Apremilast is an oral phosphodiesterase 4 inhibitor, now approved by the Food and Drug Administration in the management of psoriatic arthropathy (PsA). As biologic therapy is associated with significant amounts of adverse effects, newer treatment options with an efficacious outcome, sans the toxicity, is something all clinicians would implement readily in their therapeutic regimens. Apremilast is one such drug which has shown promise in the management of psoriasis, PsA, and a few other dermatologic disorders. This review will throw light on the dermatologic perspective regarding apremilast.

Background: Methotrexate (MTX) has been used for the treatment of severe psoriasis for more than 50 years. MTX use can be associated with many side effects, and folic acid is supplemented to reduce these side effects. MTX can be given orally or parenterally. Materials and Methods: In this study, a total of 81 patients of severe psoriasis were given 15 mg/week of MTX orally, and side effects were noted at each visit. Results: A total of 36 patients developed side effects, of which ten patients were discontinued due to the development of serious side effects. Remaining 26 patients developing nonserious side effects were given folic acid 5mg/day on non-MTX days and continued with 15 mg/week of MTX therapy. They were further evaluated for any improvement in side effects. Folic acid supplementation was associated with improvement in gastrointestinal and mucosal side effects in 17 out of 26 patients. Conclusion: Therapeutic effects were not compromised in all these patients after initiation of folic acid therapy. We recommend the supplementation of folic acid 5 mg/day in all patients of psoriasis who are receiving 15 mg/week of MTX therapy.

Introduction: Although rarely described in the Western literature, childhood lichen planus (LP) is noticed much more frequently in the Indian subcontinent. Oral and potent topical corticosteroids commonly used for the treatment of childhood LP can result in significant side effects. Methods: In a open non-randomized follow up study of 49 children, various treatment modalities were tried based on inclusion exclusion criteria. Results: A total of 49 children had generalized or localized LP, of which 5 patients did not complete prescribed therapy. Out of 25 patients who were started with oral dapsone, a total of 20 patients completed therapy. These patients showed a significant improvement showing relief from itching associated with flattening of lesions. Complete response was seen in three-fourth of metronidazole-treated patients by 20 weeks. Remaining 11 patients who were treated oral, topical, or intralesional therapy also showed improvement as predicted. Dapsone and metronidazole therapy did not result in any side effects in this study. Conclusion: Dapsone can be utilized as an effective steroid-sparing agent in the treatment of childhood LP.

Acitretin has been commonly used in the treatment of keratinization disorders due to its anti-inflammatory and anti-proliferative properties. ILVEN is a rare form of epidermal nevus with an early age of onset usually presenting as a localized itchy linear plaque resistant to treatment. The treatment of ILVEN aims at providing symptomatic and cosmetic improvement. We present two cases of ILVEN with solitary lesions treated with acitretin, with both patients showing remarkable reduction of the lesions with long term remission.

Hailey-Hailey disease, also known as familial chronic benign pemphigus, is characterized by flaccid blisters and erosions, especially in the axillary and inguinal areas. Friction associated with local factors such as heat, moisture, microbial colonization, and secondary infections induce the typical appearance of the lesions, especially in intertriginous areas. Traditionally, the treatment is done with corticosteroids associated with topical or systemic antibiotics. We report the case of a patient with the disease presenting in the inguinal region, which has made use of different conventional drug treatments for 20 years without results. Treatment with application of botulinum toxin type A showed a significant improvement after about 20 days. The satisfactory response has been linked to decreased local sweating caused by botulinum toxin. which would lead to a less local irritation factors and lower colonization of microrganisms.

Nicolau syndrome, also known as embolia cutis medicamentosa or livedoid dermatitis, is a rare cutaneous adverse drug reaction seen at the site of injection of some particular drugs. It was first reported by Freudenthal in 1924 and Nicolau in 1925 as an adverse effect of bismuth salts used in syphilis. Typically, this syndrome is clinically manifested by intense burning or stabbing pain at the site of injection and retiform hemorrhagic patches with or without vesiculations and ulceration with a variable degree of tissue necrosis. To the best of our knowledge, <50 cases of Nicolau syndrome have been reported in medical literature which occurred following intramuscular administration of diclofenac sodium. Here, we report a 26-year-old female typically presenting with pathognomic signs and symptoms of NS after taking intramuscular injection of diclofenac.

Sorafenib is a tyrosine kinase inhibitor approved for the treatment of primary kidney cancer, advanced primary hepatocellular carcinoma and radioactive iodine-resistant advanced thyroid carcinoma. Sorafenib is known to cause milder cutaneous side effects such as maculopapular rash and serious cutaneous drug reactions such as desquamation of the skin, hand-foot syndrome Stevens-Johnsons syndrome and toxic epidermal necrolysis. We report a histopathologicaly proved case of pemphigus vulgaris caused by sorafenib.