Nepal Journal of Dermatology, Venereology & Leprology

Lichen Planus Pigmentosus with Atypical Presentation- A Case Report

Akshay Patankar, Akshata A Mane, Manjaree Morgaonkar — Mon, 02 Oct 2023 00:00:00 +0000

Lichen planus pigmentosus (LPP) is a chronic pigmentary disorder that shows diffuse or reticulated hyperpigmented, dark brown macules and patches on the sun-exposed areas such as the face, neck and other flexural folds. Clinically, it is different from classical lichen planus because LPP has a longer clinical course and it manifests with dark brown macules. In case of LPP, involvement of the scalp, nail or mucosal area is rare. The histopathological findings of the lesions show an atrophic epidermis, the presence of melanophages and a vacuolar alteration of the basal cell layer with a sparse lymphohistiocytic lichenoid infiltration. Here we report a case of lichen planus pigmentosus over sun protected areas sparing sun exposed and flexural folds.

Tattoo Inoculated Cutaneous Tuberculosis: Case Report

Megha Tandon — Mon, 02 Oct 2023 00:00:00 +0000

Tattooing is an ancient custom that has been popular for ornamental, religious, and traditional purposes in various countries and cultures since time immemorial. The surge in cases of tattoo-associated adverse reactions is an alarming situation, especially with this increasing trend of tattooing for cosmetic purposes among the youth. Tattoo‐associated tuberculous and nontuberculous mycobacterial skin infections have been reported uncommonly in literature. Here an occurrence of tattoo-inoculated cutaneous tuberculosis presenting as lupus vulgaris developing to red ink tattoo in a young male is reported who responded to standard antitubercular therapy.

Pyoderma Gangrenosum with Neurofibromatosis: Understanding a Possible Relationship and Identifying Risk with Immunosuppressants

Mihika Noronha, Vijay Aithal — Mon, 02 Oct 2023 00:00:00 +0000

Association of Pyoderma Gangrenosum with Neurofibromatosis is extremely rare; only one case has been reported so far. We present one such patient, who also developed bone marrow suppression after treatment with Azathioprine, and reported an acute onset of Telogen Effluvium. The rare association of these two seemingly unrelated conditions and the need to be vigilant about the possibility of myelosuppression with azathioprine presenting as sudden onset, severe alopecia is highlighted.

Angiolymphoid Hyperplasia with Eosinophilia- Think Twice with Scalp Papules! A Case Report

Pooja Agarwal, Kalgi Baxi, Malhar Shah — Mon, 02 Oct 2023 00:00:00 +0000

Angiolymphoid hyperplasia is an uncommon condition characterized by multiple erythematous papules and nodules which are vascular and present over the head and neck area, predominantly around the ears. It is a benign condition but treatment is often sought for the appearance of lesions. We report a case that had a recurrence of erythematous lesions after incomplete electrocoagulation and the diagnosis of angiolymphoid hyperplasia with eosinophilia was confirmed on histopathological evaluation after complete excision of the lesion. In conclusion, as angiolymphoid hyperplasia can be clinically misdiagnosed, histopathological evaluation is warranted in erythematous nodules presenting over the sites of predilection.

Teledermatology in Developing Countries (Chances and Obstacles)

Günter Burg — Mon, 02 Oct 2023 00:00:00 +0000

Telemedicine has started to be a serious tool for the improvement of healthcare in rural areas of poor developing but also in rich industrial countries. Teledermatology as a subspeciality of telemedicine is particularly suitable for diagnosing and monitoring diseases over distance. However some dermatoses are less, others are more suitable for remote management. The technologies used provide big chances if the many obstacles can be overcome.

Is Aesthetic Dermatology in Unsafe Hands?

Mohan Bhusal, Deeptara Pathak Thapa — Mon, 02 Oct 2023 00:00:00 +0000

Aesthetic Dermatology is one of the growing subspecialities that involves noninvasive to minimally invasive cosmetic procedures. It has overlapping scope with Aestheticians, Beauticians, and Non-Dermatologist medical practitioners, adding ambiguity and ethical issues. There have been global reports of invasive procedures done by Beauticians and Aestheticians leading to complications like scalp burn, infection and stroke which later led to development of guidelines in different countries. There is a strong need to develop similar guidelines in Nepal in collaboration with different stakeholders. Also, it is equally important to create public awareness so that public will be better informed about whom to consult for their skin concerns, and if needed report to governing bodies regarding negligence.

Clinicoepidemiological Profile and Sexual Behaviour Pattern of Patients with Anogenital Warts

Anup Pandit, Laila Lama Tangbetani, Nhuchhe Man Singh Dangol, Sudina Ranjit — Mon, 02 Oct 2023 00:00:00 +0000

Introduction: Anogenital wart (AGW) is the infection of the anal and genital mucosa and their adjoining areas by Human papilloma virus (HPV) 6, 11. Genital HPV infections are transmitted primarily through sexual contact. This study determines the clinicoepidemiological profile and sexual behavior patterns in patients with AGW.

Materials and Methods: A hospital-based descriptive cross-sectional study was conducted in patients diagnosed with AGW attending the Department of Dermatology and Venereology, Bir Hospital between November 2019 and December 2020.

Results: A total of 77 patients including 58 males and 19 females diagnosed with AGW were studied. The warts were recorded more commonly in married individuals (62.3%). The most common sites of warts were penis (84.5% of males) and vulva (57.9% of females) followed by perianal skin, and perineum in both males and females. Of the various morphologies, dome shaped warts were most commonly observed (58.6% in males and 73.7% in females). The individuals with extramarital contacts were at significantly more risk of AGW than those without such contacts (P =0.001). AGW cases were seen more frequent in patients with syphilis and HIV (7.8% and 2.6% respectively) compared to general population.

Conclusion: Genital warts were more common in 16 – 25 years of age, mostly married, and polygamous. Like all STD (sexually transmitted diseases), Genital warts (GWs) have important effects on the health of society and quality of life. Hence, awareness of the clinical presentations, sexual aspects, and possible risk factors of GWs leads to the use of effective protection measures.

Comparison of Efficacy of Localized Narrow-Band UVB Therapy Versus Localized PUVA Therapy in Chronic Hand Eczema

Dhan Keshar Khadka, Sudha Agrawal, Arpana Rijal, Samir Shrestha — Mon, 02 Oct 2023 00:00:00 +0000

Introduction: Hand eczema is a type of dermatitis largely confined to the hands. Narrowband UVB (NBUVB) appears to be as effective as topical PUVA therapy in the treatment of chronic hand dermatitis. However, the risks of phototoxicity and dyspigmentation associated with local PUVA therapy make NBUVB therapy a preferable initial therapeutic option.

Methods and Methodology: A total of 40 patients with chronic hand eczema were randomly divided into two groups: Group A (20) receiving localized NBUVB and Group B (20) receiving localized PUVA therapy. They were administered the designated treatment modality for the period of 8 weeks. They were evaluated every 2 weeks to see for the clinical response and any side effects.

Results: In group A, there was around 47% and 85% improvement in Clinical Assessment Score (CAS) at weeks 4 and 8 respectively. Similarly, in group B, there was around 52% and 86% improvement in CAS at weeks 4 and 8 respectively. The improvement in terms of the mean of CAS in cases of group B was more compared to group A. (p=0.636 at week 4 and 0.578 at week 8).

Conclusion: Light-based modalities of treatment in the form of localized NBUVB and PUVA can be considered as an alternative treatment of choice in cases of hand eczema as they have been shown effective by the reduction in the clinical assessment score. However, there was no statistically significant difference in the reduction in the mean clinical assessment score among the patients treated with either localized NBUVB or PUVA.

The Cost of Diagnosis of Leprosy by Active Case Detection in Kailali, Nepal

Rabindra Baskota, Dinesh Rupakheti, Anjan Rai, Bikram Gyawali, Rashmi Baral — Mon, 02 Oct 2023 00:00:00 +0000

Introduction: Leprosy is a is a chronic infectious disease caused by Mycobacterium leprae. Current modalities for early diagnosis of leprosy include active case detection campaigns, contact tracing, and skin camps. Active case detection is an effective strategy that enables early treatment, prevents impending disability, and potentially stops the spread of leprosy.

Objectives: This study was conducted to determine the cost of early diagnosis of leprosy by active case detection method in Lamkichuha Municipality of Kailali district.

Materials and Methods: In coordination with the Municipality, Leprosy Control and Disability Management Section of Ministry of Health and Population conducted a survey in July of 2022. Using active case detection method, orientation on leprosy was given to health workers followed by household visit and screening of skin lesions suggestive of leprosy. Suspected cases were confirmed by dermatologists. Data obtained from the campaign was analyzed and results presented as cost per patient.

Results: The team screened 4526 families that included 21472 persons in the Lamkichuha Municipality. Among them, 195 were suspected as leprosy by the health workers and referred to referral health facility for diagnosis. Three of them were confirmed as leprosy resulting the prevalence rate of 1.4 per 10,000 populations. The average cost spent per patient was NRS 250000 (2000 USD).

Conclusion: The cost of diagnosis of leprosy by active case detection is high. The national programs should prioritize cost-effective modalities including the awareness raising campaigns for early diagnosis.

Awareness and Pattern of Sexually Transmitted Diseases: A Hospital Based Study

Deeptara Pathak Thapa, Arnija Rana — Mon, 02 Oct 2023 00:00:00 +0000

Introduction: Sexually transmitted diseases (STDs) are infections that occurs due to sexual contact. There are various pathogens contributing for STDs. There is a rising trend of STDs globally, but actual reported cases are low due to low screening and reporting.

Materials and Methods: This study was a prospective hospital-based study. Patients were included in the study according to the inclusion criteria. All data were recorded in a preset proforma. Routine laboratory investigations along with STD workup was done in patients.

Results: A total of 62 patients were included in the study according to the inclusion criteria. The age ranged from 17-52years. There were 63% males and 37% females. The majority of patients were employed (60%). Regarding awareness about symptoms of STDs, the patients responded as Infertility in 22%, ulcers in 17%, followed by swelling, genital discharge, dyspareunia, and 24% gave multiple response. Regarding attitude about awareness of prevention of STDs, maximum patients (43%) responded that, through condom use, prevention of the STDs was possible. Out of the total patients 58% Spouse were the commonest partner in 27%. The patients presented with symptoms like urethral discharge in 26%, followed by genital ulcers, genital growth, mixed infections and vaginal discharge. The commonest diagnosis was Syphilis followed by Gonococcal urethritis, non-gonococcal urethritis, warts, Genital herpes, vulvovaginal candidiasis, molluscum contagiosum, and mixed infections.

Conclusion: Syphilis is the most prevalent STD, according to the current study. Due to the dearth of knowledge regarding STDs, the STD patients, who visit our facility may only be the tip of the iceberg. It is necessary to spread awareness about STDs among individuals through social media and educational institutions, starting at the local level and moving up to the national level.