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Our first patient was a 42-year-old healthy Chinese man with moderately severe psoriasis, not adequately controlled with potent topical steroids and vitamin D analogs. His pre-immunosuppressant work-up was normal. He was prescribed methotrexate prior to switching to cyclosporine with an initial dose of 200 mg daily (2.44 mg/kg/day). His urinalysis was normal 2 months after initiating cyclosporine. After 18 months of cyclosporine therapy, his urinalysis revealed glycosuria (300 mg/dL), even though his fasting serum glucose was 5.2 mmol/L (normal) and there was no indication of any urinary tract infection (UTI). This occurred at a dose of 100 mg every 2 days (0.610 mg/kg/day). The glycosuria resolved on the next check, and he was shifted to adalimumab.

Proficiency in dermatopathology is important for comprehending the mechanisms of skin diseases and determining efficacious clinical management. Dermatopathology learning is a core requirement for both dermatology and pathology residencies. Many traditional educational methods have been utilized over decades for teaching our residents. In the recent digitized era, technological advances are impacting the study and practice of medicine. Several innovative tools have become available that complement the conventional learning model. This contribution provides guidelines for establishing a robust dermatopathology rotation for residents and insights into the present and future advances in novel educational tools. Dermatopathology is an ever-growing body of knowledge. It takes years to accumulate practical knowledge of this discipline and requires a continuing effort to maintain and keep it updated. This journey of learning starts during the early years of postgraduate medical education. Attaining competency in dermatopathology is vital for both dermatology and pathology residents. The earlier the exposure they receive, the better the foundation and understanding of cutaneous disease processes they develop. Comprehensive training in the subspecialty of dermatopathology is critical for their medical education and the future practice.

A 79-year-old woman with psoriasis presented to the emergency department with new-onset eruptions on the trunk, extremities, and oral mucosa for 8-9 days. For psoriasis, she had been taking 15 mg of methotrexate weekly for over 18 years, and had discontinued folic acid a few months prior to this.

64-year-old woman with a history of esophageal strictures presented in 2015 for evaluation of progressive depigmented patches that developed over the preceding year. She was prescribed topical steroids with no improvement. Narrow-band ultraviolet B (NB-UVB) and topical tacrolimus were eventually added to the topical steroids accompanying an oral steroid taper. The patient discontinued topical tacrolimus because of irritation. The patient was lost to follow-up for the next 3 years, during which she did not take any treatment and her vitiligo had worsened (Figure 1). At her visit 3 years later, she repeated an oral prednisone taper and restarted mid-potency topical steroid. In January 2020, the patient was approved for and started oral tofacitinib 5 mg twice daily. Consistent improvement was observed on the subsequent visits in March 2020 and November 2020. The only adverse reaction reported by the patient was an increase in furuncles on her pelvis and thighs.

Genodermatoses are inherited skin disorders associated with manifestations pertaining to both cutaneous and systemic involvement. Most of these disorders are associated with systemic conditions leading to mortality and morbidity. Only few studies have been reported from India. Since there is predominance of consanguineous marriage in northern part of India, very rare disorders are seen but have been under-reported. The present study was done to evaluate the different types of genodermatoses present in population of Kashmir valley, India. The study included total 154 cases of genodermatoses seen over a period of 3 years. Prevalence of genodermatoses was 0.96 per 1000 new OPD cases. Male to female ratio was 1.26:1. Age ranged from 2 days to 56 years with Median age of 7 years. The disorders of keratinisation constituted major group with 67 (42.4%) cases. Mechano-bullous disorder was second most common group seen. Consanguinity in parents was found in 83 (53.8%) of cases while 71 (46.1%) had non-consanguineous marriage in parents. Positive family history was noted in 61 (39.6%) number of cases while as 93 (60.3%) had no positive family history. Recessively inherited disorders were more than dominantly inherited disorders. Predominant or only cutaneous manifestations were seen in 124 (80.5%) cases while 30 (19.4%) patients had extracutaneous associations. In conclusion, a wide spectrum of disorders were seen in our study. Though consanguinity attributes to the presence of recessively inherited disorders but dominant disorders are seen in significant proportion. In absence of genetic testing, proper history and clinical evaluation help in establishment of diagnosis and mode of inheritance in majority of cases.