Chemical injury to the eye from EMLA cream during erbium laser resurfacing.

BACKGROUND: EMLA cream is commonly used as a topical anesthetic by physicians performing dermatologic surgery. OBJECTIVE: The purpose of this article is to inform physicians that EMLA cream is highly alkaline and can be particularly toxic to the eye. Symptoms of eye irritation may be initially masked because of local anesthetic effects. METHODS: Two patients are described who developed corneal abrasions from inadvertent exposure of the eye to EMLA cream prior to erbium laser resurfacing. RESULTS: The patients developed corneal abrasions and conjunctivitis, consistent with chemical alkaline burns. CONCLUSION: EMLA cream should be used with extreme caution near the eye and probably should be avoided when there is a need to insert laser eye shields.

Defining the role of complement in experimental pemphigus vulgaris in mice.

Parenteral passive transfer of human pemphigus vulgaris IgG (PV IgG) into neonatal mice reproduces the cutaneous disease. We used this model to study the role of complement in the development of acantholysis in three steps. Peptic F(ab')2 fragments were prepared from PV IgG and were injected into seven newborn mice, and all animals developed acantholytic skin blisters without local complement activation, as shown by direct immunofluorescence. These fragments were reduced and alkylated to produce Fab' fragments with equivalent in vitro binding activity. The monovalent fragments were given in an identical fashion to five littermates but failed to produce disease even though they were bound in the epidermis in vivo. Intact PV IgG was injected in 20 genetically C5-deficient neonates (B10-D2-OSN strain) and 20 control neonates (B10-D2-NSN, normal complementemic). Extensive blistering, with a positive Nikolsky sign, was produced in all 40 animals. PV IgG was given to 34 BALB/c neonates that were complement depleted by pretreatment with cobra venom factor (CoF) for 24 hr, and to 38 untreated neonates from the same litters. There was no difference in the disease produced after CoF treatment in animals that received high doses of PV IgG (5 to 15 mg/g/day). In animals receiving 2.5 mg PV IgG/g/day, blister formation was delayed and the final extent of the cutaneous lesions was less in CoF-treated mice (n = 12) than in normal complementemic controls (n = 12, p less than 0.02). These results show that complement activation is not an essential mechanism in PV IgG-induced acantholysis in vivo, but it does have an amplifying effect on the development of cutaneous lesions under certain conditions, and lesions can be induced in vivo by bivalent F(ab')2 fragments of PV IgG, but not by the monovalent Fab' fragments, suggesting that cross-linking of the cell surface antigen is an initiating signal in acantholysis.

Human pemphigus autoantibodies are pathogenic to squamous epithelium.

In 1957, Witbesky et al. put forward several criteria that ideally should be fulfilled in order to prove the pathogenic role of an autoantibody in a putative autoimmune disease. There can now be very little doubt of the autoimmune nature of this disease and of the primary role of autoantibodies in its pathogenesis. The evidence that supports the concept that pemphigus autoantibodies are of primary pathogenic importance in the disease is as follows: IgG class autoantibodies can be found both circulating in the serum and bound to the epithelial cell surfaces in and around lesions in patients with pemphigus. These autoantibodies, purified from the serum of pemphigus patients, can induce acantholytic lesions typical of pemphigus both in experimental animals (neonatal mice) and in human and murine epidermal cell cultures. These autoantibodies react with a specific antigen of the epidermal cell. This purified antigen has been used to immunize rabbits and the resulting antibodies are capable of inducing pemphigus-like lesions in neonatal mice.

Gram-negative bacterial toe web infection: successful treatment with a new third generation cephalosporin.

Fifteen patients with gram-negative bacterial toe web infections were treated for 1 week with intramuscular cefoperazone, a broad-spectrum third generation cephalosporin. Initial bacterial cultures in eleven patients (73%) grew more than one gram-negative organism. Pseudomonas aeruginosa was the most frequent isolate. All bacteria isolated were sensitive to cefoperazone (Cefobid). Swelling, redness, and flow of exudate resolved within 1 week of antibiotic administration. By day 7 there was no evidence of inflammation, and denuded areas had begun to re-epithelialize. Side effects were mild and did not require cessation of therapy. This antibiotic causes rapid resolution of a disease which previously required prolonged hospitalizations.

Effectiveness of cefoperazone in treating cutaneous infections.

Twenty-eight patients with severe cutaneous infections received cefoperazone, 2 grams intramuscularly twice a day for seven days. A wide range of gram-positive and gram-negative pathogens were isolated from admission cultures. All patients showed rapid clinical improvement. Two patients did not complete the full course of therapy because of intervening medical problems unrelated to the antibiotic. No significant side effects were noted. Relapses or reinfections occurred in two patients. In conclusions, cefoperazone is a safe and effective antibiotic for use in skin infections requiring parenteral therapy.