Methotrexate is one of the most widely used drugs in the systemic management of psoriasis. Though the drug has been in used for over 40 years, the mechanisms of its action are still ill understood. Designed originally as an anti-proliferative agent, the therapeutic usefulness of methotraxate in psoriasis is now believed to be the result of its anti-inflammatory effects.

Fifty five patients of extensive psoriasis were treated with oral weekly methotrexate. All patients responded promptly to methotrexate therapy. Relapse was observed after variable periods following stoppage of methotrexate. Safety, efficacy, maintenance dose, relapse and long term effects of methotrexate in psorasis are discussed.

Vitiligo is an acquired, progressive pigmentary disorder of the skin and hair, which is clinically divided into segmental and non-segmental types. Segmental vitiligo is said to have an early and rapid onset and is associated with a better prognosis as disease activity ceases early compared to the non-segmental type. We have analysed the clinical features of 100 patients of segmental vitiligo seen by use at our pigmentary clinic. The findings in our series are at variance from those reported earlier. Our cases of segmental vitiligo formed a lower proportion of the total vitiligo cases, showed an earlier age of onset, multiplicity of lesions. Progressive nature and comparatively lower incidence of poliosis.

Forty patients comprising of 20 males and 20 females suffering from dermatophytosis for more than one year and who were not on any topical or systemic medication 3 months prior to the institution of therapy, were divided into 4 groups, each comprising of 5 males and 5 females, were given oral griseofulvin 250 mg twice daily for 8 weeks for group A, oral ketoconzole 200mg daily for group B, oral fluconazole 150 mg twice weekly for group C and oral itraconazole and fluconazole were most effective drugs. Griseofulvin and itraconazole were found less effective. All the four drugs did not give rise to any side effect.

A study on 400 patients of leprosy comprising of 188 patients of tuberculoid leprosy, was carried out to assess the type and extent of uveal involvement. Possible reasons of uveal involvement in tuberculoid leprosy have been reviewed. Importance of further studies including histopathology has been stressed.

A middle aged female with black piedra of the scalp hair is reported. She presented with hair loss and multiple nodules on her scalp hair. Diagnosis was confirmed by potassium hydroxide examination of the nodules and fungal culture,

A six year old female child presented with indolent nontender swellings on both buttocks and loins, was provided by histropathological and mycological examinations, to be suffering from subcutaneous zygomycosis. Being intolerant to potassium iodide, she was put on and responded to ketoconazote therapy.

A 30 year old male with a history of avulsion injury of scalp presented with discharging sinuses one year after wound repair. Patients was admitted in Neuro-Sugery unit. Subsequently microscopic grains were detected from the sinuses and N. Asteroides was grown in culture. Patient was treated with contrimoxazole. One year follow up showed clinical recovery.

A 23 year old male presented with psoriasiform dermatitis of one month duration in April 1999 and was found to be HIV seropositive. He was managed with PUVA therapy. His cutaneous lesions improved but no improvement in arthritis and in nail changes occurred. Patient discontinued the therapy and presented with relapse in July 1999 with a different clinical picture, now suggestive of Reiter’s syndrome. He had keratoderma blenorrhagica and severe deforming arthritis. Such a case presents with difficulties in arriving at the diagnosis in the HIV era and allows limited therapeutic options for management.

A 42 year old male having airborne allergic contact dermatitis suddenly developed high grade fever, chills and prostation on 7th day of admission. Two days later he developed generalized papulovescles which became haemorrhagic and crusted within one to two days. These lesions later evolved into grouped erosions. Simultaneously, he developed swelling of the face and generalized lymphadenopathy. Tzanck smear demonstrated giant cell and the patients was diagnosed as having kaposis’s varicelliform eruption. He responded to oral acycolvir. The case is reported for its rarity.

x Marking nut is a known potent irritant. A part form its most common use by washerment as a black “ink� for marking clothes, it has been put to many indigenous uses in the villages of India. Here is a report of an ill-advised young girl who used its black juice as hair-dye and suffered from a sever irritant reaction. Use of marking nut, as a hair dye is probably unheard of.

One 55 year old army officer had all 3 variants of acane rosacea occurring simultaneously for 9 years. Associated rare, serious complications as prominent rosacea keratitis, deterioration of vision, rhinophyma and lymphoedema were seen. We are reporting the present case as the above combination is rare.

A patient with nodular swelling over scalp in presented. The histopathology of the lesion is consistent with angiolymphoid hyperplasia with eosinophilia. The subtle differences form Kimura’s diseases are discussed.

Wegen’s granulomatosis is characterized by necortising granulomatous inflammation and vasculitis affecting predominantly small arteries and veins. In its generalized from there is involvement of upper and lower respiratory tract, kidney and often other organs including skin. It may also present as limited organ involvement. A case of Wegener’s granuolmatosis limited to skin is reported

An 11 year old girl had extensive port-wine stain affecting here trunk and limbs bilaterally and persistent Mongolian spots on her trunk and buttocks since birth. Combination of such congenital cutaneous vascular and pigmentary anomalies is known as phakomatosis pigmentovascularis (PPV) and we report the first such case form Nepal.

A case of multiple leiomyoma cutis in a woman is presented. This patient had multiple tender nodules on the face and back. The histopathology was consistent with the clinical diagnosis of leionyoma cutis. Differential diagnosis of painful tumours of the skin is also discussed.