Clinical, Allergological and Venereological Dermatology Unit, Department of Medical and Surgical Specialities and Public Health, University of Perugia, Perugia, Italy.
Dermatitis. 2013 Mar-Apr;24(2):85-90. doi: 10.1097/DER.0b013e318280cbe5.
The differential clinical diagnosis between drug-induced exanthema (DIE) and virus- or bacteria-induced exanthema (VBIE) is frequently not easy because the serologic analysis for virus and bacteria and skin tests are not always exhaustive. In these cases, only the oral challenge test is nullifying.
This study wants to identify 1 or more structural changes and/or cytokine markers that might be helpful in discriminating the etiology and the possible correlation with the clinical features, type of the involved drug, blood and skin eosinophilia, and time of skin biopsy.
Involved non-sun-exposed skin biopsy specimens were obtained from 36 patients with DIE and 30 patients with VBIE. Blood investigations, skin tests, and oral rechallenge tests were carried out in all subjects. The histopathologic features and the immunohistochemical expression of a cytokine panel [fatty acid synthase-ligand, granzyme B, interleukin (IL) 2, IL-4, IL-5, IL-10, IL-13, interferon γ, perforin, tumor necrosis factor α] were analyzed.
Finally, DIE and VBIE have distinct skin cytokine profile (IL-5 alone or in combination with granzyme B and perforin in DIEs was statistically more frequent than in VBIEs, mainly when skin biopsy was carried out within 2 days from clinical onset), which might be helpful in discriminating the etiology.
药物诱发疹（DIE）和病毒或细菌诱发疹（VBIE）的临床鉴别诊断并不总是容易的，因为病毒和细菌的血清学分析以及皮肤试验并不总是详尽的。在这些情况下，只有口服挑战试验才能排除。
本研究旨在确定 1 个或多个结构变化和/或细胞因子标志物，这些标志物可能有助于鉴别病因，并可能与临床特征、所涉及药物的类型、血液和皮肤嗜酸性粒细胞以及皮肤活检时间相关。
从 36 例 DIE 患者和 30 例 VBIE 患者中获得非暴露于阳光的皮肤活检标本。所有患者均进行了血液检查、皮肤试验和口服再挑战试验。分析了组织病理学特征和细胞因子谱[脂肪酸合酶配体、颗粒酶 B、白细胞介素（IL）2、IL-4、IL-5、IL-10、IL-13、干扰素 γ、穿孔素、肿瘤坏死因子 α]的免疫组织化学表达。
最后，DIE 和 VBIE 具有不同的皮肤细胞因子谱（DIE 中单独的 IL-5 或与颗粒酶 B 和穿孔素联合更为频繁，主要是在临床发病后 2 天内进行皮肤活检时），这可能有助于鉴别病因。
