• T King, T N Helm, R Valenzuela, and W F Bergfeld.
• Department of Dermatopathology, Cleveland Clinic Foundation, Ohio 44195.
• Int. J. Dermatol. 1994 Sep 1;33(9):634-6.

BackgroundToxic epidermal necrolysis is a distinctive disorder that is readily identified clinically and histologically in advanced cases. Early on, however, toxic epidermal necrolysis may be difficult to identify. Some consider fixed drug eruption a limited form of toxic epidermal necrolysis.MethodsDirect immunofluorescence was performed on biopsy material of erythematous skin lesions.ResultsDiffuse deposition of immunoreactants in the midmalpighian layer was noted. This finding has not been encountered in other disorders studied in our immunopathology laboratory.ConclusionsDiffuse immunoreactant deposition in the mid-epidermis should suggest a diagnosis of epidermal necrolysis either from toxic epidermal necrolysis or fixed drug eruption. Additional cases will need to be assessed to document the usefulness of this pattern for prospective diagnosis.

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