Human intravenous immunoglobulins (
IVIg) which contain anti-CD95
antibodies have been proposed to treat
toxic epidermal necrolysis (TEN). Presently, there is no evidence that
IVIg reach the keratinocytes in TEN patients. The aim of this study was to assess the Ig distribution in the serum,
blister fluid and skin of six consecutive TEN patients treated with
IVIg (1 g/kg/day) for 3 days. They were compared with five TEN patients who only received supportive
therapy. In all patients,
IgA,
IgM and
IgG concentrations were measured in the serum and
blister fluid using an immuno-nephelometric method. Immunohistochemistry was performed on skin biopsies taken from both TEN clinically involved and uninvolved skin to search for
IgG deposits. On admission, the
IgG concentrations were significantly higher in both TEN serum and TEN
blister fluid compared with their respective
IgA and
IgM contents. The
IgG,
IgA and
IgM concentrations in
blister fluid were significantly lower than their respective serum concentrations. The serum and
blister fluid
IgG concentrations, but not that of
IgA and
IgM, were markedly increased at the completion of the
IVIg treatment. By contrast, they remained unchanged in the TEN patients that were untreated with
IVIg. In the
IVIg-treated patients, the
IgG intraepidermal deposits raised markedly in both TEN-involved and uninvolved skin. This was not the case in patients who did not receive
IVIg. These results suggest that
IVIg perfusions brought a prominent increase in
IgG concentration in the serum,
blister fluid and epidermis of both TEN-involved and clinically uninvolved skin. The presence of potentially protective
IgG in TEN epidermis following
IVIg treatment could help limiting the
disease progression.