Topical therapy as monotherapy is useful in psoriasis patients with mild disease. Topical agents are also used as adjuvant for moderate-to-severe disease who are being concurrently treated with either ultraviolet light or systemic medications. Emollients are useful adjuncts to the treatment of psoriasis. Use of older topical agents such as anthralin and coal tar has declined over the years. However, they are cheaper and can still be used for the treatment of difficult psoriasis refractory to conventional treatment. Salicylic acid can be used in combination with other topical therapies such as topical corticosteroids (TCS) and calcineurin inhibitors for the treatment of thick limited plaques to increase the absorption of the latter into the psoriatic plaques. Low- to mid-potent TCS are used in facial/flexural psoriasis and high potent over palmoplantar/thick psoriasis lesions. The addition of noncorticosteroid treatment can also facilitate the avoidance of long-term daily TCS. Tacrolimus and pimecrolimus can be used for the treatment of facial and intertriginous psoriasis. Tazarotene is indicated for stable plaque psoriasis usually in combination with other therapies such as TCS. Vitamin D analogs alone in combination with TCS are useful in stable plaques over limbs and palmoplantar psoriasis. Topical therapies for scalp psoriasis include TCS, Vitamin D analogs, salicylic acid, coal tar, and anthralin in various formulations such as solutions, foams, and shampoos. TCS, vitamin D analogs, and tazarotene can be used in the treatment of nail psoriasis.

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Verrucous hemangioma is an uncommon congenital vascular malformation, which may clinically masquerade angiokeratoma, lymphangioma circumscriptum, or malignant melanoma. Differentiation is essential owing to varied therapeutic and prognostic implications. We present a rare case of multiple verrucous hemangiomas in a teenage girl who presented with multiple warty lesions over the dorsal aspect of the left foot since birth. Magnetic resonance imaging (MRI) scan was suggestive of a vascular malformation, and skin biopsy showed ectatic blood vessels extending from the papillary dermis into the subcutaneous tissue, diagnostic of verrucous hemangioma. A combination of 0.05% halobetasol propionate with 3% salicylic acid ointment was advised. This therapeutic intervention resulted in significant resolution of the warty lesions over a period of 2 months, following which surgical excision was performed. The implication is that we can use a combination of super potent topical steroid with salicylic acid as an adjunct to surgical resection.

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Background: While clinical trial data on the efficacy of itolizumab in the management of psoriasis is relatively well documented, data on the effectiveness of this humanized IgG1 monoclonal antibody in real-world settings is sparse. Aims: The current study assessed the effectiveness of itolizumab in real-world settings. Materials and Methods: This study assessed psoriasis area severity index (PASI), dermatology quality of life index (DLQI), safety, and tolerability data from a registry of itolizumab maintained by Syngene International, Bangalore. Registry data of 155 patients who were prescribed itolizumab at a dose of 1.6 mg/kg every 2 weeks for the first 12 weeks followed by 1.6 mg/kg every 4 weeks for up to 24 weeks for chronic plaque psoriasis. Results: In the study, 35.48% completed itolizumab for 12 weeks and 76.59% of these patients achieved PASI 75. Furthermore, 24.51% patients completed the full Itolizumab regimen for 24 weeks, of whom 92.01% patients achieved PASI 75. The mean percent change in DLQI scores at weeks 12 and 24 were 60.19 and 82.72, respectively. Adverse events and infusion reactions noted in the study were generally of mild to moderate severity. Conclusion: Itolizumab is a safe and effective option in treatment-compliant patients with chronic plaque psoriasis. Effects of putative compliance-modulators such as cost, route of administration, and delayed onset of action warrant further investigation.

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Lichen striatus is a self-limiting dermatosis presenting with sudden eruption of lichenoid papules along the lines of Blaschko. A 5-year-old girl presented with asymptomatic hypopigmented linear lesions over both upper limbs. The histopathological examination revealed spongiosis, vacuolar alteration of the basal layer and lymphocytic exocytosis with a mild-to-moderate perivascular mononuclear infiltrate in the dermis. Lichen striatus was diagnosed based upon the characteristic clinical and histopathological findings. The pathogenetic mechanism of bilateral lichen striatus is unknown at present, however, a somatic mutation in two different clones of cells can be a possibility.

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Background: There is a great body of evidence indicating that some inflammatory skin diseases, such as psoriasis, are mediated by oxidative stress. Trace metals have been shown to be involved in oxidative stress response. Altered trace metal homeostasis in psoriasis has been studied. However, limited number of studies has focused on the involvement of metal binding proteins in psoriasis. Materials and Methods: In a case control-study, serum levels of Iron (Fe), Copper (Cu), Transferrin (Trf), and Ceruloplasmin (Cp) were measured in 40 psoriasis patients and matched healthy controls. The severity of the disease was measured using psoriasis area and severity index (PASI), and the association of severity based on PASI score and measured elements and proteins was investigated. Results: Forty patients with psoriasis (mild: 14 and moderate to severe: 26) and 40 healthy controls were included in this study. The serum Fe, Trf, and Cu/Cp levels of the patients with psoriasis were statistically lower compared with those of the controls; serum levels of Cp was elevated in patients with psoriasis compared to controls (P = 0.02). No significant difference was observed between the two groups regarding serum levels of Cu (P = 0.07). Conclusion: Cu/Cp ratio of the patients with psoriasis was statistically lower compared with those of the controls.

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Angiolymphoid hyperplasia with eosinophilia is a rare vascular disease characterized by multiple erythematous to violaceous papules, commonly present on the head and neck region. We report a case of a 23-year-old female who presented with multiple, erythematous asymptomatic papules on the preauricular region and pinna, which on biopsy was suggestive of angiolymphoid hyperplasia. The lesions were treated with a novel combination of radiofrequency ablation and topical timolol. The lesions healed without scarring and there was no recurrence on 1 year follow up.

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Cutaneous horns are uncommon lesions consisting of keratotic material, resembling that of an animal horn. They account for 4% of all eyelid tumors. We report a case of giant cutaneous horn (2 × 1.75 cm) of 4-year duration arising from the right lower lid. Growth excision with direct closure of the defect was done. Histopathological examination revealed it to be well-differentiated squamous cell carcinoma. Most important concern while evaluating cutaneous horns is the underlying condition, which may be benign or malignant. Therefore, histopathological examination is mandatory.

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Tuberculosis (TB) is still a major public health problem in the world, with many factors contributing to this burden, including poor living conditions, overcrowding, poverty, malnutrition, illiteracy, and rapid spread of human immunodeficiency virus infection. Cutaneous tuberculosis is a less common form of extrapulmonary tuberculosis, and in this paucibacillary form the diagnosis depends on histopathology, tuberculin positivity, and response to treatment. The diagnosis is even more difficult in cases with drug resistant Mycobacterium tuberculosis due to lack of awareness and lack of facilities to diagnose drug resistant tuberculosis. In this article, we describe an unusual case of multidrug resistant lupus vulgaris (LV), in a 34-year-old male who responded to anti-tubercular treatment (ATT) initially, but developed recurrent disease which failed to respond to standard four-drug ATT; subsequently, tissue culture showed growth of multidrug resistant M. tuberculosis. Subsequently, he also developed cutaneous squamous cell carcinoma. This article aims to exemplify a grave complication that can occur in long-standing case of LV, the limitations faced by clinicians in developing countries where tuberculosis is endemic, and classical methods of proving drug resistance are generally unavailable or fail.

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Pheohyphomycosis is a rare heterogeneous group of mycotic infections caused by dermatiaceous (phaeoid) fungi affecting the skin, subcutaneous tissue, and the central nervous system.Involvement of the face is extremely rare, and very few cases have been reported in India so far. We reporta case of phaeohyphomycosisin a 45-year-old female with 1-year history of a well- defined hypertrophic plaque over the right cheek advancing towards the forehead. The lesion was ulcerated with rolled-up margins; a provisional clinical diagnosis of basal cell carcinoma was given. Histopathology of the skin biopsy revealed numerous multinucleated giant cells and fungal hyphae with in and in between the giant cells. Various histochemical stains were used toconfirm the presence of fungal hyphae. Melanin pigment in the fungus was demonstrated with Masson's Fontana stain. Based on the histopathological and histochemical findings, a diagnosis of phaeohyphomycosis was given and it was concluded that the disease was more of a histopathological than clinical diagnosis. This case is being reported due to its unusual presentation and it also highlights the importance of histopathology in the diagnosis of this rare disease.

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