M. Zohdimofid et Td. Horn, ACROSYRINGEAL CONCENTRATION OF NECROTIC KERATINOCYTES IN ERYTHEMA MULTIFORME - A CLUE TO DRUG ETIOLOGY - CLINICOPATHOLOGICAL REVIEW OF 29 CASES, Journal of cutaneous pathology, 24(4), 1997, pp. 235-240
Erythema multiforme (EM) is caused by various insults, frequently an i
nfectious agent or a drug. It is current practice that histologic iden
tification of the precipitating factor is not possible. Mie have obser
ved a pattern of acrosyringeal concentration of keratinocyte necrosis
in certain cases of EM. and retrospectively studied 29 consecutive cas
es of EM to establish clinicopathologic correlation for this finding.
Acrosyringeal concentration was observed in 10 of 29 specimens, all 10
clinically drug related (Group 1). Nineteen specimens lacked this pat
tern (Group 2) of which 3 cases were clinically drug related (sensitiv
ity= 0.8, specificity= 1.0). Eosinophils were present in the dermal in
filtrate of 6 specimens from Group 1 and 2 specimens from Group 2 (p=0
.025). Acrosyringeal concentration of keratinocyte necrosis in EM occu
rs in drug-related cases and is more likely to be accompanied by a der
mal inflammatory infiltrate containing eosinophils. Drug concentration
in sweat may explain this pattern with subsequent toxic and immunolog
ic mechanisms leading to the fully evolved lesion.