Nepal Journal of Dermatology, Venereology & Leprology

A Cross-sectional Study on Patients' Perspective Towards Dermatology Outpatient Services from a Tertiary Care Center in Nepal

Prajwal Pandey, Raju Shah, Swati Rani — Tue, 02 Apr 2024 00:00:00 +0000

Introduction: Patient-centered care has received greater prominence in recent years, and it is paramount to assess the patient’s satisfaction to improve the quality of healthcare services. The present study is aimed at understanding the patients’ perspectives regarding dermatology outpatient services offered at a tertiary care center to determine the areas for improvement for better patient satisfaction.

Objective: This study is intended to understand the patients’ perspectives regarding a typical dermatology OPD setup and to identify the areas for improvement in a tertiary center in Nepal.

Materials and Methods: The descriptive cross-sectional study was carried out using a content-validated, pre-tested, standardized, and translated questionnaire. All the patients who visited the outpatient department of Dermatology tertiary care center during the month of April 2022 and were willing to participate in the study were included.

Result: A total of 157 patients participated in the survey. The majority of the participants were males (56.7%) and belonged to urban domiciles (80.9%). Nearly 42% of the subjects were seeking dermatology consultation for the first time, and 68.2% responded that the duration of consultation was sufficient. The details of symptoms, clinical results, and medication were clearly understood by 89.8%, 82.2%, and 73.9% of the subjects, respectively. Maintenance of privacy was reported by 76.4% of the participants. However, 25.5% of the subjects reported a waiting time of ≥4 hours for consultation, and 34.4% suggested the need for more manpower.

Conclusion: The majority of the patients had a high degree of satisfaction. The areas of improvement include the adoption of technology-based appointment booking system, ensuring a good waiting ambience, increasing manpower, and reducing waiting time for consultations.

Comparison of Safety Of Oral Ivermectin with Topical Permethrin in the Treatment of Scabies: A Comparative Study

Rishab Dev Tripathee, Seema Sitaula, Sanjeev Kharel — Tue, 02 Apr 2024 00:00:00 +0000

Introduction: The mite Sarcoptes scabiei var. hominis is the cause of scabies, a skin illness. The Food and Drug Administration (FDA) approves permethrin cream (5%) for the treatment of scabies and is also recommended by the Centers for Disease Control and Prevention (CDC) as first-line topical therapy for scabies. Oral ivermectin, a novel antiparasitic agent that has been extensively used for several parasitic infections and can be used as an alternative approach for the treatment of scabies. This comparative study aimed to describe the adverse effects of ivermectin and permethrin and their comparison.

Objective: To compare the safety outcomes of ivermectin and permethrin for the use of scabies.

Methods: This is the prospective open-labeled randomized and comparative study carried out in the outpatient department of dermatology and venereology at Tribhuvan University Teaching Hospital, Kathmandu. In Group A, patients received oral Ivermectin tablets at a dose of 200 μg/kg on day 1 before breakfast, and in Group B, patients received topical Permethrin 5% cream to be applied all over the body below the neck at night twice a week apart.

Results: This study included 93 patients who met the inclusion criteria, with 45 patients belonging to the Ivermectin group and 48 patients belonging to the Permethrin group. In the ivermectin group, the most common side effect reported was nausea, followed by abdominal discomfort and headache. In the Permethrin group, the most common side effect was a burning sensation on the skin after application of the drug, followed by irritation and erythema, which were present in 3.2% and 2.2% of patients, respectively. The difference in overall side effects between the two groups was statistically not significant. (p=0.682)

Conclusion: Our study concludes that a single dose of oral Ivermectin given at a dose of 200 micrograms/kg is comparable to Permethrin cream 5% used twice a week in terms of safety standards. Neither drug caused any life-threatening adverse reactions in the patients.

Effect of Low dose Isotretinoin on Lipid Profile and Liver enzymes in Acne Patients: A Cross Sectional Study

Ayush Jha, Rima Shrestha, Anupa Khadka, Ashmita Wagle — Tue, 02 Apr 2024 00:00:00 +0000

Introduction: Oral isotretinoin remains the most clinically effective anti-acne therapy. However, a myriad of adverse effects are associated with isotretinoin use. Elevated liver enzymes and an altered lipid profile are well documented side effects of prolonged oral isotretinoin usage.

Objectives: To assess the alteration in liver enzymes and lipid profiles of acne patients on isotretinoin therapy.

Materials and Methods: The current prospective hospital based study, was carried out from September 2022 to December 2023, and included 150 patients with acne vulgaris on isotretinoin therapy. All consenting patients were then subjected to a detailed history and clinical examination. Subsequently, baseline Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), Triglyceride (TG), Low density Lipoprotein (LDL), and High density Lipoprotein levels (HDL) levels were measured. Patients were then started on oral isotretinoin therapy at conventional dosages. Levels of ALT, AST, TG, LDL and HDL were repeated at 3- month and 6- month follow-up visits. A self-designed proforma was used to collect all relevant data. The collected data was analyzed as per standard statistical protocol. Repeated measures analysis of variance was used to compare means between 3 groups (baseline, 3-month, and 6-month values). Results with a p<.05 were considered statistically significant.

Results: The mean age of patients was 22.31(±SD 4.44) years. Females comprised the majority of our study subjects (n = 95; 63.33%). Levels of Alanine (F2,226=30.73, p<.0005) and Aspartate transaminase (F2,232=13.13, p<.0005) were increased significantly at 3 and 6 month follow up visits. Levels of TG were, also, increased significantly at follow up visits (F2,239=14.45, p<.0005). Similarly, levels of low density lipoprotein increased significantly when compared to baseline levels (F1,215=38.43, p<.0005). High density lipoprotein levels were decreased significantly when compared to baseline levels (F1,209=105.83, p<.0005).

Conclusion: Our study has highlighted the significant alterations that occur in liver function tests and lipid profiles in patients on isotretinoin therapy.

Pattern of Inappropriate use of Topical Corticosteroid and Cutaneous Adverse Effects at a Tertiary Level Hospital in Kathmandu

Sabina Bhandari, Upama Paudel — Tue, 02 Apr 2024 00:00:00 +0000

Introduction: Topical corticosteroids are anti-inflammatory, immunosuppressive, and anti-proliferative drugs with profound efficacy. As it provides rapid relief, it is used for a wide spectrum of dermatological conditions. Rampant use of topical corticosteroids due to their easy availability gives rise to difficult-to-treat cutaneous adverse effects.

Objectives: To determine the pattern of inappropriate use of topical corticosteroids and cutaneous adverse effects

Materials and Methods: This was a hospital based cross-sectional prospective study conducted among 84 participants in the Department of Dermatology, Tribhuvan University Teaching Hospital, Kathmandu, from October 2020 to September 2021. Ethical clearance was obtained from the Institutional Review Committee. The participants fulfilling the inclusion criteria were included in the study.

Results: Out of 84 cases, 59.5% were females and 40.5% were males. The mean age of participants was 30.4±9.1years. Dermatophytoses (71.4%) were the most common cause of inappropriate use of topical corticosteroids. The most common adverse effect was tinea incognito (23.8%). The most potent class (60%) of topical corticosteroids were misused. Most of the participants used topical steroids either for the duration of 1 week to 1 month ( 23.8%) or for more than 12 months (23.8%).

Conclusion: Inappropriate topical corticosteroid use is a common problem due to its easy accessibility, resulting in several difficult-to-treat cutaneous adverse effects. So, awareness-raising activities regarding the proper use of corticosteroids have to be conducted.

Impact on Quality of Life in Chronic Pruritus in a Tertiary Level Hospital in Kathmandu

Arnab Panta, Dinesh Binod Pokhrel, Sudip Parajuli — Tue, 02 Apr 2024 00:00:00 +0000

Introduction: Chronic pruritus is a common complaint in various dermatologic as well as non-cutaneous conditions, and it leads to significant impairment in the quality of life of the individuals suffering from it. The 5-D Itch Scale is an internationally validated multidimensional tool for the assessment of the burden of itching, localization patterns, pruritus intensity and evolution, as well as impaired sleep, difficulty in performing daily household activities, and social obligations and responsibilities in school and work.

Objective: To assess the impact on various aspects of quality of life in chronic pruritus in a tertiary level hospital in Kathmandu.

Materials and Methods: This was a hospital-based descriptive cross-sectional study conducted in the Department of Dermatology and Venereology, Tribhuvan University Teaching Hospital, Kathmandu, over a period of one year (October 2020 through September 2021), involving 180 participants. The impact on quality of life was measured with the 5-D Itch Scale.

Results: The mean total 5-D score was 17.06 ± 2.697 (range 8 to 25), showing a severe impact on the quality of life of participants. Pruritus was unbearable in 22.2% and of severe intensity in 47.8% of participants. The impairments in sleep were found to be the most disabling by 40.5% of participants, while the majority of participants (93.9%) had developed some form of disability in leisure or social activities due to chronic pruritus.

Conclusion: Individuals suffering from chronic pruritus face severe deterioration in various aspects of quality of life.

Efficacy of Autologous Injectable Platelet Rich Fibrin in Facial Atrophic Acne Scars in Combination with Microneedling: A Randomized Clinical Trial

Katyayani Pandey, Sudha Agrawal, Prajwal Pandey — Tue, 02 Apr 2024 00:00:00 +0000

Introduction: Several modalities for treating acne scars exist. The combination of microneedling and injectable platelet-rich fibrin (i-PRF) is a synergistic approach.

Objective: The aim was to compare the efficacy of microneedling alone versus microneedling with iPRF in post acne atrophic scars.

Materials and Methods: This study was a hospital-based randomized clinical trial conducted at B P Koirala Institute Health Sciences, Dharan, Nepal. Twenty patients with postacne atrophic scars underwent four sessions of microneedling with-iPRF and microneedling alone, monthly. The Goodman and Baron quantitative score and Goodman and Baron qualitative scores were assessed at zero, four, eight, twelve, and sixteen weeks. The Facial Acne Scar Quality of Life questionnaire (FASQoL) was also evaluated.

Result: The Goodman and Baron quantitative score was reduced from 23 to 14 in microneedling + i-PRF group (p=0.005) and from 16 to 11.50 for microneedling only group (p=0.005).The percentage reduction in the Goodman and Baron quantitative score after the 16th week was 39.13% for group A and 28.12 % for group B. There was a statistically significant difference in the net reduction of the Goodman and Baron quantitative score from the baseline to the 16th week between group A and group B (p=0.004).

Conclusion: Injectable platelet rich fibrin (i-PRF) in combination with microneedling was found effective in reducing lesion count, Goodman and Baron quantitative score, and qualitative grade.

Clinico-Histopathological Consistency in Dermatological Disorders in a Tertiary Care Hospital of Kathmandu

Tue, 02 Apr 2024 00:00:00 +0000

Introduction: A skin biopsy for histopathological examination is one of the most reliable investigations for confirming clinical diagnosis. When there is alignment of clinical and histopathological diagnosis, it demonstrates clinico-histopathological consistency. There is limited reported data on clinico-histopathological concordance in the context of Nepal.

Objectives: To determine the consistency of clinical and histopathological diagnosis of dermatological disorders.

Materials and Methods: A retrospective study was conducted on 551 patients who underwent skin biopsy at the Department of Dermatology and Venereology, Tribhuvan University Teaching Hospital, for a period of 1 year. Both inpatients and outpatients who had undergone a skin biopsy were included in the study. Demographic data, clinical and histopathological diagnoses were noted on a proforma sheet. Histopathological diagnoses, both definitive and descriptive, were deemed consistent when they aligned with the clinical diagnoses. Conversely, if either definitive or descriptive histopathological diagnoses were not concordant with the clinical diagnoses, they were categorized as inconsistent.

Results: The mean age of patients was 41.42 (±18.42) years. The male to female ratio was 1:1.5. Out of 551 cases who underwent skin biopsy, clinico-histopathological consistency was found in 64.43% of cases (355), whereas clinico-histopathological inconsistency was present in 35.57% (196). The maximum concordance was present in eczematous disorders (58.06%), followed by immunobullous disorders (47.22%), and vasculitis (45.45%).

Conclusion: The overall clinico-histopathological consistency was 64.43%. Both experienced dermatologists and pathologists need to assist each other in providing a better understanding of the diagnostic process. This study emphasizes need for this cooperation and will aid in evaluating clinico-histopathological consistency.

A Kaleidoscopic Navigation Through Different Shades of Colors in Dermoscopy

Balachandra S Ankad, Keshavmurthy A Adya — Tue, 02 Apr 2024 00:00:00 +0000

Dermoscopy has traveled a long way from its initial application limited to tumoral dermatology, especially melanocytic tumors, to its indispensable role in general dermatology as well as in procedural dermatology. Dermoscopy primarily serves as a diagnostic tool by virtue of its ability to visualize skin surfaces and sub-surface structures in a magnified and illuminated manner. Colors are critical and significant in dermoscopy. They are imparted by different chromophores in skin tissue. Hence, recognition of diverse colors and their variations is of paramount importance in the analysis of a dermoscopic image. In this review, we describe the various colors observed in dermoscopy, emphasizing the same in order to interpret them appropriately for an accurate diagnosis.

Vitamin D and Skin: An Review and Update

Eliz Aryal, Jyoti Bhari — Tue, 02 Apr 2024 00:00:00 +0000

Vitamin D was recognized for its pivotal role in bone formation, but it is now recognized for its impact on the optimal functioning of various tissues throughout the body, including the brain, heart, muscles, immune system, and skin. Vitamin D is a fat-soluble prohormone steroid with endocrine, paracrine, and autocrine functions. Vitamin D receptors and the enzymes that can convert 25-hydroxyvitamin D [25(OH)D] into the active form, 1,25-hydroxyvitamin D [1,25(OH)D], have been identified in numerous cells throughout the body, including the skin. Vitamin D analogs are widely acknowledged for effective treatment of psoriasis vulgaris due to their anti-proliferative and pro-differentiating impact on keratinocytes. Beyond this, emerging roles for vitamin D in skin health include immunomodulatory and anti-apoptotic effects, suggesting potential applications in conditions like atopic dermatitis and infections including verucca vulgaris. Epidemiological studies have linked low vitamin D levels to autoimmune diseases like vitiligo, leading to the use of topical vitamin D in its treatment. Recent evidence also suggests that cutaneous vitamin D synthesis may contribute to preventing skin malignancies, and oral supplementation may reduce cancer mortality. Its role in the pathogenesis of various dermatological diseases has not been an exception and has been extensively studied in recent years. In this review, we will shed light on roles of vitamin D in various skin disorders.

Premature Graying of Hair

Shreya Bastakoti, Timothy Upashna — Tue, 02 Apr 2024 00:00:00 +0000

Premature Graying of hair (PGH) is a common and psychologically distressing condition of the hair. It is seen as being aggravated by various triggering factors. But the pathogenesis and the treatment options are still under study and limited. Thus, proper and extensive research seems to be needed.

Aneurysmal Dermatofibroma: Uncommon Presentation of Common Disease

Shraddha Patel, Pooja Agarwal, Raju Chaudhary, Kalgi Baxi — Tue, 02 Apr 2024 00:00:00 +0000

Aneurysmal dermatofibroma is an uncommon, benign variant of dermatofibroma due to the slow extravasation of blood. Clinically, it is difficult to differentiate from other vascular occurring lesions like verrucous hemangioma and malignancies like malignant melanoma and nodular basal cell carcinoma. Hence, an excisional biopsy followed by a thorough histopathological examination is necessary to avoid misdiagnosis. Here, we report a case of a 38 year old female who presented with a brown colored nodular lesion on her left upper back for the last one year, and histopathological examination was consistent with aneurysmal dermatofibroma.

Pustular Pyoderma Gangrenosum with Ulcerative Colitis an Uncommonly Seen Association

Pradipsinh Parmar, Pooja Agarwal, Kalgi Baxi, Vikram Chaudhary, Raju Chaudhary — Tue, 02 Apr 2024 00:00:00 +0000

We report a case of a 36-year-old female having ulcerative colitis who had multiple papulo-pustular lesions over trunk and face. She had received treatment as acne vulgaris but due to lack of satisfactory response, histopathological evaluation was done which was consistent with pustular pyoderma gangrenosum. The diagnosis of pustular pyoderma gangrenosum is often challenging as there is no defining diagnostic clinical, laboratory or histopathological feature. Thus a high index of suspicion is essential to diagnose this condition.

Malignant Transformation in a Genitocrural Porokeratosis : A Case Report

Mrunali Joshi, Pooja Agarwal, Raju Chaudhary, Kalgi Baxi — Tue, 02 Apr 2024 00:00:00 +0000

Porokeratosis is a rare heterogenous group of keratinization disorder with an unclear pathogenesis, and has varied clinical presentations. It may present with annular papules or plaques with central atrophy and clinically and histologically distinct ridge-like border called 'cornoid lamella'. Common variants include porokeratosis of Mibelli (PM), disseminated superficial actinic porokeratosis (DSAP), linear porokeratosis, punctate porokeratosis and porokeratosis palmaris et plantaris disseminata (PPPD). Here we report the case of a 79 year old female, who developed malignancy of porokeratosis over the groin region which had been mismanaged as eczema for many months and has been eventually diagnosed as Squamous cell carcinoma.

Pseudoxanthoma Elasticum a Rare Genetic Disorder : A Case Report

Tue, 02 Apr 2024 00:00:00 +0000

Pseudoxanthoma elasticum (PXE) is a rare hereditary condition marked by the accumulation of fragmented and calcified elastic fibers in the body's tissues, leading to skin, vascular, and ocular involvement. In clinical practice, the most prevalent and typically earliest indication of PXE is observed through skin manifestations, which include laxity and the presence of yellowish papules and plaques. Here we report a case of a 40-year-old woman from Nepal presenting with yellowish multiple papules and plaque around the neck and axilla for 20 years, slowly increasing in size and number. A skin biopsy revealed fragmented eosinophilic elastic fibers in the dermis, consistent with PXE. Echocardiography, slit lamp, and indirect ophthalmoscopic examination were done.