Psoriasis is a skin disease that is evidenced primarily by plaques which can be seen throughout the body. Genetic predisposition that combines with an environmental trigger of the immune system is believed to be the root cause of psoriasis. This leads to signaling factors which coordinate the progression of inflammation and psoriatic plaques. Psoriatic patients commonly use topical agents, phototherapy, and systemic agents; however, biological therapies have become increasingly popular. This is primarily due to recent advances in the study of psoriasis which have shown that monoclonal antibodies and dimeric fusion proteins inhibit key signaling molecules within the inflammatory cascade such as TNFa, IL-12 and IL-23. This article reviews the advances made to understand the role of TNFain the progression of psoriasis, discusses treatment options such as topical agents, phototherapy and systemic agents, and then compares a variety of monoclonal antibodies and dimeric fusion proteins as biological therapies.

A 4 month year-old boy presented with a 5 day history of an erythematous exudative lesion on the lateral aspect of the face, neck and thorax. He had been observed by his physician and a topical fusidic acid ointment had been applied without success. His prior medical history was remarkable for an atopic dermatitis. On physical examination the patient had fever of 38.6ºC. An exudative erythematous lesion with multiple grouped peripheral umbilicated vesiculopustules and punched-out ulcers were observed on the face, neck and thorax (Figure 1). He hadn´t received vaccination in the prior 2 months. The laboratory showed no abnormalities except for an erythrocyte sedimentation rate of 19 mm/hr. A Tzanck test showed acantholytic balloon cells. A diagnosis of eczema herpeticum was made.

A 20 years-old-man, a native Indian of low socio-economic reckoning, had come to clinic with the complaints of severe nocturnal itching of the genitals for the past one month. A similar complaint was registered by other members of the household. The early diagnosis of the condition seemed to have been overlooked, because of conspicuous sparing of the usual sites namely the anterior axillary folds, elbows, wrists, webs of the fingers and around the umbilicus of the abdomen. Skin surface examination of the genitals, however, was remarkable, because it was studded by nodules of the size varying from 0.5 to 1cm. They were numerous (Figure 1a). Burrows were interspersed amongst them, and had miscellaneous configuration, harbouring Sarcoptes scabiei (Figure 1b). The imperative of its demonstration are emphasized to confirm the diagnosis.

The congenital melanocytic nevus is a type of melanocytic nevus found in infants at birth. This type of birthmark occurs in an estimated 1% of infants worldwide. It may be divided into the Small, mediumsize congenital nevocytic nevus and giant congenital melanocytic nevus also known as “Bathing trunk nevus,”. We report a case in a 42-year-old woman.

Multiple auto-immune syndrome is defined by the coexistence of at least three different autoimmune diseases. Immune genetic predisposition and abnormalities of humeral and cell-mediated immunity seems to be implicated in their genesis. In this observation, we describe a combination of three autoimmune diseases in the same patient namely vitiligo evolving since childhood, autoimmune dermo epidermal bullous dermatosis and autoimmune thrombocytopenia. The discovery of such associations may limit the therapeutic arsenal. And temporal sequence indicates that long-term surveillance of these patients is necessary to watch the occurrence of another autoimmune disease.