The efficacy of cyclosporine and related drugs in the treatment of psoriasis was the key to the development of the concept that psoriasis is an immune mediated disorder. These therapies demonstrably reduce the number of activated T-lymphocytes, which correlates with clinical remission. Monoclonal antibodies directed against key components of the inflammatory process have been studied in an attempt to produce safer, more effective and selective immunosuppressive agents. This review summarizes the information available on cyclosporine and related drugs, and cytokine therapy, including monoclonal antibodies directed against T-cell mediated inflammation. It should be realized that biologic therapies for psoriasis are very new and that efficacy and safety information from clinical trials is just becoming available.

Psoriasis is an immunologically mediated disease caused by activation of T lymphocytes that elaborate a Th1 type of immune response. Targeted manipulation of the various mechanisms involved in T cell activation and blockade or inactivation of the various proinflammatory cytokines released by the process of T cell activation are methods used in treatment of psoriasis by use of ‘biologicals’.

Background: Methotrexate is the drug of choice in extensive psoriasis in developing countries. In patients who can not take methotrexate either due to intolerance or concomitant liver disease, there is an urgent need for an alternative affordable and accessible drug. Aims: To evaluate the therapeutic efficacy and safety of hydroxyurea as an alternative in the management of patients with extensive psoriasis. Methods: A prospective study was carried out over 16 months on 34 patients with chronic plaque psoriasis (>20% body surface area involvement), erythrodermic or generalized pustular psoriasis who were partially responsive or non-responsive to the conventional topical and systemic modalities of therapy. Besides doing a baseline hemogram, liver and renal function tests, and urine analysis, these tests were frequently repeated during the course of therapy. Hydroxyurea was started at 1 g daily and increased to 1.5 g, if required. The therapeutic response was evaluated by a global assessment made by the patient and physician and regular PASI scoring. Results: Good to excellent response was observed in 25 (73.5%) patients, less than 50% response in 7 (20.6%) patients, while 2 (5.9%) patients were lost to follow up. The mean PASI score was reduced by 76% at 10-12 weeks. Therapy was discontinued in 3 patients due to leukopenia that recovered on discontinuation of hydroxyurea. Patients were followed up to 1 year and relapse was observed in 5 patients. The duration of remission varied from 6 months to 1 year. Conclusion: Hydroxyurea is an effective and reasonably safe second line agent for psoriasis.

Background: Autonomic dysfunction, an early manifestation of diabetic neuropathy, presents with altered sweating patterns, leading to dryness and fissuring. We conducted a study to assess the sweat function in the diabetic foot and to determine the interrelation between the duration of diabetes, sensation, fissuring, and sweating. Methods: The sweat function was assessed in 30 diabetic patients, 28 of whom had fissuring of the feet, using Ninhydrin impregnated discs. Results: There was a significant association between fissuring and sensation, but not between the duration of diabetes and fissuring and between loss of sweating and fissuring. In 18 patients (60%) there was impairment or absence of sweating in the presence of normal sensation. Conclusion: Although fissuring increases with long-standing diabetes and sweating is reduced in diabetic patients with fissures on the foot, the correlation between these entities was not statistically significant. Since 60% patients had altered sweating in the presence of normal sensations, the sweat test can be used as an early indicator of diabetic neuropathy.

Background: Adverse cutaneous drug reactions (ACDRs) are caused by a wide variety of agents. Aims: Our objective was to ascertain the clinical spectrum of ACDRs and the causative drugs in this part of India and to find any risk factors. Methods: Ninety patients with adverse cutaneous drug reactions were recruited for this study during 2001-2003. Hematological and biochemical investigations were done in all of them. The VDRL and HIV (ELISA) tests were performed where the underlying risk factors were present. Patch testing, intradermal testing and oral provocation tests were done wherever feasible. Results: The mean age of the patients with cutaneous drug eruptions was 37.06 years. Most of them (52.2%) were in the age group of 20-39 years. The male to female ratio was 0.87: 1. The most common eruptions observed were fixed drug eruption (31.1%) and maculopapular rash (12.2%), and the most common causes were co-trimoxazole (22.2%) and dapsone (17.7%). Conclusion: The pattern of ACDRs and the drugs causing them is remarkably different in our population. Knowledge of these drug eruptions, the causative drugs and the prognostic indicators is essential for the clinician.

Background: Dandruff is a common condition in clinical practice. We undertook a study to evaluate the efficacy and safety of a combination of zinc pyrithione and polytar in a shampoo base for the treatment of dandruff. Methods: A combination of polytar (1%) and zinc pyrithione (1%) was used for 4 weeks to treat 954 patients suffering from mild to severe dandruff. Scoring of dandruff was done on a 0-10 scale for each of the 6 regions of scalp at weeks 0, 2, 4 and 6. Follow up was for 2 weeks. Results: There was consistent improvement in dandruff scores over the treatment and the follow up period. There was significant improvement in signs and symptoms such as erythema and itching, with a negligible adverse event profile. The global assessment by investigators showed good-excellent results in the majority of patients and there was high acceptability for the treatment among the patients. Conclusion: A combination shampoo of polytar (1%) and zinc pyrithione (1%) offers a safe and effective option in the treatment of dandruff and its associated symptoms.

A 39-year-old soldier presented with anhidrosis affecting both upper extremities below the shoulders, the right side of the trunk below the third rib in front and the third vertebra on the back, and the left lower extremity below the inguinal ligament since 1992. Ten years later in 2002, he was also found to have bilateral absence of Achilles reflex and decreased right knee jerk. In addition, the patient was found to have congenital spinal abnormalities in the form of block of vertebrae C3-C4; decreased disc space C4-C5; and break in pars interarticularis L5-S1 with decreased disc space. A total of seven cases of Ross syndrome, Holmes-Adie syndrome (tonic pupil with lost tendon jerks) with segmental anhidrosis, have been described in the literature. Our case, however, did not have any pupillary abnormality. A case of progressive isolated segmental anhidrosis has also been described. The association of congenital spinal abnormality, which may be pathognomonic in the causation of this progressive sudomotor degeneration, is quite interesting in our case. The distribution of anhidrosis on the right side is just below the level of sweating loss sometimes described in lesions of superior sympathetic cervical ganglion in Horner’s syndrome.

We report an alcoholic Indian man, a known case of contact dermatitis to nickel, who presented with recurrence at the same site, without having recent contact with nickel, following disulfiram therapy for his alcohol addiction.

A 49-year-old farmer presented with papules on the face, arms, chest and back associated with sclerosis. Histopathology and PAS stain confirmed the clinical diagnosis of scleromyxedema. He also had elevated CPK levels due to myopathy. Screening for internal malignancy was negative.

Bullous pemphigoid is a common autoimmune skin disease characterized by the presence of subepidermal blisters. It has been associated with underlying neoplasia in isolated reports. A 78-year-old man with generalized blisters was diagnosed as bullous pemphigoid on clinical, histopathological and direct immunofluorescence grounds. His free and total prostate specific antigen (PSA) levels were high and histopathological examination of a prostate specimen revealed prostate adenocarcinoma. We present this rare case to discuss the possible association between bullous pemphigoid and prostate adenocarcinoma.