Browsing by Author "Agrawal, Sudha"
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Publication Association of Androgenetic Alopecia with Benign Prostatic Hyperplasia: A Case Control Study(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2018) Chaudhary, Manoj Kumar; Agrawal, Sudha; Agrawal, Chandra ShekharAbstract Introduction: Androgenetic alopecia (AGA) is associated with increased risk of several systemic diseases and some environmental factors, however, controversies exist. Since AGA and Benign Prostatic Hyperplasia (BPH) share common pathogenesis and AGA manifests some decades before BPH onset, it may serve as an early marker of BPH. Objective: This study was conducted to know AGA and its association with BPH in men ≥20 years of age. Materials and Methods: Clinically diagnosed cases of AGA (n=176) and 117 age matched healthy controls were enrolled. All cases and controls were subjected for abdomino-pelvic ultrasonography, urinary flowmetry, fasting lipid profiles, glycemic index and body mass index. International Prostate Symptom Score (IPSS) was also assessed. Results: Among 176 patients, 120 (68.18%) had Hamilton-Norwood grade III AGA and 56 (31.82%) had grade IV-VII AGA. In both groups, 140 (79.55%) cases and 93 (79.49%) controls were aged <35 years respectively. Family history of AGA was present in 108 (61.36%) cases and 2 (1.71%) controls. This observation was statistically significant with OR= 89.61 (95%CI 23.67-339.29). Three (1.7%) cases and none of the controls had prostate volume >30ml. Seventeen (9.66%) cases and 4 (3.42%) controls were graded as moderately/severely symptomatic IPSS. Statistically significant association was seen between family history and early onset of hair loss (<35 years) in a male sibling or parent. Conclusion: Although positive family history was associated with early onset of AGA, no association between AGA and BPH could be elicited in our study. Keywords: Alopecia, body mass index, glycemic index, lipids, prostatic hyperplasiaPublication Better Disease Control by Multidrug Regimen in Scabies: A Randomized Controlled Trial(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2022) Pandey, Prajwal; Agrawal, SudhaAbstract: Introduction: Scabies is a highly resilient condition with varying morbidity worldwide. The treatment options widely used for the disease include topical permethrin 5% and oral Ivermectin with similar efficacy. Treatment failure due to non-compliance is a major problem with the current treatment modalities. Objectives: This study was designed to compare the efficacy of combination to the gold standard treatment regimen of scabies. Materials and Methods: A randomized controlled trial was done with 212 patients, divided randomly into two groups Group 1 and Group 2. Group 1 were treated with two-time application of 5% permethrin one week apart while Group 2 were treated with a combination of 5% permethrin and oral ivermectin (200μg/kg) on a single day. Patients were followed up every week for 4 weeks to assess the efficacy and adverse events. Results: The treatment efficacy in group 2 was more compared to group 1 after 2 weeks of follow up (72.6% vs 65.1% after 1 week; 89.6% vs 80.2% after 2 week) however it was not statistically significant. After 4 weeks of follow up, the treatment efficacy in both the groups was similar. The reduction in intensity of itching was almost similar in both the groups at every follow up. Conclusion: The combination of 5% topical permethrin and oral ivermectin showed earlier resolution of clinical symptoms compared to 5% topical permethrin alone repeated in 1 week. The reduction in intensity of itch was similar in both the groups.Publication Combination Treatment for Extensive Chromoblastomycosis: A Case Report(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2021) Khadka, Dhan Keshar; Pandey, Dipayan; Agrawal, SudhaAbstract: Chromoblastomycosis is a chronic and progressive recalcitrant fungal infection of the cutaneous and subcutaneous tissue caused by traumatic inoculation of a specific group of dematiacious fungi through skin. There are different treatment modalities for chromoblastomycosis (medical/surgical) having various efficacy. However, there is no treatment of choice for this disease. Though several therapeutic regimen has been proposed for almost 100 years, the disease may be recalcitrant and almost difficult to eradicate if diagnosed in later stage. Relapses are frequently reported. A combination of various treatment modalities is needed to achieve the best result. We report here a case of chromoblastomycosis in a 62-year-male who presented with verrucous nodules and plaques on right lower limb. The patient was unresponsive to oral itraconazole 400mg daily for 2 months but was subsequently treated with multiple serial sittings of surgical excision and carbon dioxide laser in combination with oral itraconazole over 6 months. This case report focuses on proper management and specifically on differential diagnoses and treatment modalities for chromoblastomycosis.Publication Comparison of Efficacy of Localized Narrow-Band UVB Therapy Versus Localized PUVA Therapy in Chronic Hand Eczema(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2023) Khadka, Dhan Keshar; Agrawal, Sudha; Rijal, Arpana; Shrestha, SamirAbstract: 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.Publication Cutaneous Manifestations of Thyroid Hormone Disorder(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2019) Sijapati, Karuna Singh; Rijal, Arpana; Agrawal, Sudha; Khadka, Dhan Keshar; Maskey, RobinAbstract: Introduction: Thyroid hormone disorder (THD), a major health problem, is associated with a wide range of diseases. One of the organs, which shows this wide range of clinical signs is the skin. Some dermatological findings may be the first symptoms of THD. Therefore, this study was planned to determine various cutaneous manifestations of THD that can be used as a diagnostic marker for THD. In Nepal due to lack of awareness, thyroid diseases may go unnoticed .So, cutaneous manifestations help in early diagnosis and treatment of THD. Objectives: To identify cutaneous manifestations of THD and to evaluate dermatological manifestations specific for THD. Materials and methods: Seventy six patients with diagnosis of THD attending endocrine clinic of Internal Medicine Department in BPKIHS, Dharan were consecutively assessed for cutaneous changes by detailed history and clinical examination. As a control group, 26 age and sex matched individuals without THD were included to assess frequency of cutaneous manifestation in normal individuals. Results: Fifty five (72.3%) cases and 4(15.4%) control had skin changes. This observation was statistically significant with OR-14.4(95% CI4.43 – 46.78) and p<0.001.Hair changes (OR-2.100, 95% CI 0.647-6.821 and p=0.210) and nail changes (OR-1.818, 95% CI 0.371-8.902 and p=0.726) had no statistically significant association with THD. Conclusion: THD may present as or be associated with many changes in skin, hair and nails. Keywords: Cutaneous changes, Hypothyroidism, HyperthyroidismPublication Dermatological Practice in Nepal during COVID-19 Crisis: Recommendations of National Panel of Experts(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2020) Parajuli, Sudip; Pokhrel, Dinesh Binod; Agrawal, Sudha; Kumar, Ajay; Pokhrel, Kumar; Bastola, Anup; Bhattarai, Sabeena; Shrestha, Shristi; Shrestha, Manisha; KC, Shekhar; Joshi, Smita; Das, Anil Kumar; Shah, Mahesh; Joshi, Shambhu Dutta; Paudel, Sushil; Hirachan, Shashi; Paudel, Upama; Neupane, SaraswotiAbstract: Introduction: Novel Coronavirus disease has caused a substantial halt to the ongoing world in every aspect. There are medical and social implications of the disease. Cutaneous manifestations have been reported to be a part of the disease as well. Dermatologists globally are in dilemma with the clinical practice because of the fear of acquiring the disease. Objectives: This article aims to recommend best practice measures that can be followed in local scenario for re-opening up of dermatological services in the context of Nepal. Materials and Methods: A preliminary draft for guidance on Dermatological services based on recommendations of American Academy of Dermatology, International league of Dermatological societies, National recommendations from Ministry of Health, Nepal was sent to a panel of national experts to determine the level of consensus in first week of April, 2020. A preliminary survey was sent to all the members of Society of Dermatologists, Venereologists, and leprologists of Nepal on first week of June and a second draft was subsequently formed which was sent again to experts and revised based on the opinions of national experts. Results: A total of 19 experts participated in the preparation of draft and reached a national consensus after a series of revisions in preliminary draft. Conclusion: Agreements regarding the opening of practice in dermatology discipline have been summarized. Recommendations have been made for opening of dermatological services – opening of outpatient department, performing dermatosurgical and cosmetic procedures as well as strategies on triage of patients and use of masks. Keywords: Coronavirus, Dermatology, Disease, NepalPublication Efficacy of Autologous Injectable Platelet Rich Fibrin in Facial Atrophic Acne Scars in Combination with Microneedling: A Randomized Clinical Trial(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2024) Pandey, Katyayani; Agrawal, Sudha; Pandey, PrajwalAbstract: 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.Publication Efficacy of Intense Pulse Light with Triple Combination Cream Versus Triple Combination Cream alone in the Treatment of Melasma(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2021) Verma, Anshul; Agrawal, SudhaAbstract Introduction: Various studies explored the use of intense pulse light (IPL) therapy in treating melasma, but only a few randomized clinical trials have evaluated the combination of triple combination cream (TCC) with IPL so far. Objective: This study compared the efficacy and safety of the combination of IPL and triple combination cream with triple combination cream alone in treating melasma. Material and Methods: Sixty patients with melasma were enrolled in this assessor-blinded, parallel-group randomized controlled study. Thirty patients were treated with IPL (15J/cm2, two sessions at 2-week intervals) and TCC (Hydroquinone 2%, tretinoin 0.025%, fluocinolone acetonide 0.01%) at night and broad-spectrum sunscreen during day time whereas other groups received only TCC and broad-spectrum sunscreen. The median percentage reduction in melasma area and severity index (MASI) and physician’s global assessment scale was assessed at 12-week to determine the efficacy of the treatment. The incidence of adverse effects at each follow-up and relapse at 16-week were also noted during the study period as the secondary outcome measure. Results: The median reduction in MASI achieved at 12 weeks was 48% in the IPL+TCC group and 13.1% in the TCC group from the baseline. The incidence of relapse was seen in 7.14% and 13.04% patients in the IPL+TCC group and TCC alone group respectively at 16 weeks however, this difference was not statistically significant (p<0.05). Conclusion: Our study supports that IPL and TCC are more effective than TCC therapy alone in treating melasma. Keywords: Intense Pulse Light, Melasma, Triple Combination CreamPublication Evaluation of Nail Psoriasis: Delving into Some Useful Scores(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2023) Agrawal, Sudha; Khare, ShikhaAbstract: 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.Publication Perception of Tele-dermatology Consultation among Social Media Users(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2022) Poudel, Sishir; Pokharel, Sushan; Agrawal, Sudha; Marahatta, SuchanaAbstract Introduction: Tele-dermatology is significant for faster delivery of health care particularly in geographically isolated areas. Objectives: To know the perceptions of tele-dermatology consultation among social media users in terms of impact, their willingness to pay for the consultation and the barrier they may have during the consultation. Materials and Methods: An exploratory cross-sectional study was done on 360 social media users online regarding impact (time and cost), willingness to pay and the barriers of tele-dermatology consultation by using the questionnaire. Results: Participants believed the services to be time saving (91.7%) and cost effective (89.2%). Majority (70.3%) were willing to pay for services and 30.8% agreed NRs.400 fee and 37.2% agreed NRs.200 fee. Those willing to pay less than NRs 200 felt “services not being 100% reliable (59.3%), OPD price being cheaper (48.1%), saving doctor’s time too (38.3%), Wi-Fi and mobile data also cost (22.2%) and transportation fee could not be accounted to the doctor’s fee (13.6%)”. While participants not willing to pay any money responded as the services not being 100% reliable (60.7%) and preferred to visit OPD for consultation (47.7%) if paying the price. The barrier in using tele-dermatology were dissimilarity from face-to-face interaction, poor networking in rural area, unavailability of physical examination, low camera quality leading to misdiagnosis and not convenient for multiple lesions. Conclusion: The impact of tele-dermatology in terms of cost and time is appreciable. However, for better service implementation the barriers of the participants, needs to be evaluatedPublication Role of Anti-oxidants in the Treatment of Vitiligo(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2019) Kumar, Amit; Agrawal, Sudha; Dhali, Tapan Kumar; Majhi, Shankar KumrAbstract: Introduction: The role of free radicals and oxidative damage in the pathophysiology of vitiligo has been documented in recent studies. Antioxidant supplementation has been reported to be useful in the treatment of vitiligo. Objective: To evaluate the role of oral antioxidants supplementation therapy in the treatment of vitiligo by assessing the onset of repigmentation and oxidative stress. Materials and Methods: A total of 80 cases of vitiligo randomized into two groups: antioxidant and placebo comprising 40 patients each and were followed up for 8 weeks for the assessment of onset of repigmentation of vitiliginous lesions as primary outcome. The activities of Malondialdehyde (MDA), Vitamin C, and Vitamin E in serum and of Catalase (CAT) in erythrocytes of patients at baseline and at end of eight weeks were also assessed by using the spectrophotometric assay. Results: The onset of repigmentation was noted significantly earlier among the anti-oxidant group as compared to the placebo group (p=0.015). At the baseline, between the two groups, no significant difference was found in the different biochemical parameters. However, at the end of 2 months the level of MDA (p<0.001) was found to be significantly lower and that of Vitamin E (p<0.001) and CAT (p=0.005) was significantly higher among the anti-oxidants group as compared to the placebo group. Conclusion: Antioxidant supplementation carried a better response in terms of early onset of repigmentation and significant decrease in the oxidative stress, in the short follow up of two months. Keywords: Anti-oxidants, Vitiligo, Oxidative stressPublication Sporadic Progressive Symmetric Erythrokeratoderma: Classical Presentation of a rare Condition(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2019) Agarwal, Kompal; Agrawal, Sudha; Pradhan, AnjuAbstract: Progressive symmetrical erythrokeratodermia (PSEK) is a rare autosomal dominant genodermatosis presenting in infancy or early childhood. An 11-year-old male presented with a history of pruritic, erythematous, scaly, hyperkeratotic plaques first noted at 5 years of age, with no history of similar lesions in the family. Cutaneous examination revealed multiple, irregularly shaped, erythematous plaques with fine, shiny white, adherent scaling distributed symmetrically over the face, trunk, inguinal area, bilateral axillae and extensor surfaces of limbs. Palmoplantar keratoderma was present with thickened, yellowish discolored nails. No systemic abnormality was found. The histopathological findings were consistent with PSEK. The case is being reported to increase the awareness about this rare disease. Keywords: Genetic Heterogeneity, Keratoderma, palmoplantar, Nepal, RetinoidsPublication Steroid-induced Rosacea- A Study From a Tertiary Care Hospital of Eastern Nepal(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2021) Chaudhary, Manoj; Agrawal, SudhaAbstract: Introduction: Topical corticosteroids (TC) are useful for treatment of various dermatological conditions in all age groups. Due to its cosmetic application TCs misuse is intertwined with fairness creams in our colour conscious society where people are obsessed with fair colour. Aims and Objectives: To find the clinical presentations of steroid induced rosacea like-dermatitis on the face and to evaluate the purpose behind misusing TCs on the face. Materials and methods: Descriptive prospective questionnaire-type case series study was approved by Institutional Ethical Committee of BPKIHS which involved 205 patients diagnosed as Steroid Induced Rosacea who consulted Dermatology OPD between March to June 2017. Results: Among 205 patients enrolled, majority were from second to fourth decade (87.31%) of their life and maximum being females I.e. 91.2%. Around 97% of the study population were unaware of side effects of TCs. Most patients use Mometasone fuorate (58.04%) for melisma (88.29%). Friends acted as source of prescription (29.75%), followed by Pharmacist (24.88%) & Beauty centers (20%). Dermatologists prescribed TCs in only 6.34% cases. Sun exposure was identified as the triggering factor for steroid induced rosacea in 73.17% patients. Cheek was the commonest site involve in 92.19%, followed by forehead (65.36%), perioral area (46.83%), and chin (9.75%). Mixed type of lesions was the commonest lesion found in 52.20% patients, followed by diffuse facial erythema (36.09%), & telangiectasia (33.17%). Conclusion: TCs misuse in the younger people for the sake of fairer skin with little or no knowledge about the adverse effects of this medication should be stopped. Keywords: Misuse, Steroid Induced Rosacea, Topical CorticosteroidsPublication Sturge Weber Syndrome – Roach’s Type II Variant(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2020) Bista, Muna; Agrawal, Sudha; Taparia, SwetaAbstract: Sturge-Weber syndrome (SWS) is a neurocutaneous sporadic disorder caused by mutation in GNAQ gene responsible for persistence of vascular plexus around cephalic portion of neural tube. It has a wide spectrum of cutaneous, neurologic and ophthalmic manifestations, which may or may not be associated with one another. Roach scale has classified it into three types. Here, we present a case of Roach’s Type II variant of SWS with Port-wine stain (PWS) and ocular abnormalities without Central Nervous System (CNS) involvement. A 24 months old female presented with hemangioma involving the left side of face since birth. She had history of corneal edema and buphthalmos at two days of life. There was no history of seizure or developmental delay and Magnetic Resonance Imaging (MRI) of the head ruled out cranial hemangioma. Roach’s Type II is a rare variant of SWS and should be suspected in any case having PWS along the course of trigeminal nerve with congenital glaucoma because the neurologic involvement in a given case may vary from an absence to overt clinical manifestations with or without radiological changes. Due to its wide range of manifestations, a multidisciplinary approach is required for proper management of these patients. Keywords: Neural Tube, Neurocutaneous Syndromes, Port-Wine Stain, Sturge-Weber Syndrome