Background: Dexamethasone-cyclophosphamide pulse (DCP) therapy for the pemphigus group of disorders is being widely used in India after its introduction in 1986. However, there are certain limitations to its application due to the serious side effects of cyclophosphamide. Methods: Between 1995 and 2001, we treated 41 patients of pemphigus with modified pulse therapy. These modifications included certain changes in the DCP therapy protocol and substitution of cyclophosphamide with either azathioprine or methotrexate in a few patients. Results: We observed a good response to pulse therapy in all 34 patients who took treatment regularly. Conclusions: We found the modifications to the original DCP therapy protocol to be very effective and useful.

Background: The complications associated with the use of systemic corticosteroid therapy have prompted a search for alternative agents. However, these agents are themselves associated with increased risk of myelosuppression or malignancy. Methods: The present study included twenty patients with recalcitrant pemphigus or steroid induced side effects who were treated with intravenous cyclophosphamide pulse therapy. Results: Out of 18 patients who completed the study, 14 showed good to excellent response. Thirteen were able to decrease their daily dose of steroid to 5-10 mg prednisolone while one could stop steroids altogether. Most patients did not experience serious side effects. Discussion: Thus intravenous pulse cyclophosphamide is a promising form of therapy in pemphigus either recalcitrant or intolerant to steroid therapy. The decreased total cumulative dose of cyclophosphamide with intravenous therapy as compared to oral therapy may reduce the incidence of secondary malignancy.

A 20-year-old man presented with thickening, subungual hyperkeratosis and discoloration of all the nails of both hands and both great toes since birth. No other ectodermal abnormalities were found. Treatment with vitamins A and E in high doses along with a moisturizing ointment topically for one year resulted in complete resolution of all nail abnormalities.

Chilblain lupus erythematosus with depigmentation is a rare presentation of lupus erythematosus that may simulate vitiligo. A 52-year-old lady with such a manifestaiton is being reported.

Lipodystrophy and associated metabolic abnormalities are being increasingly recognized as complications of juvenile dermatomyositis. We report one such case.

An unusual complication, multiple cystic swelling of scalp, arising due to intralesional steroid injections given for alopecia areata using a Dermajet is being reported.

An elderly man with a long history of smoking presented with an excruciatingly painful mass of short duration on the left side of the neck, without any systemic complaint. Clinical and radiological examination revealed left upper lobe consolidation which was proved to be secondary to bronchogenic carcinoma. Histopathological findings from a skin biopsy from the neck mass were consistent with inflammatory cutaneous metastasis. Interestingly, this was the presenting feature of the underlying malignancy in this patient. This pattern of cutaneous metastasis has rarely been reported in association with bronchogenic carcinoma.