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BACKGROUND: Bullous pemphigoid is a blistering skin disorder with increased mortality. We tested whether a strategy of starting treatment with doxycycline gives acceptable short-term blister control while conferring long-term safety advantages over starting treatment with oral corticosteroids. METHODS: We did a pragmatic, multicentre, parallel-group randomised controlled trial of adults with bullous pemphigoid (three or more blisters at two or more sites and linear basement membrane IgG or C3). Participants were randomly assigned to doxycycline (200 mg per day) or prednisolone (0·5 mg/kg per day) using random permuted blocks of randomly varying size, and stratified by baseline severity (3-9, 10-30, and >30 blisters for mild, moderate, and severe disease, respectively). Localised adjuvant potent topical corticosteroids (

Field cancerization was first described in 1953 as histologically altered mucosa surrounding tumours removed from the upper gastro-intestinal tract. Over the years the definition has changed to include an area which is clinically occult but has multifocal preneoplastic changes, showing genetic mutations and which precedes the development of second primary tumours and local recurrences. Field cancerization has been described in the oropharynx, oesophagus, stomach, lung, colon, anus, cervix, bladder and skin. Various molecular techniques have been developed to look for genetic mutations and clonality in areas of field change. These studies have highlighted the need for early detection and treatment in order to prevent the development of tumours and local recurrences. In this article we examine the concept of field cancerization and treatments available to manage field change.

Clinical profile of 105 patients with cutaneous drug eruption due to antiepileptic drugs was studied between 1992-1996. Maculopapular rash was the most common presentation though significant number of patients (29.5%) had serious rashes like Stevens Johnson syndrome (SJS) and toxic epidermal necrosis (TEN). Phenytoin and carbamazepine were the two commonly implicated drugs. Significant number of our patients had liver and kidney involvement (47.34 and 21.04%, respectively). The overall prevalence of drug rash with antiepileptics in a review of 240 cases was found to be 2.5%. Patch testing with antiepileptic drugs done in 20 patients gave 60% positive results with the suspected drug. Thus patch test is a useful tool in confirming the diagnosis of drug rashes and warrants further studies.