Browsing by Author "Karn, D"
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Publication Publication Bowen's disease: Response to topical 5% imiquimod and cryotherapy(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2015) Rajouria, Eliz Aryal; Amatya, A; Karn, DAbstract: We present a case of persistent and progressive Bowen's disease (squamous cell carcinoma in situ) in right inner thigh, skin type V in 65 years age female from Ramechap in 2014. Treatment with imiquimod 5% cream was effective when applied once a day for three consecutive days for three month followed by maintenance with cryothrerapy for further three month. Keywords: Benign disease, Liquid nitrogen, Cryotherapy, lmiquimod, Bowen's diseasePublication Clinical Profile and Management of Paederus Dermatitis: Insights from Teledermatology in a Tertiary Care Setting in Nepal(Kathmandu University, 2025) Shrestha, E; Basukala, MS; Mishra, A; Basnet, A; Karn, D; Tamang, AABSTRACT Background Paederus dermatitis is a cutaneous reaction caused by the contact of rove beetles (Paederus species) on the skin. Common in tropical regions, including Nepal, this dermatitis poses a diagnostic challenge in remote areas where dermatological care is limited. Teledermatology, employing telecommunications for remote consultations, has shown promise in addressing these limitations, yet its effectiveness in diagnosing and managing Paederus dermatitis in Nepal has yet to be thoroughly explored. Objective To analyze the clinical profile and management outcomes of Paederus dermatitis through teledermatology at a tertiary care hospital in Nepal. Method A retrospective cross-sectional study was conducted on 54 patients diagnosed with Paederus dermatitis through teledermatology at Dhulikhel Hospital between June 2024 and August 2024. Statistical analysis was performed to evaluate associations with demographic and clinical factors. Result The study comprised 54 patients (59.26% males and 40.74% females) with a mean age of 28.4 ± 6.6 years. The most frequent symptoms included itching with a burning sensation (35.2%) and pain (24.1%). Linear erythematous plaques were observed in 42.6% of cases. Only 20.4% reported direct insect contact. Correlation analysis showed weak relationships between age, symptom duration, and lesion count. Multivariate regression indicated a baseline symptom duration of 2.7 days, with no significant association between age or lesion count and symptom duration. Conclusion Teledermatology is a valuable tool in diagnosing and managing Paederus dermatitis in rural Nepal, where direct access to dermatological care is limited. Future research should focus on expanding teledermatology’s role in other dermatological conditions. KEY WORDS Dermatology, Paederus dermatitis, Pederin, Rural health, TeledermatologyPublication Clinico-etiological Profile of Melasma among Female Health Workers in a Tertiary Care Center of Central Nepal - A Cross Sectional Study(Kathmandu University, 2017) Karn, D; Subedi, A; KC, SABSTRACT Background Melasma is an acquired symmetrical dyschromia with profound psychosocial impacts. It is a common pigmentary disorder with less clear etiology and limited management options. There are limited data regarding melasma in our scenario. Objective To evaluate the clinico-etiological profile of melasma, among the female health workers (FHW) in a tertiary health center. Method This is a single center, cross-sectional, descriptive study involving female health workers with or without melasma. A total of 198 female health workers were evaluated at Dhulikhel hospital Kathmandu university hospital for clinic-etiological profile of melasma in January 2017. Video-dermatoscopy was used for the clinical diagnosis of melasma. A structured, self-administered questionnaire was used for assessment. Risk factor assessment of etiological agents as sun exposure, hormonal medication, photo aggravating drugs, stressors as night duty were evaluated. Result The point prevalence of melasma among female health workers 20.7% (n=41). The mean age of respondents was 26.2 ± 3.23 years with duration of disease process 3.6 ± 2.5 years. Centro-facial pattern was the commonest clinical type (53.7%) and video-dermatoscopy revealed mixed pattern as the commonest (56.1%) pigment deposition pattern. Among 132 female health workers doing night duty on regular basis, 23 had melasma while 66 female health workers not doing night duty, 18 had melasma (p = 0.10). Whereas while comparing hours of night duty per week among respondents with melasma (n=23) and without melasma (n=18) were 23.72±10.08 hours and 17.8±4.77 hours respectively (p=0.02). Conclusion The present study reveals higher prevalence of melasma among female health workers having more stressors as night duty. KEY WORDS Female, health worker, melasmaPublication Combination Topical PUVAsol with Methotrexate Versus Methotrexate in the Treatment of Palmoplantar Psoriasis(Kathmandu University, 2016) Karn, D; KC, SABSTRACT Background Non-pustular palmoplantar psoriasis (PPP) is chronic and disabling dermatosis. Topical psoralen and solar ultraviolet - A therapy (PUVAsol) is efficacious and safe therapy in psoriasis management. Objective To study the efficacy and adverse clinical effect profile of topical PUVAsol along with methotrexate in PPP. Method This is a prospective, randomized, clinical trial conducted among 54 patients with moderate to severe PPP. Patients were grouped into two categories. Group I was treated with weekly oral methotrexate only while group II had additional soak PUVAsol therapy twice weekly for a total of three months. Modified palmoplantar psoriasis area severity index (mPPPASI) score was used for quantification of severity. Patients were followed up monthly for the efficacy and adverse clinical event profile for 3 months; additionally patients were followed up monthly for next three months for assessment of relapse. Result The mean age of patients with PPP was found to be 38.7 ± 13 years and male: female ratio was 1.1:1. In comparison to group I patients, statistically significant improvement was observed among group II patients in the third month follow up (p= 0.039). Fifteen patients (35%) achieved mPPPASI 75 during the treatment period. No significant difference was noted among the mPPPASI score during relapse assessment. Eleven (29%) patients had evidence of relapse (mPPPASI more than 25% of baseline) during follow up period. No statistically significant adverse clinical events were noted. Conclusion Topical PUVAsol is an efficacious, safe and cost effective modality in moderate to severe PPP. It could be employed in rotational or maintenance therapy of psoriasis. KEY WORDS Palm, psoriasis, PUVA therapyPublication Comparative Efficacy of Fexofenadine Versus Levocetrizine Versus Desloratadine via 1% Histamine Wheal Suppression Test(Kathmandu University, 2020) KC, S; Aryal, A; Adhikary, M; Karn, DABSTRACT Background Urticaria and allergic dermatoses remains a great challenge to treating dermatologist. Histamine is the major mediator in such disorders. Antihistamines as levocetrizine, fexofenadine and desloratadine are often used to treat such conditions. Ability of antihistamines to suppress the allergic response helps to evaluate the efficacy of the medicine. Objective To compare the efficacy of levocetrizine versus fexofenadine versus desloratadine in suppressing histamine induced wheals in adults. Method One hundred and two healthy adult volunteers completed the study. Subjects were randomized into 3 groups using an envelope method. First group received fexofenadine (N=36), second group received levocetrizine (N =37), and third group received desloratadine (N=29). Pretesting was performed by skin prick test with histamine 1% (positive control) and normal saline (negative control). Wheal size was recorded before and after the treatment (at 0.5, 1, 2, 4 and 24 hours). Result At 30 minutes and 1 hour fexofenadine showed statistically significant wheal suppression than levocetrizine and desloratadine (p=0.0016). However by 2 and 4 hours all three antihistamines; fexofenadine, levocetirizine and desloratadine showed significant suppression of wheal. Whereas at 24 hours desloratadine showed greater wheal suppression than levocetrizine and fexofenadine (p= 0.014). Conclusion The results of the present study showed that fexofenadine presented early onset of action but longer suppression of wheal size was seen with desloratadine as compared to other antihistamines. These potentials could be employed in clinical aspects; depending upon the response needed. KEY WORDS Desloratadine, Fexofenadine, LevocetrizinePublication Comparative Study of 5 % Potassium Hydroxide Solution Versus 0.05% Tretinoin Cream for Molluscum Contagiosum in Children(Kathmandu University, 2011) Rajouria, EA; Amatya, A; Karn, DABSTRACT Background Molluscum contagiosum is one of the commonest cutaneous viral infections in children. All treatment modalities are associated with substantial pain, tissue destruction, and frequent recurrence. Objectives To compare the efficacy and side effects of KOH 5% solution with tretinoin 0.05% cream for the treatment of molluscum contagiosum in children. Methods Fifty patients were randomly divided into 2 groups; 25 each for 5% KOH solution and 0.05% tretinoin cream. The given medication was applied at bed time over molluscum lesions. The assessment of response and side effects were performed weekly for 4 weeks. Results At the end of 4 weeks, the mean lesion count decreased from 9.48±3.00 SD to 1.67±0.58 SD and from 8.35±2.82 SD to 2.00±1.00 SD in patients treated with 5% KOH solution and 0.05% tretinoin cream respectively. Conclusion The result of both KOH and tretinoin showed good response, well tolerated by children but between the two, KOH showed fast recovery and most lesions were resolved before 4 week. The side effects could be minimized if applied as stated above. On the other hand, tretinoin showed delayed response and even some of lesion extended beyond 4 week but the side effect were less, and hence can be used in recurrent cases. KEY WORDS Molluscum, Potassium Hydroxide, tretinoinPublication Comparative study of Methotrexate and Cyclosporine in the treatment of Psoriasis(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2010) Karn, D; Amatya, A; Khatri, RAbstract 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.Publication Concurrent Vitiligo and Psoriasis(Kathmandu University, 2012) Karn, D; KC, SABSTRACT Coexistence of vitiligo and psoriasis in a single patient is a rare occurrence. The exact pathogenesis of this coexistence is obscure. Various autoimmune disorders are reported to occur more frequently in patients with both diseases. A case of this interesting coexistence seen on a 26 year old female patient who presented to the dermatology department of Dhulikhel hospital is presented here. She also had hypothyroidism. The possible pathogenesis and literature review of this rare condition is discussed here. KEYWORDS Vitiligo, psoriasis, autoimmune disorders, hypothyroidismPublication Darier White disease(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2010) Amatya, A; Karn, D; Aryal, E; Makaju, R; Shakya, A; Priyadarshinee, AAbstract Darier’s disease was described inependently by Darier and White in 1989 AD. Reported prevalence varies from 1/100,000 in Denmark to 1 in 30- 35,000 in northern England and Scotland.1 Darier’s disease has been reported from other parts of the world, however,there has been no reported cases in Nepal. It is an inherited autosomal dominat disease characterized by dark crusty lesions over the seborrheic areas of the skin. We are reporting a case of Darier’s disease in a Nepalese patient who developed skin leison’s over his face and body at the age of 12 years. We took skin punch biopsy from the leisons, which showed findings suggestive of Darier’s disease. Our case was treated with isotrerenoin and topical keratolytics. He responded with the given treatment within two weeks of therapy.Publication Publication Diseases in Disaster: Post-Earthquake Dermatoses, Nepal 2015(Kathmandu University, 2016) KC, S; Khanal, L; Ojha, A; Karn, DABSTRACT Nepal experienced a devastating earthquake measuring 7.8 Richter scale on 25th April 2015. Although the heightened effects were secondary to trauma, the indirect effects were also of prime importance. We came across different dermatoses, directly or indirectly secondary to earthquake. We here present an audit of the cutaneous effects following four months of the major shock presenting to a tertiary care center of central Nepal. A total of 7326 patients presented to the dermatology department over a period of four months following the major shock. Among them a total of 3833 patients (52.32%) had direct or indirect dermatoses following earthquake. KEY WORDS Disaster, dermatoses, NepalPublication Emerging trends of nosocomial Citrobacter species surgical wound infection: concern for infection control(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2010) Thapa, B; Karn, D; Mahat, KAbstract Background Surgical wound infection is a common problem among patients who undergo operation. Several factors play important role in this infection process including endemic nosocomial infection without proper infection control measures. Objectives To study the occurrence of the pathogens in post-operative wound infections, their antibiotic resistance patterns, and comparison with published reports. Methods Various specimens obtained from the surgical wound during a period of four months were processed for bacteriological culture in the Department of Microbiology, Kathmandu Medical College, Kathmandu. Antibiotic susceptibility test was performed by Kirby-Bauer disk diffusion test for pathogens isolated. The relevant literatures were searched and compared with the present study. Results Among 79 culture positive cultures, Citrobacter sp. (n=23) was most frequently isolated from surgical wound infection. Twenty strains were multidrug resistant. In comparison with other studies, this study highlights the emergence multi-drug resistant Citrobacter sp. as a leading cause of surgical wound infection. E. coli, Staphylococcus aureus, Acinetobacter sp., Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus sp., and Enterobacter sp. were also isolated from 19, 13, 10, 8, 2, 2, and 2 cultures, respectively. More than 50% of these pathogens were resistant to most of the β-lactam antibiotics tested and most of them were multi-drug resistant while these pathogens showed variable level of resistance to fluroquinolones and amino glycosides. Conclusion The frequent isolation of multi-drug resistant nosocomial strains of Citrobacter sp. in surgical wound infection is a remarkable trend. This pathogen and their resistant genes could be endemic to the institution and can cause difficult-to-treat infection if infection control committee is not revitalized and infection control strategies are not implemented. Key words Citrobacter sp.; Multi-drug resistant; surgical wound infection.Publication Lichen Planus Pigmentosus: A study for association of Thyroid Dysfunction(Kathmandu University, 2016) Karn, D; KC, S; Timalsina, MABSTRACT Background Lichen planus pigmentosus (LPP) is considered a chronic and progressive variant of lichen planus. Although pigmentation occurs in the sun exposed areas, the etiology remains unknown and there are no appropriate treatment guidelines. Association with thyroid disorder has been described in various disorders of pigmentation. Objective The objective of this study was to find the association between LPP and thyroid dysfunction. Method A total of 54 clinically diagnosed cases of LPP and 54 age and sex matched healthy control volunteers were included in this case control study. Thyroid function test and thyroid peroxidase antibody were analysed to determine the probable association between thyroid diseases and LPP. Result Seventeen (31.7%) patients had biochemical evidence of hypothyroidism and 3 had hyperthyroidism among the diseased group. Among the control group two persons were tested positive for hypothyroidism (c2 = 0.34; p <0.05). Similarly, the levels of thyroid peroxidase antibody in the LPP patients were found to be significantly higher than those of controls (p<0.05). Conclusion Thyroid disorder was found to be an associated factor in LPP. Hence, we recommend routine thyroid function tests in patients with LPP. Further research is warranted among large number of patients to elucidate the exact association. KEY WORDS Lichen planus pigmentosus, thyroid disordersPublication Long Pulsed Nd:YAG Lasers in the Management of Cutaneous Warts(Kathmandu University, 2018) Shrestha, S; Karn, DABSTRACT Background Despite multiple treatment options, there is no consensus on a particular treatment modality in warts. Previous studies have reported safety and efficacy of long-pulsed Neodymium-doped yttrium aluminium garnet (Nd:YAG) laser, with clearance rates higher than those achieved with other therapies. This study was designed to evaluate the efficacy of long-pulsed Nd:YAG laser in the treatment of warts in Nepal. Objective To assess the efficacy of Long pulsed Nd:YAG in the management of verruca vulgaris. Method Fourty cases of common warts over hands and feet were enrolled in the study. Patients with less than 10 lesions were chosen. Up to three sessions of 1064 nm Long pulse Nd:YAG treatment were done, at the interval of one month. No concomitant topical or other treatment was done. Result Out of the 40 patients, four patients were lost to follow up. Among 36 patients, eight patients (22%) achieved clearance of warts in single session, while 12 (33%) patients and six patients (16%) improved after second and third sessions of laser respectively. Hence, we observed 72% clearance rate after three sessions of lasers. Adverse effects were pain during treatment and scarring in few patients. Conclusion Long pulse Nd:YAG is effective in the treatment of verruca. However, pain and tissue damage are the limitations. Hence, we suggest that Long Pulsed Nd:YAG lasers are effective in recalcitrant cutaneous and palmoplantar warts. KEY WORDS Clearance, Lasers, Palmoplantar, VerrucaePublication Nevus Lipomatosus Cutaneous Superficialis of Hoffmann and Zurhelle: a rare cutaneous hamartoma(Kathmandu University, 2022) KC, S; Aryal, A; Jha, A; Karn, DABSTRACT Nevus lipomatosus cutaneous superficialis (NLCS) is a rare idiopathic cutaneous hamartoma characterized by ectopic clusters of mature adipose tissues in dermis. It is classified into two types. Classical type presenting as multiple lesions with onset at birth or within third decade of life and solitary type with onset between third to sixth decade of life. Here we present a case of 45 years female with adult onset, asymptomatic, grouped, skin colored, soft sessile growth in zosteriform pattern on left buttock. We here intend to report rare case of classical Nevus Lipomatosus Cutaneous Superficialis. KEY WORDS Hoffmann, Nevus lipomatosus cutaneous superficialis, ZurhellePublication Oral Tranexamic Acid for the Treatment of Melasma(Kathmandu University, 2012) Karn, D; KC, S; Amatya, A; Razouria, EA; Timalsina, MABSTRACT Background Melasma poses a great challenge as its treatment is unsatisfactory and recurrence is high. Treatment of melasma using tranexamic acid (oral, topical or intralesional) is a novel concept. Objective To compare the efficacy of oral tranexamic acid with routine topical therapies for the treatment of melasma. Methods It is a prospective, interventional, randomized controlled trial conducted among 260 melasma patients. Patients were divided into two groups consisting of 130 patients each. First group (Group A) was given routine treatment measures and oral Tranexamic Acid while second group (Group B) was treated only with routine topical measures. Capsule Tranexamic Acid was prescribed at a dose of 250 mg twice a day for three months and cases were followed for three months. Response was evaluated on the basis of Melasma Assessment Severity Index (MASI). Mean scores between the two groups were then compared. Results Statistically significant decrease in the mean Melasma Assessment Severity Index from baseline to 8 and 12 weeks was observed among group A patients (11.08±2.91 vs 8.95±2.08 at week 8 and vs. 7.84±2.44 at week 12; p<0.05 for both). While among group B patients the decrease in mean score was significant at 8 weeks and insignificant at 12 weeks follow up (11.60±3.40 vs 9.9±2.61 at 8 weeks and vs. 9.26±3 at 12 weeks; p<0.05 for former but p>0.05 for later). Conclusion Addition of oral tranexamic acid provides rapid and sustained improvement in the treatment of melasma. KEY WORDS Melasma, tranexamic acidPublication Practical Aspects in Topical PUVAsol in Dermatology: An Experience in a Teaching Hospital(Kathmandu University, 2014) KC, S; Karn, DNAPublication Prevalence of Sexually Transmitted Infections in a Tertiary Care Centre(Kathmandu University, 2011) Karn, D; Amatya, A; Aryal, ER; KC, S; Timalsina, MABSTRACT Background The burden of sexually transmitted infections is huge and is disproportionately affecting developing nations. In Nepal, recent available data on sexually transmitted infections are mostly targeted to high risk population. A prevalence study was thus done to explore the pattern of sexually transmitted infection syndromes among general population of Nepal. Objectives To highlight the prevalence and changing pattern of sexually transmitted infections among general population. Methods A retrospective study. The study was conducted among 145 patients attending Department of Dermatology and Venerology, Dhulikhel Hospital Kathmandu University Hospital, for voluntary counseling and testing from April 2010 to April 2011. Syndromic case management approach was used for the classification and treatment of the patients. Results 106 patients were suffering from Sexually Transmitted Infections and 2 patients were positive for Human Immunodeficiency Virus. The most common diagnosis was genital viral infections (41.7%). Prevalence was highest among drivers/conductors (26.9%) and migrating workers (23.1%). Age group 20 to 24 years was the maximum sufferers (37%). Unsafe sexual activity (66.7%) was the most potential exposure and majority of the patients were not consistent in using condom. Conclusions Genital viral infections constitute the major bulk of sexually transmitted infections. Majority of the patients suffering from sexually transmitted infections were in the age group 20 to 24 years and were mostly drivers, conductors or migrating workers by occupation. In the background of few available baseline data, the results are expected to assist successful target interventions in the near future. KEY WORDS prevalance, sexually transmitted infectionPublication Prevalence of Skin Diseases in Kavre District, Nepal(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2010) Karn, D; Khatri, R; Timalsina, MAbstract Background Skin is the major interface of human to the environment . It is the major susceptible organ for any disease. Wide prevalence of skin diseases in the community is a well established fact. Objectve The aim of this study is to determine the prevalence of skin diseases among the general population of Kavre District,Nepal . Methods This is a hospital based, retrospective study done among all the patients visiting Dhulikhel Hospital, Kathmandu University Teaching Hospital, in Dhulikhel, Kavre during the year 2007-2008 AD. Data were obtained from the hospital out-patient records and analyzed. The total number of patients who visited the hospital were 74,279 (male-30,809 female- 43,470), out of which 7374 (9 .92 %), male 4155, female 3219, visited the Dermatology Department. Among this total study population now comparative study of the prevalence of skin diseases was performed based on sex, age and type of dermatological condition. Results The overall prevalence of skin diseases were 9.92% with slight higher rates seen among males ( 56.34 %) than females (43.65 %).Non-infective conditions , 6063 ( 82.22% ) outweighed infective conditions 1311 (17.78 %), commonest one being the pigmentary disorders (32.56 %) and in the age group 16-35 years old (31.23% ). Conclusion This study demonstrates that skin diseases are one of the most prevalent disease condition among the general population, representing a major public health problem. Keywords Prevalence; infective diseases; non-infective diseases.