With severe epidemics of CHIK spreading from Asia and Africa to the Western hemisphere, we must consider bullous CHIK as a differential diagnosis in cases with fever and purpuric and vesiculobullous lesions.

Background:Although psoriasis generally does not affect survival, it certainly has a number of major negative effects on patients, demonstrable by a significant detriment to quality of life.Aims:We have done a study with the objective of assessing the clinical variables adversely affecting quality of life in patients diagnosed with psoriasis.Materials and Methods:This study is a cluster analysis of 50 consecutive consenting patients with psoriasis, of both sexes, aged over 18 years, attending the dermatology outpatient department of a tertiary care center. We measured the clinical severity using psoriasis area severity index and health-related quality of life using psoriasis disability index (PDI). Statistical analysis was performed using unpaired independent student's t-test, analysis of variance (and Scheffe's post hoc test as appropriate) and Pearson's correlation coefficients.Results:There was a significant correlation between the physician-rated severity of psoriasis and the extent of impact of psoriasis on physical disability as measured by the PDI. We have identified that a younger age at onset of disease and self-reported stress exacerbators suffer greater disability in most aspects of quality of life.Conclusions:On the basis of this study, we would recommend that psoriasis patients especially with severe disease require a more holistic treatment approach that encompasses both medical and psychological measures.

Despite considerable overlap, the confusion hovering over the four common sparing signs can be cleared as follows: Reverse Koebner relates to sparing by physical trauma; isotopic non-response/reverse isotopic response relates to sparing over an already healed dermatosis; Renbok Phenomenon relates to sparing among two concomitant active diseases often with autoimmune etiology; anatopic phenomenon relates to sparing caused by presence of certain infectious diseases of skin. In conclusion, sparing phenomenon of dermatology seems to command our attention by their sheer number, variety, and clinical implications. Therefore, it may be said that astute clinician is the one who will look, not only for the presence of lesions in the patient but also for the conspicuous absence thereof.

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