Pathophysiology of fixed drug eruption: the role of skin-resident T cells

Curr Opin Allergy Clin Immunol. 2002 Aug;2(4):317-23. doi: 10.1097/00130832-200208000-00005.

Abstract

Purpose of review: Fixed drug eruption is a distinct variant of drug-induced dermatoses characterized by their relapse in the same location after the administration of the causative drug. We have recently shown that intraepidermal CD8+ T cells phenotypically resembling effector memory T cells are greatly enriched in the resting lesions of FDE. Although effector memory T cells have been implicated as the mediators of protection in epithelial tissues, our observation raises an alternative possibility that improper, enhanced or uncontrolled activation of intraepidermal T cells could contribute to severe tissue injury. Until recently, however, their detrimental effects on epithelial tissues have rarely been examined. The focus of this review is on how intra-epidermal T cells originally evolved to protect tissue integrity can exert an opposite action that is deleterious to the host.

Recent findings: Because those T cells residing in the lesions, upon activation, can rapidly produce large amounts of IFN-gammaepsilon followed by localized epidermal injury, their activation is probably essential for the initiation of deleterious inflammatory responses in the lesions. The activity of these potent effector T cells is therefore carefully controlled to prevent unwanted tissue injury under physiological conditions. A complex interplay of stop and go signals to the skin-resident T cells provides a delicate balance between cell death and survival, thereby determining the degree and outcome of inflammation generated in response to pathogens or antigens.

Summary: This consideration may provide important insights into the way in which skin-resident T cells maintain immunological homeostasis in the skin.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Drug Eruptions / immunology
  • Drug Eruptions / physiopathology*
  • Humans
  • Skin / blood supply
  • Skin / cytology
  • T-Lymphocytes / physiology