INTRODUCTIONVitiligo is a common depigmenting skin disorder characterized by acquired, idiopathic, progressive, circumscribed hypomelanosis of the skin and hair. It occurs worldwide, with an incidence of 0.5% to 2.0%. 1 Vitiligo is disfiguring in all races but particularly more so in dark skinned people because of strong contrast.2 Vitiligo may entail significant psychosocial consequences. Vitiligo is a social stigma and is associated with a decreased quality of life, especially when lesions are located over the face; thus, it may affect the quality of social and personal life depending on the patient's perception. 3In India and perhaps elsewhere also men, women and children with vitiligo face severe psychological and social problems. Many vitiligo patients felt distressed and . Vitiligo patients presented with symptoms of pain, irritation and itching (P<0.0001). Vitiligo patients when assessed for feeling domain were significantly embarrassed for their overall look and appearance. (P < 0.0001). When Personal relationship domain was analysed physical contact was a major concern (P <0.002). Patients suffering from Vitiligo were significantly worried about spread of vitiligo and occurrence of cancer (P<0.0001). Therapy for Vitiligo was time consuming time and was a work place challenge for the patients (P <0.0001). The reliability of VQLQ in our study was Cronbach's α coefficient was 0.876. Conclusions: QoL impairment was relatively high in vitiligo patients. Medical intervention and counselling should focus to improve feelings, personal relationship, anxiety, school/work, leisure and symptom domains.

Drug Therapeutic failure is a rare condition which is underreported in recent scenario. It is important for the chronic diseases like Hypertension where it could lead to fatal outcome. In our case report elderly male patient taking tablet Amlodipine once daily as antihypertensive medication and had 2 years without any events. Patient came to the emergency department with the complaint of altered sensorium and elevated blood pressure. The mechanism for sudden increase in blood pressure (Decreased Therapeutic Response) in patient with ongoing treatment with amlodipine could be due to sympathetic over activity (e.g. stress), pharmacokinetic variation or counterfeit drug.