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<p align="left">We describe two cases of low dose methotrexate (MTX) toxicity in patients with psoriasis. Patient was a 49-year-old male, known case of chronic plaque psoriasis from 10 years on and off. He was advised to take MTX 2.5 mg 2 days a week but patient took 2.5 mg twice daily (BD) for 6 continuous days following which he developed ulceration over psoriatic plaques and bone marrow suppression. MTX is safe and effective if adhered to standard treatment guidelines but inadverent use may lead to it’s toxicity.</p>

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Aplasia cutis congenita (ACC) is a rare condition in which there is congenital focal absence of skin with or without absence of underlying structures such as bone. Consanguinity may play a role. The cause of this condition is unclear and appears to be multifactorial; contributory factors may include teratogens, genes, trauma and compromised blood flow to the skin. Various expressions of Adams Oliver syndrome (AOS) have also been reported which is a rare autosomal dominant congenital disorder characterized by absence of skin and or underlying structure over scalp along with transverse limb defect. It was first described by Adam and Oliver in 1945.

INTRODUCTIONAdverse drug reactions (ADRs) are unexpected or dangerous reaction to a drug and are a major clinical problem in terms of human suffering. Adverse cutaneous drug reactions (ACDRs) are the most common ADRs (30-45%) and are responsible for about 2% of hospital admissions. 1 ACDR occur with variable severity. A few can result in significant morbidity, health care costs, hospitalization, and death. The mortality rate in toxic epidermal necrolysis (TEN) can be high. 2The incidence of ACDRs among in-patients in developed countries and in developing countries such as India is 1-3% and 2-5% respectively. 1,3 Incidence among outpatients is 2-6%. 2 ACDRs are responsible for approximately 3% of all disabling injuries during hospitalization. The incidence of acute cutaneous drug reactions among all drug reactions is between 24-29%. The Incidence of drug eruptions in our country varies between 6 to 30 % and about 8% hospital admissions are due to drug eruptions. 4 The large majority of cases were in the age group of 21-40 years with female preponderance. 1 ABSTRACT Background: Adverse cutaneous drug reactions (ACDR) are the most frequent ADRs (30-45%) and are responsible for about 2% of hospital admissions and few can result in significant morbidity, health care costs, hospitalization, and death. To study different clinical patterns of ACDR, assess the cause and identify the offending drug and to study the relationship of ACDRs to age and sex among patients referred to the department of DVL, NRI General Hospital. Methods: This is a retrospective study of 70 cases of colorectal carcinoma analysing incidence, clinicopathological features and outcome after different therapies including surgery, radiotherapy and chemotherapy. It was a descriptive hospital-based case series study. All out-patients and in-patients referred to the department of DVL, NRIGH, Chinakakani and in whom a diagnosis of ACDR is made, form the subjects for this study. The study was conducted over a period of two years. Results: 100 patients with adverse cutaneous drug reactions were included in the study. 42 (42%) were males and 58 (58%) were females. The age group ranged from 6 to 80 years with a maximum (43) belonging to 21 to 40 years. Maculopapular rash was most common followed by urticarial drug reaction, FDE, acneiform eruptions, EMF, erythroderma, DRESS, SJS, SJS/TEN, TEN and drug-induced hyperpigmentation. NSAIDs were the commonest culprits followed by antibiotics, antiepileptics and ATT. Conclusions: The commonest ACDR was maculopapular rash followed by urticaria, FDE and acneiform eruption. Antimicrobials as a group were the most common offending agents followed by individual drugs like diclofenac (13%), isoniazid (11%), efavirenz (9) and prednisolone (8%).