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Topical tacrolimus for oral cicatricial pemphigoid

association with other pathogens. Necrotizing fasciitis due to S. marcescens exclusively has been only reported in four cases including ours, summarized in Table 1. Risk factors and underlying conditions were found in two patients including diabetes mellitus and cancer treated with chemotherapy. The two other cases had no underlying condition. Of note one of these latter patients had taken diclofenac prior to the onset of necrotizing fasciitis and the deleterious role of nonsteroidal anti-inflammatory drugs in cellulitis is well known. The bacteria were found in bullae and ⁄ or tissue in all patients and in blood cultures in three of these four patients. Two patients died from necrotizing fasciitis despite aggressive surgery and antibiotics. The route of infection remains questionable. Pathogenesis of necrotizing fasciitis due to this agent is unclear. However, injection of purified proteinases from S. marcescens into rat dermis can induce increased vascular permeability, necrosis of epidermal tissue, dermal inflammation and oedema, and infiltration of neutrophils into the subcutaneous fat and muscle. Treatment of necrotizing fasciitis due to S. marcescens does not differ from that due to other pathogens and includes surgical debridement and antibiotics. Most strains are susceptible to third generation cephalosporins, fluoroquinolones, imipenem ⁄ cilastin, and amikacin but definitive therapy should be based on the results of sensitivity testing because of a high rate of multiple drug resistance.