To the Editor.—
The editorial by Bauer and Cooper concerns itself primarily with an overproduction of collagenase, the collagen enzyme, as a cause of the epidermolysis bullosa and the therapeutic value of drugs that are capable of inhibiting this overproduction.They fail to mention another possible cause of epidermo- lysis bullosa, namely, lipid peroxidation of cell membranes from various causes, leading to the formation of free radicals, which, in turn, destroy the cell lysosomes, releasing the enzyme collagenase. This process of release could account for the increased collagenase found in the lesions, which should be considered a result rather than a cause of the pathologic changes. Criep1 has hypothesized that enzymes liberated by damaged lysosomes may then attach themselves to normal cells, altering them so that they become foreign proteins, to which the body reacts with the formation of autoimmune antibodies.A logical therapeutic procedure, therefore, would be to