Melasma is a common acquired, chronic hyperpigmentation most commonly occurring over face. Although benign in nature, it causes significant cosmetic deformity leading to great impact on quality of life and social as well as emotional well-being. Autologous platelet-rich plasma (PRP) in pigmentary disorder is a

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IntroductionOverlap syndromes include a heterogenous group of conditions presenting with mixed features of more than one autoimmune disorder simultaneously in the same patient. Systemic lupus erythematosus (SLE) with myositis overlap is a rare scenario, particularly in the pediatric age group.Case DetailsWe describe an adolescent girl presented with photosensitivity, cutaneous ulcers, alopecia, periorbital edema, proximal muscle weakness, and digital gangrene. She was diagnosed as SLE‐juvenile dermatomyositis (DM) overlap based on overlapping clinical features, laboratory markers like anemia, significant proteinuria, hypocomplementemia, raised muscle enzymes, and positivity for antinuclear antibody, dsDNA, and anti‐Ro/anti‐SSA. Prompt treatment with combination of methylprednisolone‐cyclophosphamide pulse led to marked improvement.ConclusionOverlap syndromes are challenging in terms of diagnosis and management with unpredictable outcomes and unclear treatment guidelines.

Introduction: Methotrexate is an antifolate agent commonly used in various dermatological and rheumatological diseases such as psoriasis, systemic lupus erythematosus, and other connective tissue disorders. Acute toxicity manifesting as mucocutaneous ulcerations is a rare event in 3 - 10% of patients. Normal dosing commonly used for dermatologic and rheumatologic diseases is 15 - 25 mg/week. The main culprit leading to toxicity is the overdose of medication. Nausea, leukopenia, infections, gastrointestinal bleeding, renal impairment, etc. are the common manifestations of methotrexate toxicity. Mucocutaneous ulcerations, though infrequent, can appear as early as 3 - 7 days following methotrexate administration. Thus, it can be the imminent sign of methotrexate toxicity, providing a clue to its timely diagnosis. The crucial steps in the management of methotrexate toxicity are withdrawal of medication, immediate administration of leucovorin which is the biologically active form of folic acid, adequate hydration for increasing renal clearance, and urinary alkalinization with sodium bicarbonate, wherever necessary. Case Presentation: Here, we report an accidental methotrexate overdose in a patient with psoriasis, presenting with extensive mucocutaneous ulceration mimicking autoimmune vesiculobullous disorder and Stevens-Johnson syndrome- toxic epidermal necrolysis, leading to an extremely rare and challenging scenario. Conclusions: This case report emphasizes that careful history and evaluation of medical records facilitate early diagnosis and prompt management, which is critical to improving outcomes and patient’s survival.

Pemphigus vulgaris is an autoimmune blistering disorder commonly involving oral mucosa and skin with characteristic acantholysis that results in formation of fluid filled blisters and painful erosions. Herein we report a case distinguished by its unusual clinical presentation. A twenty-five year old man, presented to our outpatient department of dermatology, complaining of ulcer on forehead in the last one year. Examination revealed single ulcer covered with crust on right side of forehead. Clinically lupus vulgaris, pyoderma gangrenosum, recurrent herpes simplex, leishmaniasis and pemphigus vulgaris were kept as differential diagnosis. Tzanck smear revealed multiple acantholytic cells and mild neutrophilic inflammatory infiltrate. Histological examination of biopsy sample showed suprabasal clefting, acantholytic cells and mild perivascular dermal lymphocytic infiltrate. Features were suggestive of pemphigus vulgaris. Significant improvement occurred after three months of treatment with oral prednisolone, azathioprine and topical steroid. Although oral and skin involvement is common, in the form of flaccid blisters and erosions, but non healing ulcer is unusual. This may represent a period of limited activity during this chronic disease. There is paucity of data in literature regarding this. So, this case report highlights a, perhaps unique, clinical presentation of this autoimmune disease.