Blister fluid cytokines in cutaneous inflammatory bullous disorders

Cytokines are important regulators of immune and inflammatory reactions in the skin, and may contribute to inflammatory blister induction, We examined the profiles of interleukin-6 (lL-6) and tumour necrosis factor-alpha (TNF -alpha) in fluid of spontaneous blisters in the immune-based inflammatory d isorders bullous pemphigoid (8 patients), allergic contact dermatitis (5 pa tients) and toxic epidermal necrolysis (5 patients). These were compared wi th levels in 9 patients with burns, i,e, inflammatory blisters of non-immun e aetiology, and 4 patients with blisters of physical origin. Very high lev els of IL-6 were found in bullous pemphigoid and toxic epidermal necrolysis (p<0,001) compared with non-inflammatory and burn blisters. TNF-alpha leve ls were high in bullous pemphigoid and burns, but undetectable in non-infla mmatory blisters. The pattern in bullous pemphigoid (very high IL-6, high T NF-alpha) differed substantially from toxic epidermal necrolysis (very high IL-6, low TNF-alpha), while burns and allergic contact dermatitis showed l esser elevation of both cytokines. Hence, differences in cytokine profiles were identified, although the relevance to underlying pathomechanisms is un certain.