Table of Contents
ISRN Dermatology
Volume 2013, Article ID 651590, 6 pages
Research Article

Toxic Epidermal Necrolysis and Graft-versus-Host Reaction: Revisiting a Puzzling Similarity

1Laboratory of Skin Bioengineering and Imaging (LABIC), Department of Clinical Sciences, University of Liège, 4000 Liège, Belgium
2University of Franche-Comté, 25030 Besançon, France
3Department of Dermatopathology, Unilab Lg, Liège University Hospital, 4000 Liège, Belgium
4Intensive Care Department and Burn Centre, Liège University Hospital, 4000 Liège, Belgium

Received 4 April 2013; Accepted 12 May 2013

Academic Editors: E. Alpsoy and B. Amichai

Copyright © 2013 G. E. Piérard et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Drug-induced toxic epidermal necrolysis (TEN) and acute cutaneous graft-versus-host reaction (GVHR) under immunopreventive therapy share some histopathological resemblance. So far, there are no serum biomarkers and no immunohistochemical criteria distinguishing with confidence and specificity the skin lesions of TEN and GVHR. Both diseases present as an inflammatory cell-poor necrotic reaction of the epidermis. This report compares three sets of 15 immunostaining patterns found in TEN, GVHR, and partial thickness thermal burns (PTTB), respectively. Three series of 17 skin biopsies were scrutinized. Irrespective of the distinct causal pathobiology of TEN and GVHR, similar secondary effector cells were recruited in lesional skin. Burns were less enriched in cells of the monocyte-macrophage disease. These cells likely exert deleterious effects in TEN and GVHR and cannot be simply regarded as passive bystanders. These life-threatening conditions are probably nursed, at least in part, by macrophages.