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Cutaneous inflammatory T-cell–mediated activation requires two signals mediatedvia cell–cell interactions by surface proteins and antigen-presenting cells, such asdendritic cells or macrophages: (1) interaction of the T-cell receptor with antigen, and(2) costimulation, which is mediated through various surface interactions.• Activated T cells migrate from lymph nodes and the bloodstream into skin andsecrete cytokines (eg, interferon-γ, interleukin 2 [IL-2]) that induce pathologicchanges. Local keratinocytes and neutrophils produce other cytokines (eg, tumornecrosis factor-α [TNF-α], IL-8). T-cell production and activation results in keratinocyteproliferation.• There is a significant genetic component. Studies of histocompatibility antigens showassociations with human leukocyte antigens (HLA)-Cw6, TNF-α, and IL-3.
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