RFP Journal of Dermatology

Introduction: Methotrexate (MTX) is a widely used immunosuppressive drug. Though being safe, it has some non-fatal and fatal side effects. Granulocyte-monocyte colony stimulating factor (GM-CSF) a hemopoietic growth factor, is an upcoming preventive and therapeutic modality to curb harmful effects of bone marrow suppressive drugs.Case series: Herein, we narrate three cases of acute MTX toxicity. Two of these presented with cutaneous ulcerative lesions while one presented with only constitutional symptoms. Two patients had derailed liver function tests while one had altered renal function tests. All showed pancytopenia.GM-CSF was given in two cases which responded well, whereas one succumbed to death before administration.Conclusion: Pre-treatment and periodic monitoring; strict avoidance of self-administration are of utmost importance when patient is on MTX. GM-CSF needs exploration in MTX toxicity treatment, and could be a pivotal drug in prevention of fatality in presence of pancytopenia.

Keywords: Methotrexate; Adverse Drug Reaction; Ulceration; Pancytopenia; Self-Medication.

Context:  125 million people worldwide 2 to 3 percent of the total population-have psoriasis. Psoriasis prevalence in African Americans is 1.3%compared to 2.5% percent of Caucasian12. Aims: To study the socio demographic profile and disease characteristics in a psoriasis. Settings and Design: Cross Sectional Study. Methods and Material:The study comprised of total 417 cases of psoriasis vulgaris. According to body surface area involvement disease was graded as mild moderate and severe.  Metabolic syndrome was diagnosed and .Dermatology life quality index was evaluated. Out of 417 psoriasis patients,90 patients with psoriasis were randomly selected and divided in 3 groups. PASI score was evaluated at baseline and then at every follow up of 2 weeks, 4 weeks and 6 weeks. Results:Psoriasis is more common in males.49.96% of male patients were involved in farming and manual work.31.65% patients were smokers. Most common site was lower limb (94.72%). Nail changes were present in 79.85% and Arthiritis was present in 11.99% of patients. Prevalence of obesity was more in females (26.86%). No significant difference was observed in prevalence of type 2 diabetes or hypertension or obesity. There was a positive association of hypertriglyceridemia with psoriasis. Quality of life is definitely greatly impaired by psoriasis as DLQI was hugely affected in 26.85% of patients and moderately affected in 36.58% of patients. Calcitriol ointment (0.0003%) had very effective role in keeping the disease under remission and has moderate response compared to clobetasol propionate (0.05%) cream. Conclusions: Psoriasis is associated with several comorbidities and can have a significant impact on a patient's quality of life.

 Keywords: Psoriasis; DQLI; Metabolic Syndrome.

Background:Urticaria is a vascular reaction characterized by appearance of wheal which is immunological or non-immunological.Urticaria is one of the most distressing, frustrating and challenging dermatologicalconditions for both patients and doctors.Although usually not life threatening, it often impairs quality of life to a degree comparable with triple coronary heart disease.Only curative treatment is to find out cause and eliminate. Aims: To study the various aetiology of urticaria and to perform Autologous Serum Skin Test (ASST) as a screening test in chronic spontaneous urticaria (CSU).Materials and Methods:A prospective study of aetiology of urticaria in 312 patients was carried out over a period of 3 years in skin outpatient department at tertiary care hospital.The diagnosis was based on history and confirmed by elimination and rechallenge in less severe cases of food and drug.CSUwas diagnosed after excluding other aetiology and ASST was performed in all cases of urticaria labelled as CSU. Specific investigations like TSH were done as and when necessary.Statistical analysis: mean, standard deviation, chi square test, z test. Results:Most common type wasCSU(28.21%) followed by food (25.64%), drugs(21.47%) and physical urticarial (10.89%).Urticaria associated with infection in 4.8%, multiple causes(2.88%) and by aerosol (dust/mite/pollen in 2.24%). Atopy in 1.28%, mosquito bite, associated with thyroid disease, contrast induced,premenstrual precipitation etc. were found in <1%. Among CSU 19.31%were ASST positive.Conclusion: Most common type of urticaria was CSU followed by food and drugs. Among food most common cause was citrous food. Most common drug causing urticaria were NSAIDS followed by Sulphonamides and cephalosporin.  

Keywords: Urticaria; Angioedema; Aetiology; CSU; ASST.

Chronic spontaneous urticaria affects 0.5-1% of individuals (lifetime prevalence) and significantly reduces quality of life (QOL) 1. More than half of the patients of chronic urticaria suffer from autoimmune urticaria. Chronic urticaria (CU) is a troublesome problem and patients of CU are affected by the morbidity that arise from irritable itch and wheals and are also subjected to a huge antihistamine pill burden. The symptoms are more profound in autoimmune urticaria (AU) where auto-antibodies in blood flare-up the condition. A vigilant search for a novel modality of treatment which can decrease the pill burden is needed.Aims:This study evaluates the effectiveness of autologous serum therapy (AST) in CSU and also determines its usefulness in AU.Materials and Methods: The prospective interventional, randomized single blind studySingle blind, parallel group, randomized, controlled study. Eighteen patients were given AST and seventeen patients were given injection normal saline (placebo), along with Cetrizine given on-demand basis in both groups. AST/Placebo was given weekly for nine weeks and the patient was followed-up for a total period of 24 weeks. Of the 250 patients in whom ASST was performed, 150 were ASST positive of which 115 withdrew (Remote residence from treatment center). 35 ASST positive patients were administered treatment according to below-mentioned groups:Group A: 18 ASST positive patients received AST with antihistamines.Group B: 17 ASST positive patients received only antihistamines.AU was diagnosed by autologous serum skin test. Urticaria activity score (UAS) was used as primary effectiveness variables. Safety parameters assessed were the spontaneously reported adverse events and laboratory parameters.

Keywords: CSU (Chronic Spontaneous Urticaria); AU(Autoimmune Urticaria); AST (Autologous Serum Therapy).