells infiltrating the dermis (P = .006) and a decrease in the number of dermal CD4(+) cells (P = .044). There was also a significant decrease in the ratio of CD25(+) to CD4(+) cells in the epidermis of HIV-infected skin (P = .011).
LIMITATIONS:
This study is limited by small sample sizes.
CONCLUSION:
A decrease in the number of skin-directed CD4(+) cells and an increase in the ratio of CD8(+) to CD4(+) cells exists in TEN lesions among HIV-infected individuals and likely contribute to an increased risk of developing drug reactions because of the loss of skin-protective CD4(+)CD25(+) regulatory T cells.
AD
Department of Dermatology at Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
PMID