[Staphylococcal toxic epidermal necrolysis].

Staphylococcal toxic epidermal necrolysis is a well defined disease and can be ideally reproduced in a mouse model. It is due to the action of a staphylococcal exotoxin (exfoliatin) which is produced by phage group2 staphylococci. Exfoliatin acts on a hitherto unknown target site which is likely to be located in the cell membrane of keratinocytes of the subgranular layer. Sensitivity to exfoliatin is common to only few mammals and appears to be genetically determined. Exfoliatin leads to loss of intercellular adherence resulting in acantholysis; cellular morphology and function remains unimpaired. The action of exfoliatin on the epidermis is not influenced by serum factors nor by the mesenchyme. It is also not age dependent although adult humans as well as adult mice do not develop systemic disease. This is due to suppression of growth of staphylococci and rapid renal excretion of exfoliatin in the mature, immunologically competent organism.