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Background Psoriasis is a chronic skin disease characterized by sharply demarcated, erythematous squamous lesions, with an estimated worldwide prevalence of 0 to 11.8%. Methotrexate (MTX) and cyclosporine (CsA) are well known systemic therapies for moderate to severe chronic plague psoriasis. Objective The aim of this study is compare the efficacy of methotrexate and cyclosporine in the treatment of Psoriasis. Methods A prospective randomized study was conducting at the Dhulikhel Hospital, KUTH, Dhulikhel during November 2008 to July 2009 with the objective to compare the effectiveness, side effects and cost of MTX and CsA treatment in a context reflecting normal clinical practice. Results A total of 64 patients (33 receiving MTX and 31 receiving CsA) were enrolled. These patients were followed every week for first month and their PASI score and side effects were recorded at 0, 1st, 2nd and 3rd month interval. In the study, the mean (± S.E) PASI score at base line was 23.34 ± 1.12 for MTX and 21.25 ± 1.07 for CsA group. After 12 weeks of treatment the mean ± S.E PASI score found to be 5.37 ± 0.42 for MTX and 4.56 ± 0.41 for CsA group. The difference in the response between the groups acquired statistically not significance (p=0.160 > 0.05) meaning there is no difference in the effectiveness of MTX and CsA. Conclusions The efficacy, side effects, ease of administration (once weekly vs. twice daily treatment) and cost, it seems that treatment of psoriasis patient with systemic therapy using MTX is preferable than CsA even though, both have similar clinical efficacy. Keywords Methotrexate; Cyclosporine; Psoriasis. DOI: http://dx.doi.org/10.3126/njdvl.v9i1.5763 NJDVL 2010; 9(1): 15-21

In the course of a study of the local effect of penicillin on chronic recurrent aphthous ulcers, a cheilitis was observed. The patient was a 61 year old white woman who had had recurrent ulcerations of the buccal mucosa, tongue and posterior wall of the pharynx for fifteen years. Periods of remission had lasted more than from two to two and a half weeks. Complete physical examinations, tests for allergy to foods and inhalants and all types of local and systemic therapies had been without help. There were no episodes of herpes simplex. The mouth was edentulous. Numerous painful shallow, sharply marginated reddish ulcers, with intense red collars, were scattered over the buccal mucosa, under the tongue, about the gums and on the hard palate. There was no atrophy or scarring visible. A smear of material from the early lesions showed staphylococci and streptococci. No bacilli or spirillas were