Anogenital ulceration; an unusual presentation of mixed connective disease

Mixed connective-tissue disease [MCTD] is an autoimmune disorder with overlapping clinical features of systemic lupus erythematosus [SLE], scleroderma, and myositis, with the presence of antiUl-ribonucleoprotein [RNP] antibody. We report a case of a male patient with unusual clinical presentation of the condition

Efficacy and safety of methotrexate in lichen Planus

Objective: To evaluate the efficacy and safety of methotrexate in lichen planus

Methods: This quasi-experimental study was carried out in the Skin outdoor, Mayo Hospital, Lahore from March 2011 to September 2011. Fifty five patients of either sex from puberty onwards were included in the study. Efficacy was determined by >/=50% clearance of number of mucocutaneous lesions after 12 weeks of oral methotrexate 15mg/week. Safety of methotrexate was analyzed by taking history of nausea, fatigue and measuring hemoglobin [Hb], white blood cell count [WBC], platelet count, serum alanine aminotransferase [ALT], aspartate aminotransferase [AST] levels at base line, 2nd, 4th,8th and 12th week

Results: Methotrexate was efficacious in 63.6% patients. Out of these, 21.8% patients were with cutaneous involvement while 41.8% patients had both skin and mucous membrane involvement. There was a significant reduction in number of cutaneous lesions, with little or no effect on mucosal lesions of patients. Methotrexate did not prove efficacious even in a single patient with isolated mucosal involvement. The drug was safe and well tolerated in 91% cases

Conclusion: Methotrexate proved efficacious and safe in our study for most of the patients

Necrolytic acral erythema: a rare entity

Necrolytic acral erythema [NAE] is a rare but distinct clinical entity. It is one of the necrolytic erythemas that presents with itchy well-defined, dusky, erythematous to violaceous papules and plaques on acral areas

We report a case of a 50-year-old woman with 8-year history of itchy hyperpigmented papules and plaques on dorsum of both feet. Later, she developed similar lesions on both hands along with hemorrhagic blisters and purpura

She was found to be a hepatitis C virus [HCV] positive case. Histopathological findings were consistent with necrolytic acral erythema. She was treated with topical tacrolimus, oral zinc and cetirizine, and referred to medical outpatient department for treatment of HCV infection i.e. interferon and ribavirin