Neetu Bhari

Newer targeted therapies in psoriasis.

Psoriasis is a common, chronic, inflammatory skin disease that can have a significant impact on the quality of life of those who are afflicted due to chronicity of the disease and frequent remissions and relapses. Many available systemic therapies, however, are unsuitable for chronic administration due to the risk of cumulative toxicity. Recent advances in the understanding of the pathophysiology of psoriasis have led to the development of new, genetically engineered, targeted therapies for this disease. These include approaches targeting antigen presentation and co-stimulation, T-cell activation and leukocyte adhesion, action on pro-inflammatory mediators, and modulating the cytokine balance. Although only preliminary data are available so far and there is limited data supporting their use, these trials contribute to a further understanding of the disease and will eventually lead to new therapeutic options for psoriasis.

Transplantation of In a Vivo–Harvested Epidermal Cell Suspension for Acute Cutaneous Lupus Erythematosus–Induced Depigmentation

Vitiligo-like depigmentation is known to occur with discoid lesions of chronic cutaneous lupus erythematosus (LE) and subacute cutaneous LE; however, we could not find any report of depigmentation occurring after the resolution of malar rash of acute cutaneous LE. Because there is scarcity of literature regarding acute cutaneous LE rash-associated leukoderma, the course of the disease and the outcome of various therapeutic modalities are not known. Phototherapy and photochemotherapy, the mainstay of therapy for leukoderma and vitiligo, cannot be used in leukoderma caused by LE rash due to the risk of aggravation of LE itself and, therefore, worsening of depigmentation. We report a case of leukoderma caused by acute cutaneous LE treated with transplantation of in vivo–harvested noncultured epidermal cell suspension (NCES) without added phototherapy.

Orangechrome Due to Carotenemia Presenting as Trichrome Vitiligo

A 44-year-old woman presented with orangish discolouration of existing stable vitiligo for 1.5 years. On mucocutaneous examination, the orangish pigmentation was prominent at the margins of vitiligo patches with sparing of the centre. Palms and soles, palatal mucosa, and conjunctiva also showed similar discolouration. The patient was receiving 60 mg β-carotene once daily and alternate-day topical PUVAsol from outside for 3 years with good improvement but poor colour match. Uptake of β-carotene is much higher in melanocytes exposed to ultraviolet radiation compared to keratinocytes. Preferential localization of carotene at the margin of vitiligo lesions in our case might be due to more active melanocytes at the periphery caused by ongoing topical photochemotherapy.

Tufted angioma with recurrent Kasabach-Merritt phenomenon.

Sir, A 5‐month‐old male child presented with an erythematous plaque on the right cheek extending to the mandibular area and neck. The lesion was noticed at birth and had gradually increased in size with rapid growth over the past 2 months. There was no history of ulceration or bleeding. He did not have any associated systemic complaints. Examination revealed a dusky erythematous, firm and tender plaque of 10 cm × 14 cm size with surface nodularity on the right cheek and extending to the right side of the neck and chest [Figure 1a and b].

SkinIndia Quiz 45: Asymptomatic nodular lesion over the neck in an old woman

A 56‐year‐old woman presented with an 8‐month history of single, asymptomatic nodule over the neck, which was progressively increasing in size. The patient was systemically well. On examination, there was a single firm nodule of size 2.5 × 3.5 cm over the right lateral aspect of the neck. The nodule was dark brown in color and was fixed to the overlying skin. The lesion had a lobulated appearance with a zone of erythema at the periphery [Figure 1]. An excision biopsy was performed to reach a diagnosis.