Nail involvement is an extremely common feature of psoriasis and affects approximately 10-78% of psoriasis patients with 5-10% of patients having isolated nail psoriasis. However, it is often an overlooked feature in the management of nail psoriasis, despite the significant burden it places on the patients as a result of functional impairment of manual dexterity, pain, and psychological stress. Affected nail plates often thicken and crumble, and because they are very visible, patients tend to avoid normal day-to-day activities and social interactions. Importantly, 70-80% of patients with psoriatic arthritis have nail psoriasis. In this overview, we review the clinical manifestations of psoriasis affecting the nails, the common differential diagnosis of nail psoriasis, Nail Psoriasis Severity Index and the various diagnostic aids for diagnosing nail psoriasis especially, the cases with isolated nail involvement. We have also discussed the available treatment options, including the topical, physical, systemic, and biological modalities, in great detail in order to equip the present day dermatologist in dealing with a big clinical challenge, that is, management of nail psoriasis.

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Background:Chronic allergic skin disorders are the inflammatory and proliferative conditions in which both genetic and environmental factors play important roles. Chronic idiopathic urticaria (CIU) and atopic dermatitis (AD) are among the most common chronic allergic skin disorders. These can be provoked by various food and aeroallergens. Skin prick tests (SPTs) represent the cheapest and most effective method to diagnose type I hypersensitivity. Positive skin tests with a history suggestive of clinical sensitivity strongly incriminate the allergen as a contributor to the disease process.Aims and Objectives:To determine the incidence of positive SPT in patients with chronic allergic skin disorders and to identify the various allergens implicated in positive SPT.Methods:Fifty patients of chronic allergic disorders were recruited in this study. They were evaluated by SPT with both food and aeroallergens.Results:In our study, SPT positivity in patients of CIU was 63.41% and in AD was 77.78%. Out of the 41 patients of CIU, the most common allergen groups showing SPT positivity were dust and pollen, each comprising 26.83% patients. SPT reaction was positive with food items (21.6%), insects (17.07%), fungus (12.20%), and Dermatophagoides farinae, that is, house dust mite (HDM) (7.32%). The allergen which showed maximum positivity was grain dust wheat (19.51%). Among nine patients of AD, maximum SPT positivity was seen with Dermatophagoides farinae, pollen Amaranthus spinosus, grain dust wheat, and cotton mill dust; each comprising 22.22% of patients.Conclusion:Our study showed that a significant number of patients of CIU and AD showed sensitivity to dust, pollen, insects, Dermatophagoides farinae, and fungi on SPT. Thus, it is an important tool in the diagnosis of CIU and AD.

Anti-epileptic drugs can be associated with a wide spectrum of cutaneous adverse reactions ranging from simple maculopapular rashes to more severe and life threatening reactions like Stevens-Johnson syndrome and toxic epidermal necrolysis. These rashes are well documented with older antiepileptic drugs like phenytoin, phenobarbitone and carbamazapine. Lamotrigine is a newer, unrelated antiepileptic drug that causes skin rashes in 3-10% of new users. Higher starting dose or rapid escalation, concurrent treatment with valproic acid, and a previous history of a rash with other antiepileptic drugs are well recognized risk factors for lamotrigine related serious rashes. We report two patients with toxic epidermal necrolysis, resulting from concomitant use of lamotrigine and valproic acid. It is emphasized that clinicians adhere to the recommended dosage guidelines and adopt a slow dose titration when initiating treatment with lamotrigine.

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<p class="abstract"><strong>Background:</strong> Contact dermatitis in housewives is a common dermatological problem as almost all housewives have to handle vegetables, fruits, soaps and detergents. The purpose of this project was to study etiologic profile of contact dermatitis occurring in housewives.</p><p class="abstract"><strong>Methods:</strong> One hundred housewives, clinically diagnosed as having contact dermatitis, were randomly selected for the study. Each patient was then subjected to patch testing using the Indian standard battery and certain indigenously prepared antigens i.e. vegetables, soaps and detergents. The first reading was taken 60 minutes with second reading at 96 hours. Reading equal to or more than 1+ was considered to be a positive test.<strong></strong></p><p class="abstract"><strong>Results:</strong> Majority patients were in the age group of 20-30 years. Morphological diagnosis was wear and tear dermatitis in 43%, discoid eczema (19%), fingertip eczema (16%), hyperkeratotic (15%) and pompholyx (7%). Nickel sulphate was found to be the commonest allergen (19%) followed by para-phenylenediamine (8%), fragnance mix (7%), Balsam of Peru (6%), parthenium (6%) and cobalt (5%). Amongst vegetables, the commonest culprit was garlic. Allergic reaction to detergents was positive in 13% patients. Forty-four percent of the cases tested positive to the suspected allergen whereas 31% patients tested positive for allergens not initially suspected of causing contact dermatitis in them.</p><p class="abstract"><strong>Conclusions:</strong> Thus patch testing is an important tool in establishing the cause of allergic contact dermatitis of the hands in housewives in whom the hand eczema is multifactorial. This enables the correct etiological diagnosis and proper management of housewives with hand dermatitis.</p><p> </p>

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