Asymmetrical periflexural exanthem exhibiting pseudoisomorphic Köebner response in an adult.

Asymmetrical periflexural exanthem is a rare clinical condition, seen almost exclusively in children. Very few adult cases have been reported in the literature. We report a case of this rare eruption in an adult man showing characteristic clinical and histological features. Interestingly, this patient also exhibited a pseudoisomorphic Köebner response. Although an infective aetiology of viral origin has been suggested for this localized eruption, the aetiology remains unknown. We are of the opinion that the pseudoisomorphic Köebner response in this patient may support the inoculation hypothesis in the pathogenesis of this disorder.

Efficacy of concomitant use of PUVA and methotrexate in disease clearance time in plaque type psoriasis.

OBJECTIVE: To document the efficacy of concomitant use of PUVA and methotrexate in disease clearance time in plaque type psoriasis. METHOD: Sixty male patients between 18 to 50 years of age suffering from plaque type of psoriasis with PASI score more than 10 were enrolled in the study between March 2001 to November 2001. They were divided into three groups of 20 patients each. Group A received only PUVA, Group B received only Methotrexate and group C received both PUVA and Methotrexate concomitantly. PUVA was given four times a week according to11011 schedule. The end point for clearance of psoriasis was taken as 75% reduction in PASI score from the baseline. RESULTS: Group A: The minimum number of PUVA sessions needed for clearance was 20 and the maximum number was 25 (mean - 22.5). The mean clearance time was 5.5 weeks. The cumulative dose of UVA radiation ranged from 150-250 J/cm2 (mean -200 J/cm2). Group B: The time required for clearance was 7 weeks at the minimum and 9 weeks at the maximum (mean - 8 weeks). Group C: The minimum number of PUVA sessions needed for clearance was 8 and maximum was 12 (mean 10). The mean time for clearance was 2.5 weeks. The cumulative dose of UVA radiation ranged from 56-108 J/cm2 (mean-82 J/cm2). No significant side effects were seen in the three treatment groups. CONCLUSION: The results suggest that combination of PUVA and methotrexate is an effective and safe modality for clearance of psoriasis.