Nepal Journal of Dermatology, Venereology & Leprology

Book Review - Dermoscopy Atlas of Facial Melanoses

2022-10-18T06:15:35+00:00

Handbook of Facial Melanosis by Dr Bibush Amatya is an excellent book worth reading and seems well mounted for post graduate medical students, young Dermatologists and senior consultants alike, who want to improvise their practice with Dermoscopy.

Monkeypox - A Review

2023-01-03T04:16:21+00:00

The recent past emergence of pandemics has made the world prepare for all the worst-case scenarios. First COVID-19 pandemic caught us unaware, and since then, diseases like Dengue and Monkeypox are making us take steps to avert the casualties caused by these infections. Monkeypox is a viral disease caused by orthopoxvirus. It spreads from close personal contact with the patient. The disease is severe among children, pregnant, and immunosuppressed patients. Recent outbreak among MSM group has added it to be amongst sexually transmitted infections. It is usually self-limiting, but severe disease-causing deaths have been reported by infection, particularly with central African types. Prevention is possible by vaccination with smallpox vaccines. Treatment is still evolving, with new drugs like Tecoviramet showing promising results.

Key words: Monkeypox; Orthopoxvirus; Sexually transmitted infection; Tecoviramet

Dermatological Publications from Nepalese Dermatologist Before and During the COVID-19 Pandemic Period: A Review

2022-02-14T09:28:52+00:00

Introduction: The COVID-19 pandemic created a nation-wide lockdown with hospital services resorting only to the emergency sections. Dermatology out-patient was closed with majority of services being deferred for a later date or through online platform. Here, we try to find whether Nepalese dermatologists were contributing to sciences through research.

Methods: A Google Scholar search using certain key words to search for publications done by Nepalese dermatologist during the pandemic was done for year 2020-2021 described as pandemic period. Similar search was conducted for year 2018-2019 for the same time frame called as pre-pandemic. All the publications were analyzed using appropriate statistical methods.

Results: A total of 197 publications were retrieved for pandemic period as compared to only 106 published articles in the non-pandemic period. Among 197 publications, 81 (41.11%) were published in PubMed indexed journal as compared to only 40 (37.73%) publications out of 106 total publications during the earlier period. However, the increase in the number was not statistically significant.

Conclusion: An interest among Nepalese dermatologists for academic publications was noted during the pandemic period. This might be due to the proper use of time during the lockdown and closure of out-patient department.

Aesthetic Dermatology, The Rising Trend

2022-11-28T06:33:36+00:00

Aesthetic Dermatology, also known as cosmetic dermatology provides treatment for skin, hair or body that emphasizes on improving an individual’s appearance. It is widely conducted to treat conditions such as moles, wrinkles, scars, excess fat, skin discoloration, skin laxity, and cellulite. Benefits such as minimally invasive or non-invasive and relatively less time-consumption with better outcomes has foster the patients to seek these treatments. With soaring demand for these treatments, numerous myths and misconceptions regarding the field of aesthetic dermatology have arisen which need to addressed. Also, this constantly evolving field with new devices and tools requires extra vigilance, continue medical education and a governing body to have check upon negligent professional activity, if occurs any

A Neglected Swollen Limb: Resurgence or Common Tropical Disease?

2023-01-22T06:08:12+00:00

Mycetoma is uncommon, chronic granulomatous infection caused either by fungi or by aerobic filamentous actinomycetes which is characterized by a triad of painless subcutaneous mass, multiple sinuses and discharge containing grains. We report a case of 40 years old male, farmer who presented with multiple painless swollen lesions over right foot for 8 years. Swelling had gradually increased in size over a few years followed by multiple episodes of discharge. It had not restricted his daily activities. On examination, there were multiple nodules and sinuses discharging serous fluid from the right foot. Gram staining showed gram positive filamentous rods and KOH was negative. Histopathology showed multiple granulomas. Patient was treated for 5 cycles using modified Welsh regimen with Amikacin 750mg intravenously once a day, oral Cotrimoxazole 960mg twice daily and oral Rifampicin 600mg once daily along with oral iron and folic acid supplementation continuously for 21days which constituted 1 cycle with an interval of 15 days between each cycle. Patient was assessed by measuring girth of foot and number of lesions in each visit and showed significant improvement at the end of fifth cycle. Patient was followed for 1 year after treatment without any recurrence.

Rapid Progression of Red Itchy Rash, Diagnostic Dilemma

2023-02-16T08:40:37+00:00

Cutaneous T-cell lymphoma (CTCL) is an uncommon type of cancer that begins in white blood cells called T lymphocytes (T cells). Normally, T cells help body's immune system to fight off infection but, in CTCL, these cells develop abnormalities that make them attack the skin. It comprises heterogeneous group of skin neoplasms, the most common being mycosis fungoides (MF). Skin lesions are classified into patches, plaques, and tumor stage. Extra skin manifestations like enlarged lymph nodes are usually seen in plaques or tumor stage, when there are thick lesions on skin. It is usually a slow growing cancer that develops over many years. Herein, we present an 83-year female patient who suddenly developed extremely itchy patches on abdomen, which had spread to involve the entire trunk and all four limbs in about 10 days’ time. She already had lymphadenopathy and splenomegaly at the time of presentation. Skin biopsy and immunohistochemistry revealed CD4+ T cells CTCL. Moreover, bone marrow was hypercellular for age with 12% atypical lymphocytes. It is very unusual for CTCL to involve bone marrow at patch stage with no any plaques or nodules on the skin. Also, the sudden onset of skin lesions and its rapid progression with probably, the involvement of lymph nodes and spleen warrant further studies to guide diagnostic approaches and treatment recommendations for CTCL

A Rare Case of Idiopathic Atrophoderma of Pasini and Pierini

2022-10-12T03:40:22+00:00

Idiopathic atrophoderma of Pasini and Pierini (IAPP) is a rare pigmented atrophic cutaneous disease. Here, we report a case of a 27-year-old woman who presented with asymptomatic brown patches on her upper back for one year. There was no prior history of swelling or induration of the lesions. Physical examination showed atrophic patches with clear boundaries, consistent with snow footprints or cliff-drop-like changes on edge. Dermoscopy revealed numerous bare linear, branched blood vessels and perifollicular brownish areas, which differs from only one previously reported IAPP. Biopsy showed perivascular mononuclear cells infiltrating the dermis and reduced elastic fibers in the upper and middle dermis. Typical clinical findings of “footprints in the snow” appearance and dermoscopy could combine for a definite diagnosis aiding in differentiating from morphea presenting with whitish structureless and hairless areas. This case report might stimulate clinicians to diagnose such a rare disease in patients with similar lesions to avoid unnecessary treatment.

Dermatological Diseases in a Chepang Community

2022-12-21T09:06:34+00:00

Chepang is an indigenous group residing mostly in the hilly region of central Nepal. They are still considered as most marginalized and socio-economically deprived group in the country. There are just a handful of studies on the health status of this community but none of these studies were dedicated on the dermatological issues. A two-day dermatological outreach camp dedicated for Chepang community was conducted at Makawanpur district of central Nepal. Dermatophyte infections and scabies were the most common dermatological problems noted. The poor socio-economic status, poor hygiene combined with illiteracy was the major factor contributing to these conditions and their overall health.

Comparing the Clinical Efficacy of Topical Application of Virgin Coconut Oil and 1% Clotrimazole Cream as an Adjuvant to Systemic Antifungal in Chronic Dermatophytoses: A Randomized Controlled Trial

2022-08-30T06:09:09+00:00

Introduction: Dermatophyte infections have become a common entity with a prevalence ranging from 36.6-78.4%. Majority of the patients are from low socioeconomic background who favour topical treatment. High treatment costs of antifungal medication and consequent poor compliance have given rise to the need of an effective and economical topical preparation.

Objectives: To compare efficacy of topical 1% clotrimazole versus virgin coconut oil application as an adjuvant to systemic antifungals in dermatophytosis.

Materials and Methods: A total of 100 patients presenting to the dermatology outpatient department and diagnosed with tinea infection clinically and by potassium hydroxide mount were taken up for the study. The patients were randomized into two groups with 50 patients in each group. One group received virgin coconut oil while the other group received 1% clotrimazole cream twice daily application as the topical preparation. Mycological cure was assessed by potassium hydroxide mount and clinical improvement was assessed objectively by severity score for itch, changes in clinical signs and symptoms and subjectively by Dermatology Life Quality Index questionnaire. Statistical analysis was analyzed using SPSS software version 17.

Results: Virgin coconut oil and 1% Clotrimazole had equivocal response after 12 weeks of treatment with respect to potassium hydroxide mount positivity, itch severity, clinical improvement and changes in Dermatology Life Quality Index scores when used along with systemic antifungal.

Conclusion: Virgin coconut oil can be easily used as a topical emollient and antifungal preparation along with systemic antifungals in the treatment of dermatophytosis.

Low Dose Oxybutin in Primary Hyperhydrosis: A Prospective Study from a Tertiary Care Center in Nepal

2022-10-23T04:52:16+00:00

Introduction: Hyperhydrosis is a clinical condition where there is excessive sweating beyond the physiological need of the patient’s body. This can directly or indirectly affect the quality of patients life. Oxybutin is widely used in urology as anticholinergic medication for bladder urge incontinence. It can be used safely at a high doses (over 15 mg/day) to treat urological disorder. It also acts against excessive sweating and can be used in cases of hyperhidrosis.

Objectives: To evaluate effectiveness of oxybutin at low dose and to assess the Hyperhidrosis Disease Severity Scale (HDSS) .

Materials and Methods: This is a hospital based cross-sectional study in primary hyperhydrosis. Oxybutin was prescribed to all patients of primary hyperhydrosis with gradual increment of dosage of 2.5 mg orally once a day to 5 mg twice a day. Patients were evaluated at zero wk (baseline), 4 wk, 8 wk, 12 wk and follow-up in 16 wks with Hyperhidrosis Disease Severity Scale (HDSS) along with adverse effects were noted.

Results: There was a significant difference in HDSS at zero wk (baseline) and 4^thwk (p=0.001) at a dose of 2.5 mg once a day of oxybutynin. Also, a significant difference was noted (p=0.022) in HDSS between zero wk (baseline) and 12 wk. Similarly, a significant difference between HDSS at zero wk (baseline) versus the 16^th wk was also noted.

Conclusion: Oxybutin is an anticholinergic drug with an emerging role in hyperhydrosis. Low doses have shown significant results with minimal side effects. The dose requirement varies among authors. Studies with long-term follow-ups with ideal protocol need to be established in the future.

Clinicoepidemiological Study of Cutaneous Leishmaniasis: A Hospital Based Study

2022-11-05T14:26:42+00:00

Introduction: Cutaneous leishmaniasis is a tropical disease transmitted by the bite of an intracellular parasite infected sandfly. Visceral leishmaniasis is common in Nepal. However, cutaneous leishmaniasis remains rare with only limited number of cases documented in Nepal.

Objectives: To describe the clinical and epidemiological distribution of cutaneous leishmaniasis in Karnali province of Nepal.

Materials and Methods: All cases clinically diagnosed from direct microscopic Giemsa-stain smears, histopathology or fine needle aspiration cytology as cutaneous leishmaniasis were enrolled in the study for one year. Demographic data and clinical details were recorded on a printed proforma. Statistical analysis was done using STATA/SE version 15.0 for MacBook.

Results: Only 46 cases with age ranging from 2 to 75 years were included in the study. Mean age was 23±2.45 years. Majority of cases below 20 years (47.83%) were infected. Male to female ratio was 0.70:1. Mean duration of the disease was 4.96±0.47 months. Single lesions (73.91%) were mostly present. Single lesions were particularly presented on the face (73.53%). Cutaneous leishmaniasis (95.65%) outnumbered mucocutaneous one on lips (4.35%). Ulcerative-papulonodular type lesions (58.70%) were mostly presented in the cases. Kalikot district (56.52%) had the majority of cutaneous leishmaniasis cases in Karnali province. Majority of the cases presented during the months of February, March, April, August, November, and December (65.22%).

Conclusion: The study concluded that the increase in cutaneous leishmaniasis is alarming in the Kalikot district of Karnali province in Nepal. The result of this study would continue contributing to the existing data in the literature and encourage early diagnosis and treatment of cutaneous leishmaniasis.

Evaluation of Nail Psoriasis: Delving into Some Useful Scores

2023-01-22T06:45:49+00:00

Introduction: Several scoring systems have been established for nail psoriasis severity assessment. However, there is a lack of consensus on these tools.

Objectives: To evaluate the nail changes in psoriasis patients and to correlate the severity of nail findings by Nail Psoriasis Severity Index (NAPSI) and modified NAPSI (m-NAPSI) scores.

Material and Methods: Three hundred and seventy consecutive adult psoriatic patients were studied to describe the pattern of nail changes with its frequency and the findings were compared with data collected on age-and gender-matched 150 control subjects to determine which of the observed features are psoriasis disease-specific nail changes. The nail severity was assessed by NAPSI and m-NAPSI scores and correlated.

Results: Nail signs included in NAPSI were more commonly seen in psoriatic patients as compared to healthy controls and it was statistically significant. Beau’s line was also found more in patients as compared to controls. None of the cases and controls had red spots in the lunula, and leukonychia was comparatively common in the controls. There was a strong and significant correlation found between NAPSI and m-NAPSI (r=0.916). Fingernails had a stronger correlation as compared to toenails between NAPSI and m-NAPSI (r=0.920 vs. r=0.877; p<0.001).

Conclusions: m-NAPSI may be considered to measure the degree of nail changes however leukonychia and a red spot in the lunula could be removed and Beau’s line could be added as further modification of m-NAPSI.

Serum Levels of 25-Hydroxyvitamin D in Chronic Plaque Psoriasis

2023-02-06T01:54:39+00:00

Background: Psoriasis is an immune mediated inflammatory disease that involves the innate and acquired arm of immunologic system. The regulatory role for vitamin D in immune system is suggested by presence of vitamin D receptors on activated lymphocytes and suppressive or inhibiting effect of 1,25-dihydroxyvitamin D in different autoimmune diseases. Hence, the current proposed study aims to study the 25-hydroxyvitamin D status of patients with psoriasis.

Objective: The primary objective of this study was to analyze the 25-hydroxyvitamin D status of patients with chronic plaque psoriasis in comparison to healthy control subjects.

Materials and Methods: A comparative cross-sectional study, including forty patients with chronic plaque psoriasis and forty age- and sex-matched control subjects, was conducted from April 2021 to December 2022, at our dermatology department. After informed consent, all patients were subjected to detailed clinical and anthropometric examination. Serum concentration of 25-hydroxyvitamin D was evaluated in chronic plaque psoriasis cases and healthy control subjects. Data was be analyzed as per standard statistical protocol.

Results: The mean serum 25-hydroxyvitamin D level in psoriatic group and control group were 18.02 (±SD 9.82) ng/ml and 24.47 (±SD 6.77) ng/ml, respectively. (p=.001) Serum 25-hydroxyvitamin D was negatively correlated with Psoriatic area and severity index (PASI) score (r=-.11). However, this correlation was not significant (p=.493).

Conclusion: Serum 25-hydroxyvitamin D levels were significantly lower in psoriatic patients than in control subjects.