Staphylococcal toxic epidermal necrolysis: species and tissue susceptibility and resistance.

The staphylococcal exfoliatin, which is responsible for the "scalded skin syndrome" in man, cleaves the epidermis directly beneath the stratum granulosum. Its activity in vivo is paralleled in organ cultures, providing a rapid and convenient assay. The cutaneous responses of several mammalian and nonmammalian species were examined both in vivo and in vitro. Human and murine skin, as well as that of hamsters and monkeys exfoliated, while all other species tested (rat, rabbit, guinea pig, dog, frog, and chicken) were refractory. Results were identical in vivo and in vitro. Susceptibility and resistance are inherent, presumably genetic, attributes of the epidermis, since neither dermal elements nor circulating factors interfered with or influenced sensitivity to staphylococcal exfoliatin. Besides possessing species specificity, this exfoliatin is also tissue specific, failing to cleave all mouse nonkeratinizing epithelia tested, while the reactions of some extracutaneous keratinizing epithelia were equivocal. The species and tissue specificity of the staphylococcal scalded-skin syndrome may be attributable to either keratinocyte receptors specific for exfoliatin or the presence of specific, as yet undefined, substances in the intercellular space.