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Case Reports
. 2011 Jun;147(6):719-23.
doi: 10.1001/archdermatol.2011.13. Epub 2011 Feb 21.

Progression of toxic epidermal necrolysis after tanning bed exposure

Na Tosha Gatson  1 , Jared B Travers, Mohammed Al-Hassani, Simon J P Warren, Ann-Marie Hyatt, Jeffrey B Travers
Affiliations
Case Reports

Progression of toxic epidermal necrolysis after tanning bed exposure

Na Tosha Gatson et al. Arch Dermatol. 2011 Jun.

Abstract

Background: In addition to recreational tanning bed use, UV radiation exposures are sometimes sought to self-treat skin conditions. The ability of tanning bed radiation exposure to trigger toxic epidermal necrolysis has not been reported.

Observations: A young woman attempted to treat a self-limiting drug hypersensitivity reaction via tanning bed radiation exposure, which resulted in a systemic toxic epidermal necrolysis-like reaction. Studies with cultured keratinocytes and an epithelial cell line reveal that UV-A radiation can synergize with other stimuli such as phorbol esters or interleukin 1 to produce large amounts of tumor necrosis factor, providing a potential mechanism for this exaggerated reaction.

Conclusion: In addition to inducing photodamage and skin cancer, tanning bed radiation exposure can trigger a toxic epidermal necrolysis-like reaction, possibly via the exaggerated production of keratinocyte cytokines such as tumor necrosis factor.

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Figures

Figure 1
Figure 1. Clinical Photographs Demonstrating Photo-accentuation of Blistering Skin Eruption and Biopsy Specimen of Skin Showing Epidermal Necrosis and Increased TNF-α Immunoreactivity
A,B-clinical pictures of patient demonstrating blisters in areas of tanning bed exposure and residua of mild morbilliform eruption on covered skin (breasts). C-. Histology of skin biopsy specimen demonstrating necrotic keratinocytes (100×). D,E- Immunohistochemical studies demonstrating increased cytoplasmic TNF-α immunoreactivity in patient (D) over control tissue (E); (200×)
Figure 2
Figure 2. UVA Irradiation Augments TNF-α Production in Human Keratinocytes and KB cell line
Primary cultures of human keratinocytes or KB cell line were treated with vehicle control, 1 ng/ml IL-1α, or 10 nM PMA, followed 30 min later by treatment with sham, 5 or 20 kJ/m2 UVA. The TNF-α released into the supernatants was measured 6 h following UVA treatment by EIA. The data depicted are mean +/− SD from triplicate samples of a representative experiment from at least four with similar results.
See this image and copyright information in PMC

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