Increased interleukin 10, tumor necrosis factor alpha, and interleukin 6 levels in blister fluid of toxic epidermal necrolysis.

Abstract

Toxic epidermal necrolysis is a severe, usually drug-induced disease that shares clinical, histologic, and immunologic similarities with the severe forms of cutaneous acute graft-versus-host disease. Our purpose was to further characterize common immune-inflammatory pathways in these skin disorders by measurement of different cytokines. Evaluation of serum levels of interleukin 10 (IL-10), tumor necrosis factor alpha, IL-6, and soluble IL-6 receptor in the early phase of both diseases and in blister fluid of toxic epidermal necrolysis. Serum levels of IL-10 and IL-6 were significantly higher in patients with toxic epidermal necrolysis (P =.0001) and acute graft-versus-host disease (P =.001) compared with those of blood donors. We found an increase in IL-6 levels in blister fluid and significantly higher levels of IL-10 (P =.018) and tumor necrosis factor alpha (P =.028) in blister fluid compared with serum in patients with toxic epidermal necrolysis. A similar serum cytokine profile of toxic epidermal necrolysis and acute graft-versus-host disease further emphasizes common immunologic mechanisms. The presence of inflammatory cytokines, IL-6 and tumor necrosis factor alpha, in the blister fluid of patients with toxic epidermal necrolysis is associated with significantly higher levels of IL-10, which through its down-regulatory role, may be involved in limitation of the disease extension.