Newer insights into the mechanism of action of low dose weekly Methotrexate in psoriasis

Methotrexate is one of the most widely used drugs in the systemic management of psoriasis. Though the drug has been in use for over 40 years, the mechanisms of its action are still ill-understood. Designed originally as an anti-proliferative agent, the therapeutic usefulness of methotrexate in psoriasis is now believed to be the result of its anti-inflammatory effects.

Efficacy and safety of methotrexate in psoriasis - a reappraisal

Fifty five patients of extensive psoriasis were treated with oral weekly methotrexate. All patients responded promptly to methotrexate therapy. Relapse was observed after variable periods following stoppage of methotresate. Safety, efficacy, maintenance dose, relapse and long term effects of methotrexate in psorasis are discussed.

Segmental vitiligo in northern India

Vitiligo is an acquired, progressive pigmentary disorder of the skin and hair which is clinically divided into segmental and non-segmental types. Segmental vitiligo is said to have an early and rapid onset and is associated with a better prognosis as disease activity ceases early compared to the non-segmental type. We have analysed the clinical features of 100 patients of segmental vitiligo seen by us at our pigmentary clinic. The findings in our series are at variance from those reported earlier. Our cases of segmental vitiligo formed a lower proportion of the total vitiligo cases, showed an earlier age of onset, multiplicity of lesions, progressive nature and comparatively lower incidence of poliosis.

Efficacy and safety of systemic antifungal agents in chronic dermatophytosis - an open trial

Forty patients comprising of 20 males and 20 females suffering from dermatophytosis for more than one year and who were not on any topical or systemic medication 3 months prior to the institution of therapy, were divided into 4 groups, each comprising of 5 males and 5 females, were given oral griseofulvin 250 mg twice daily for 8 weeks for group A, oral ketoconazole 200 mg daily for group B, oral fluconazole 150 mg twice weekly for group C and oral itraconazole 200 mg daily for 1 week followed by the same dose 3 weeks later for group D. Ketoconazole and fluconazole were most effective drugs. Griseofulvin and itraconazole were found less effective. All the four drugs did not give rise to any side effect.

Uveal involvement in tuberculoid leprosy

A study on 400 patients of leprosy comprising of 188 patients of tuberculoid leprosy, was carried out to assess the type and extent of uveal involvement. Possible reasons of uveal involvement in tuberculoid leproy have ben reviewed. Importance of further studies including histopathology, has been stressed.

Black piedra - a report

A middle aged female with black piedra of the scalp hair is reported. She presented with hair loss and multiple nodules on her scalp hair. Diagnosis was confirmed by potassium hydroxide examination of the nodules and fungal culture.

Subcutaneous zygomycosis treated with ketoconazole

A six year old female child presented with indolent nontender swellings on both buttocks and loins, was proved by histopathological and mycological examinations, to be suffering from subcutaneous zygomycosis. Being intolerent to potassium iodide, she was put on and responded to ketoconazole therapy.

Scalp mycetoma - a diagnostic puzzle

A 30 year old male with a history of avulsion injury of scalp presented with discharging sinuses one year after wound repair. Patient was admitted in Neuro-Sugery unit. Subsequently microscopic grains were detected from the sinuses and N. Asteroides was grown in culture. Patient was treated with cotrimoxazole. One year follow up showed clinical recovery.

HIV associated psoriasiform dermatitis or Reiter's syndrome

A 23 year old male presented with psoriasiform dermatitis of one month duration in April 1999 and was found to be HIV seropositive. He was managed with PUVA therapy. His cutaneous lesions improved but no improvement in arthritis and in nail changes occurred. Patient discontinued the therapy and presented with relapse in july 1999 with a different clinical picture, now suggestive of Reiter's syndrome. He had keratoderma blenorrhagica and severe deforming arthiritis. Such a case presents with difficulties in arriving at the diagnosis in the HIV era and allows limited therapeutic options for management.

Kaposi's varicelliform eruption in allergic contact dermatitis

A 42 year old male having airborne allergic contact dermatitis suddenly developed high grade fevern chills and prostation on 7th day of admission. Two days later he developed generalised papulovesicles which became haemorrhagic and crusted within one to two days. These lesions later evolved into grouped erosions. Simultaneously, he developed swelling of the face and generalised lymphadenopathy. Tzanck smear demonstrated giant cells and the patient was diagnosed as having kaposi's varicelliform eruption. He responded to oral acyclovir. The case is reported for its rarity.

Irritant dermatitis due to marking nut used as hair dye

Marking nut is a known potent irritant. Apart from its most common use by washermen as a black "ink" for marking clothes, it has been put to many indigenous uses in the villages of India. Here is a report of an ill-advised young girl who used its black juice as a hair-dye and suffered from a severe irritant reaction. Use of marking nut, as a hair dye is probably unheard of.

Acne rosacea with rare eye changes

One 55 year old army officer had all 3 variants of acne rosacea occurring simultaneously for 9 years. Associated rare, serious complications as prominent rosacea keratitis, deterioration of vision, rhinophyma and lymphoedema were seen. We are reporting the present case as the above combination is rare.

Angiolymphoid hyperplasia with eosinophilia

A patient with a nodular swelling over scalp is presented. The histopathology of the lesion is consistent with angiolymphoid hyperplasia with eosinophilia. The subtle differences from Kimura's disease are discussed.

Wegener's granulomatosis - an unusual presentation

Wegener's granulomatosis is characterized by necrotising granulomatous inflammation and vasculitis affecting predominantly small arteries and veins. In its generalised form there is involvement of upper and lower respiratory tract, kidney and often other organs including skin. It may also present as limited organ involvement. A case of Wegener's granulomatosis limited to skin is reported.

Bilateral extensive port-wine stain (naevus flammeus) with persistent Mongolian spots : phacomatosis pigmentovascularis type IIa in a Nepalese girl

An 11 year old girl had extensive port-wine stain affecting her trunk and limbs bilaterally and persistent mongolian spots on her trunk and buttocks since birth. Combination of such congenital cutaneous vascular and pigmentary anomalies is known as Phakomatosis pigmentovascularis (PPV) and we report the first such case from Nepal.

Multiple leiomyoma cutis

A case of multiple leiomyoma cutis in a woman is presented. This patient had multiple tender nodules on the face and back. The histopathology was consistent with the clinical diagnosis of leiomyoma cutis. Differential diagnosis of painful tumours of the skin is also discussed.