A Woman with Leonine Facies and Monoclonal Gammopathy

A 32-year-old woman presented to the dermatology clinic with a three-year history of progressive skin thickening. On examination, skin of glabella was thickened with longitudinal furrows, resulting in leonine facies. Skin-colored to reddish-brown, firm, waxy, closely spaced papules partially coalescing to form sheets of induration with circular punched out areas of sparing in between, over face, neck, trunk, abdomen, arms and thighs. She additionally complaint of tingling sensation and occasional pain over lateral side of hands. Punch biopsy obtained from a papule over the nape of neck revealed fibroblast proliferation with collagen and mucin deposition in upper and mid-reticular dermis.

General dermatology & dermatology in primary health care

A woman in her late 50s presented with rapidly progressing, painful nodulo-ulcerative lesions on bilateral forearms that ulcerated and bled within two weeks of onset. She reported low-grade fever, productive cough, epistaxis, myalgias, and bilateral mixed hearing loss. Investigations revealed microcytic hypochromic anemia, elevated erythrocyte sedimentation rate, hematuria, and lobulated opacities in the chest. A skin biopsy showed dermal neutrophilic infiltration, vessel destruction, and granulomas, with negative stains for tuberculosis and absence of fungal elements.

Dermatology journals from India: A critical appraisal of the journal metrics

Background Bibliometrics refer to documents and citation-based measures that measure different aspects of performance of a journal, including impact, output and prestige. Objective The aim of this study was to collect bibliometric data of various Indian dermatology journals as well as Indian journals from other disciplines, in order to compare relative performances. Methods Journal metrics pertaining to various Indian journals, both from dermatology [Indian Journal of Dermatology, Venereology and Leprology (IJDVL), Indian Journal of Dermatology (IJD), Indian Dermatology Online Journal, Indian Journal of Pediatric Dermatology and International Journal of Trichology] and other disciplines [Indian Journal of Medical Research (IJMR), Indian Journal of Pediatrics (IJP), Indian Journal of Ophthalmology and Indian Journal of Pharmacology] were sought. Data pertaining to the following 8 metrics during the year 2021 was collected: Journal Impact factor, SCImago Journal Rank, h5-index, Eigenfactor score and normalized Eigenfactor Score, Journal Citation Indicator, Scimago Journal and Country Rank H-index, CiteScore and Source Normalized Impact per Paper. Results Among Indian dermatology journals, for the year 2021, IJDVL had the highest impact factor (2.217) and h-index (48). IJD led in terms of prestige metrics such as SCImago Journal Rank (0.403), Eigenfactor score (0.00231) and Source Normalized Impact per Paper (1.132). IJDVL underperformed with respect to an average dermatology journal on all three prestige metrics. Among selected journals from other disciplines, two (IJMR and IJP) had impact factor exceeding five, despite lagging behind IJDVL two years ago. Most had normalized scores exceeding 1, indicating better performance than an average journal from their respective fields. Limitations Non-inclusion of altmetrics related data Conclusion IJDVL is one of the leading Indian journals in the field of dermatology, followed closely by IJD. A rise in IJDVL influence is evident over the past decade, as evident by various metrics. However, the progress still trails behind the average of global dermatology journals as evident by the field-normalized journal metrics, indicating potential for further growth of journal influence.

Increased prevalence of metabolic syndrome and non-alcoholic fatty liver disease in children with atopic dermatitis: A case-control study from northern India

BACKGROUND/OBJECTIVES

Atopic dermatitis (AD) is a chronic inflammatory skin disorder that affects children worldwide, with potential associations to metabolic syndrome (MetS) and non-alcoholic fatty liver disease (NAFLD). Limited research exists on the interplay between AD, MetS, and NAFLD in the pediatric population. This study aimed to investigate the prevalence and potential relationships among AD, MetS, and NAFLD in children.

METHODS

A case-control study design was employed, recruiting 50 children with AD (median age: 9.5 years) and 50 age- and sex-matched healthy controls (median age: 11.5 years, p = .051). Data on demographic characteristics, clinical features, disease severity, treatment history, anthropometric measurements, and laboratory evaluations were collected. MetS and NAFLD were diagnosed based on established criteria.

RESULTS

The prevalence of MetS was significantly higher in children with AD compared with controls (24% vs. 2%, p = .002). Significant differences for systolic blood pressure (p < .001), diastolic blood pressure (p = .012), and waist circumference (p = .040) were observed between AD patients and controls. Children with AD had higher triglyceride levels (p = .005). NAFLD was exclusively seen in moderate to severe AD cases (6% vs. 0%, p = .242). AD severity showed associations with increased body mass index (p = .020).

CONCLUSION

This study highlights the increased prevalence of MetS and the potential association with NAFLD in children with AD. The findings suggest that AD may contribute to the development of metabolic abnormalities at an early age. Further research is needed to elucidate the underlying mechanisms and explore preventive strategies for these interconnected conditions.

Tofacitinib in dermatology: a potential opportunity for topical applicability through novel drug-delivery systems

Tofacitinib is a first-generation JAK inhibitor approved by the US FDA for treating rheumatoid arthritis. It exhibits a broad-spectrum inhibitory effect with abilities to block JAK-STAT signalling. The primary objective of this review is to obtain knowledge about cutting-edge methods for effectively treating a variety of skin problems by including tofacitinib into formulations that are based on nanocarriers. The review also highlights clinical trials and offers an update on published clinical patents. Nanocarriers provide superior performance compared to conventional treatments in terms of efficacy, stability, drug bioavailability, target selectivity and sustained drug release. Current review has the potential to make significant contributions to the ongoing discussion involving dermatological treatments and the prospective impact of nanotechnology on transforming healthcare within this field.

Athena: Specialty Certificate Examination case for general dermatology

This Athena concerns a 45-year-old man who presented with a 1-year history of recurrent tense fluid-filled lesions over his forearms, hands, feet and face associated with scarring and pigmentary changes. He had a history of regular alcohol intake (&gt; 3 units daily). Lesion biopsy revealed a thick granular deposition of IgG along the basement membrane with thick homogeneous positivity of papillary dermal vessels for various immunoreactants (IgG, IgA, C3, IgM).

Mucocutaneous manifestations of chikungunya fever: an update

Chikungunya is a viral disease transmitted by female Aedes mosquitoes that has been increasingly reported in many parts of the world across the geographical borders. In addition to fever and joint pain, mucocutaneous manifestations of chikungunya have been reported in 40-75% of infected patients. Dermatological manifestations of chikungunya are often under-recognized and misdiagnosed as clinicians are not sensitized or educated regarding these. The early-onset cutaneous manifestations of chikungunya fever, occurring within 1 month of the fever, include maculopapular rashes, vesiculobullous eruptions, Steven-Johnson syndrome/toxic epidermal necrolysis-like eruptions, flagellate lesions, scrotal dermatitis, oro-genital ulcers, and exacerbation of preexisting dermatoses like psoriasis. Hyperpigmentation, lichenoid eruptions, diffuse hair fall, and exacerbation of acne usually occur as a late manifestation. Diagnosis of these mucocutaneous manifestations can be challenging as they often resemble other common dermatoses. This review article elaborates on various mucocutaneous manifestations of chikungunya fever, based on literature review and authors' clinical experience.

Differences among Indian and European pemphigus patients based on demographics, clinical parameters and propensity for relapse: results of a prospective bicontinental cohort study

Limited studies have explored pemphigus variations among different ethnic groups residing in their respective geographical locations. This bicontinental study aimed to compare clinical and immunological parameters in Indian and European pemphigus patients in complete remission, off therapy, or on minimal therapy. 105 patients (India, n= 75; Bulgaria, n=15; Greece, n=15) with pemphigus vulgaris (PV) or pemphigus foliaceous (PF) in complete remission on minimal therapy (n=64) or complete remission off therapy (n=41) were recruited. Demographic, clinical, and immunological parameters were compared. Indian patients were significantly younger, the maximal disease severity during the preceding active disease phase was significantly lower, and treatment duration until complete remission was significantly shorter, compared to European patients. European patients had significantly higher anti-Dsg3 serum levels and higher IgG positivity rate based on direct immunofluorescence microscopy at baseline. Furthermore, European patients revealed higher CD19, CD19+ CD27+ cell counts, compared with patients from India. Of note, none of the European patients (n=30) relapsed within the study period, in contrast to 29/75 (38.6%) Indian patients. Treatment strategies differed significantly between the two cohorts, with more frequent utilization of rituximab to achieve remission in the Indian cohort, while prednisolone was more widely used for maintaining remission in the European cohort. The observed heterogeneity of pemphigus among patients of different ethnicities in terms of demographics, clinical parameters, and propensity for relapse may be due to genetic background or different treatment strategies.

Aflibercept monotherapy versus aflibercept with targeted retinal laser to peripheral retinal ischemia for diabetic macular oedema (LADAMO)

OBJECTIVE

We tested the hypothesis that targeted retinal laser photocoagulation (TPRP) to peripheral retinal ischaemia reduces the overall burden of aflibercept injections when treating diabetic macular oedema (DMO) over a 24-month period.

METHODS

Prospective, double-masked, multicentre, randomised controlled trial in Australia comparing aflibercept monotherapy, following a treat-and-extend protocol, or combination therapy of aflibercept and TPRP for DMO. The aflibercept monotherapy group received placebo laser. The primary outcome measure was the mean number of intravitreal aflibercept injections for each group at 24 months. Secondary outcome included: mean change in central macular thickness (CMT) and vision at trial completion, the proportion of eyes whose DMO resolved and the mean injection treatment interval. Ocular and systemic adverse events were recorded.

RESULTS

We enrolled 48 eyes of 47 patients; 27 eyes were randomised to combination therapy (aflibercept and TPRP) and 21 to aflibercept monotherapy. Thirty-two eyes (67%) completed the 2-year study. The number of intravitreal treatments given were similar for combination therapy (10.5 (SD 5.8) and monotherapy (11.8 (SD5.6)) (P = 0.44). The mean visual improvement (+4.0 (-1.8, 9.8) and +7.8 (2.6, 12.9) letters, P = 0.32), mean decrease in CMT (-154 (-222,-87) µm and -152 (-218,-86) µm, P = 0.96), proportion of eyes with CMT < 300 µm (48% and 67%; P = 0.50) and safety outcomes were similar in both the combination and monotherapy treatment groups (respectively).

CONCLUSIONS

Laser to areas of ischaemic peripheral retina does not reduce the burden of intravitreal aflibercept injections when treating diabetic macular oedema.

Outcome of COVID-19 in patients with autoimmune bullous diseases

Background Data on outcomes of Coronavirus disease 2019 (COVID-19) infection in autoimmune bullous diseases (AIBDs) patients is scarce. Materials and methods This single-centre survey-based-observational study included patients registered in the AIBD clinic of the Postgraduate Institute of Medical Education and Research, Chandigarh, India. All registered patients were contacted over telephone between June and October 2021. A survey was conducted after obtaining informed consent. Results Among 1389 registered patients, 409 completed the survey. Two hundred and twenty-two (55.3%) patients were females and 187 (45.7%) were males. The mean age was 48.52 ± 14.98 years. Active disease was reported by 34% patients. The frequency of COVID-19 infection in responders was 12.2% (50/409), with a case-fatality ratio of 18% (9/50). Rituximab infusion after the onset of pandemic significantly increased the risk of COVID-19 infection. Active AIBD and concomitant comorbidities were significantly associated with COVID-19 related death. Limitation Relative risk of COVID-19 infection and complications among AIBD patients could not be estimated due to lack of control group. The incidence of COVID-19 in AIBD could not be determined due to lack of denominator (source population) data. Other limitations include telephonic nature of the survey and lack of COVID-19 strain identification. Conclusion Use of rituximab is associated with higher probability of COVID-19 infection, while advanced age, active disease and presence of comorbidities may increase the risk of COVID-19 mortality in AIBD patients.

Emerging role of topical Janus kinase inhibitors in dermatological disorders: a review

Janus kinase (JAK) refers to a family of tyrosine kinases that are involved in the production of proinflammatory mediators in response to various extracellular signals. The JAK-signal transducer and activator of transcription (STAT) pathway is an appealing target in many inflammatory illnesses as this pathway modulates immune cell activation and T-cell-mediated inflammation in response to several cytokines. The practical considerations of prescription for topical and oral JAK inhibitors (JAKis) in atopic dermatitis, vitiligo and psoriasis have been covered in prior publications. Currently, the US Food and Drug Administration has approved the topical JAKi ruxolitinib for atopic dermatitis and nonsegmental vitiligo. None of the remaining first- or second-generation topical JAKis have been approved for topical application in any dermatological indications so far. For this review, the PubMed database was searched using 'topical' and 'JAK inhibitor' or 'Janus kinase inhibitor' or the names of individual drug molecules as the keyword in the title with no date limits. The description of topical JAKi usage in dermatology from the literature was evaluated in each abstract. The current review concentrates on emphasizing the rising use of topical JAKis in both approved and off-label dermatological applications for both old and novel conditions.

Extramammary Paget's disease of vulva and metastatic adenocarcinoma: A rare conundrum

Extramammary Paget's disease (EMPD) is a rare intraepithelial adenocarcinoma. To increase awareness and knowledge regarding this rare dermatosis, we hereby reported a case of ulcerated plaque on genitalia.

Correlation of plasma levels of itraconazole with treatment response at 4 weeks in chronic dermatophytosis: Results of a randomised controlled trial

BACKGROUND

Itraconazole in varying doses and duration is being frequently used for the management of dermatophytosis. There is a scarcity of studies on the bioavailability of various itraconazole brands available in the market.

AIMS AND OBJECTIVES

The aim of this study was to determine the plasma concentration of itraconazole of various brands and its correlation with clinical efficacy in chronic dermatophytosis.

MATERIALS AND METHODS

One hundred patients with chronic dermatophytosis with age >18 years were studied at the outpatient clinic of our tertiary care hospital. Plasma itraconazole level was estimated on Week 2 and Week 4 after randomly dividing the patients into Groups A, B and C who received cap itraconazole 100 mg twice a day of innovator, multinational and local generic brands, respectively, for 4 weeks. Both efficacy (cure, partial cure or no cure), safety and recurrence were compared between the three groups.

RESULTS

At 4 weeks, number of patients classified as 'cured' were 10/26 (38.4%) in Group A, 5/22 in Group B (22.7%) and 3/21 (14.2%) in Group C (p = .002). Mycological cure rates at Week 4 in Groups A, B and C were 21 (80.8%), 17 (81.0%) and 5 (26.3%), respectively (p = .006). Plasma levels of itraconazole were comparable between the three groups at Week 2 and Week 4. No statistically significant correlation was found between itraconazole levels and treatment response in any of the groups at 4 weeks. Incidence of adverse effects and recurrence rates was also similar among the three groups.

CONCLUSION

Cure rates for chronic dermatophytosis were poor with all three itraconazole brands at 4 weeks of treatment. Higher cure rates were obtained with innovator drug as compared to multinational and local generic brands at 4 weeks. Plasma levels of the three drugs were however similar, indicating that factors other than serum bioavailability are at play in determining response of chronic dermatophyte infections to oral itraconazole.

Pyoderma gangrenosum-like ulcers or pyoderma gangrenosum associated with antineutrophil cytoplasmic antibody-associated vasculitis

We read with interest the report by Shakshouk et al. discussing cutaneous ulcers in setting of ANCA associated vasculitis (AAV). These ulcers were diagnosed as pyoderma gangrenosum (PG)-like ulcers, and authors aimed to differentiate these from classical PG. Characteristics of PG-like ulcers in association with AAV remain obscure, and differentiation from PG is not only challenging but perhaps also unnecessary.

Unusual clinical presentations in leprosy: a case series and review

Conventionally, leprosy has been divided into various spectra of presentation ranging from the tuberculoid to the lepromatous pole, as well as histoid, pure neuritic leprosy and reactional states. This however is an oversimplification as leprosy can present in unusual clinical forms that may obfuscate the diagnosis. Our objective was to highlight unusual clinical presentations of leprosy occurring across all spectra of the disease. Our case series describes eight uncommon presentations of leprosy seen over a period of 10 y from 2011 to 2021, wherein clinical diagnosis followed by a histopathological confirmation of leprosy was performed. These include rare presentations such as psoriasiform plaques, Lazarine leprosy, verrucous plaques and hypertrophic scarring. Many of these rare presentations remain hitherto unreported, such as primary hypogonadism and annular plaques mimicking erythema annulare centrifugum and erythema gyratum repens. Sarcoidosis and syphilis have been labeled as great mimickers in dermatology. The current case series and review is an attempt to highlight a multitude of unusual presentations of leprosy that need a separate mention to make a correct and timely diagnosis and prevent the debilitating sequelae of this otherwise treatable infectious disease.

Monkeypox: a new global health emergency with predominant dermatological manifestations

Monkeypox is a zoonotic virus belonging to the Orthopoxvirus genus. Previously endemic to Africa, outbreaks have been reported from all over the world, the largest of which is currently ongoing. Dermatologists are principally involved in recognition and diagnosis of the infection. This narrative review primarily focuses on clinical manifestations and highlights the unique epidemiological features of current outbreak. Lesions observed during the current outbreak lack the evolution described in endemic disease. Polymorphic lesions are common and may be confined to anogenital area. Onset of "prodromal" symptoms may coincide with onset of skin rash, and these may be altogether absent. Mortality rates observed are low. The exanthem should be differentiated from other infections such as herpes, molluscum contagiosum, smallpox, and other poxvirus infections. Presentation as an isolated genital lesion warrants differentiation from syphilis, chancroid, and other sexually transmitted diseases. Close intimate contact during sexual encounters is the primary mode of transmission, and other coexisting sexually transmitted infections are frequently diagnosed.

Biological treatment for erythrodermic psoriasis

INTRODUCTION

Erythrodermic psoriasis (EP) is an extreme and potentially life-threatening form of psoriasis in which most or all of the body surface area is affected by psoriasis. It occurs in 1-2% of patients with psoriasis and is less responsive to conventional therapies. Biologics have shown promise in the management of EP.

AREAS COVERED

This review briefly discusses the pathophysiology of EP. Current evidence on established and emerging targeted therapies for EP is covered, including anti-TNF-α biologics, IL-12/23, IL-17, and IL-23 inhibitors.

EXPERT OPINION

The need for rapidly acting, safe, and efficacious agents in EP has been met with advent of newer biologics, particularly IL-17 and IL-23 inhibitors. These targeted approaches warrant consideration as first-line management option for the management of EP; however, high-quality evidence regarding their long-term efficacy and safety in EP is lacking. Novel biologics such as bimekizumab and mirikizumab, and nanobodies such as netakimab and sonelokimab have shown promise in the management of plaque psoriasis, and potential of these molecules in management of EP should be explored. Management of patients with prior biologic failure remains a challenge. Guidelines for the management of EP need to be revisited in light of the recent advances.

Clinical and laboratory parameters associated with treatment response to third-line therapies in chronic refractory urticaria: a real world study from northern India

BACKGROUND

Current guidelines recommend omalizumab and cyclosporine for management of chronic spontaneous urticaria (CSU) refractory to anti-histamines.

AIMS AND OBJECTIVES

Identification of clinico-epidemiological characteristics predictive of treatment response with both modalities which will aid therapy selection.

METHODS

Clinical records of CSU patients receiving omalizumab and cyclosporine from 01/05/2016 to 31/12/2020 were reviewed retrospectively. Patients with a minimum follow up duration of 4 months were included in the analysis. Treatment response was defined as >90% recorded reduction in Urticaria Activity Score-7 (UAS7) as compared to baseline four months after treatment initiation.

RESULTS

Records of 1364 CSU patients were reviewed. Fifty-six patients who received omalizumab and 132 patients who received cyclosporine fulfilled the inclusion criteria. Treatment response was observed in 46/56 (82.1%) patients in omalizumab cohort and 106/132 (80.3%) patients in cyclosporine cohort (P=0.76). Factors significantly associated with response to omalizumab included high baseline serum Ig E levels (P=0.028), lesser disease duration (P=0.001) and absence of prior immunosuppressant use (P=0.024). Factors predictive of cyclosporine response included high baseline UAS7 (P=0.048), low baseline Ig E levels (P=0.047) and normal baseline D-dimer levels (P=0.027). Concomitant inducible urticaria, atopy and angioedema were associated with non-response in both groups (P≤0.05). Incidence of adverse events was slightly higher in cyclosporine group (28.7%) as compared to omalizumab group (19.5%) (P=0.19).

CONCLUSION

This study highlights several clinical parameters and laboratory markers that may be utilized to predict treatment response and aid in prognostication of patients with chronic spontaneous urticaria. This article is protected by copyright. All rights reserved.

Candidiasis presenting as pseudocircinate balanitis in a preschooler

Candidal balanitis typically affects sexually active adult males and may present as eroded papules, pustules, whitish discharge or erythema with dry glazed appearance. We report an unusual presentation of this common infection in an uncommon demographic, candidal balanitis presenting as coalescent vesicles and erosions arranged in an arcuate pattern in a pre-school child.

Evolving utility of apremilast in dermatological disorders as off label indication

Apremilast, a small molecule that acts by inhibition of phosphodiesterase-4 enzyme, has been approved by FDA for the management of psoriatic arthritis, plaque psoriasis and Behçet's disease. The drug has drawn much interest from the practicing dermatologists in view of the exceptional safety profile and prescription convenience as evident by the recent surge in literature for its off-label indications. This review was carried out with the aim of summarizing literature on off-label use of apremilast in dermatology in order to guide clinicians regarding currently available evidence. The PubMed database was searched using 'apremilast' as keyword in title. Abstracts were individually screened to determine whether there was a description of an off-label use of apremilast in dermatology within the article. Randomized controlled trial data was available for vitiligo, alopecia areata, hidradenitis suppurativa and atopic dermatitis. Case series and case reports describing apremilast were also reviewed. Due to the broad spectrum of immunomodulatory activity, apremilast may be useful in several chronic inflammatory skin diseases recalcitrant to conventional therapies, either alone or in combination with other drugs. Further studies are needed to establish its role in various dermatological indications.

Distribution of soil carbon fractions under different bamboo species in northwest Himalayan foothills, India

Soil carbon and its fractions are important in understanding the mechanism of soil carbon sequestration. The present study evaluated the impact of seven commercial bamboo species, viz., Bambusa balcooa, B. bambos, B. vulgaris, B. nutans, Dendrocalamus hamiltonii, D. stocksii, and D. strictus, on labile and non-labile carbon fractions. In the 0-15-cm layer, B. nutans had the highest very labile C (7.65 g kg^-1) followed by B. vulgaris > B. balcooa > D. stocksii > D. hamiltonii > B. bambos > D. strictus > open. The active carbon pool was significantly low under the control plot (i.e. the open) indicating the positive influence of bamboo in soil C build-up in the top 0-15 cm soil layer. Amongst the different species of bamboo evaluated in this study, D. strictus accumulated the highest active C pool in 0-30-cm soil layer followed by B. vulgaris. Of the total organic C in the 0-30 cm soil depth, majority (55-60%) was contributed by the passive C pool comprising the less labile and the non-labile fraction of SOC. A high value of carbon stratification ratio (> 2) was observed for D. strictus, B. bambos, and D. hamiltonii which proves their potential for restoration of the degraded lands. The majority of bamboo species except for B. balcooa and D. stocksii showed a higher carbon management index than open systems, thereby indicating higher rates of soil C rehabilitation. Of the seven bamboo species, B. vulgaris, D. strictus, and B. nutans can be adopted for cultivation in the northwest Himalayas given their ability to positively impact the SOC and its fractions in both surface and sub-surface soil.

Effect of lockdown due to COVID-19 on health and lifestyle of psoriasis patients: A web-based survey

Background:

Chronic skin diseases like psoriasis affect a patient’s physical, psychological, and social functioning as well as well-being, and the lockdown acted as a cofactor in further worsening the quality of life in psoriasis patients.

Objective:

The objective of the study is to assess the effect of lockdown on the health, lifestyle, and mental well-being of psoriasis patients.

Methods:

A cross-sectional study was done using an online questionnaire shared through messenger applications to the patients of chronic plaque psoriasis who registered in the psoriasis clinic between August 2020 and December 2020. Data regarding demographics, psoriasis, lifestyle changes, mental status, financial loss, and problems faced during lockdown were collected.

Results:

Our study included 181 completed questionnaires. The mean age was 37.7 (SD 13.9) years, and 124 (68.5%) were males. Sixty-five (35.9%) patients reported worsening of their psoriasis during the lockdown. Ordinal regression analysis revealed male sex had a higher proportion of worsening of psoriasis (OR 2.56, 95% CI 1.29–5.08, P < 0.007). Duration of illness <6 months (OR 0.14, 95% CI 0.02–0.98, P < 0.04) and feeling relaxed (OR 0.14, 95% CI 0.03–0.56, P < 0.005) were negatively associated with disease worsening.

Conclusion:

The findings of our study reveal the impact of coronavirus disease 2019 (COVID-19) lockdown on the life of people with psoriasis. A substantial number of patients had a flare of psoriasis during the lockdown. A shorter duration of illness and relaxed mental status was negatively associated with disease worsening. Individuals with financial loss felt anxious or depressed.