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 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 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 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.Publication Q-Switched Neodymium-Doped Yttrium Aluminum Garnet Laser Therapy for Pigmented Skin Lesions: Efficacy and Safety(Kathmandu University, 2012) Karn, D; KC, S; Amatya, A; Razouria, EA; Timalsina, M; Suwal, AABSTRACT Background Nepalese population with Fitzpatrick skin types III-V has high prevalence of pigmentary disorders and it is a growing cosmetic concern. Q-Switched Neodymium- Doped Yttrium Aluminum Garnet (QS Nd-YAG) laser is an efficacious tool in the treatment of pigment disorders. Objective To highlight the efficacy and safety profile of various pigment disorders. Methods A prospective study done in Dhulikhel Hospital, Kathmandu University Hospital from January 2009 to January 2011. Patients undergoing laser for pigmented skin lesions were followed for response and safety profile. We included total 270 patients in the study with various disorders especially nevus, tattoos and melasma. Settings were repeated at 3-4 weeks interval and response was evaluated on clinical basis. Efficacy was then evaluated according to various parameters. Results For nevus, total 840 treatment sessions had been performed with an average of 6.88 sessions (range 3-11). Nd: YAG laser was very efficacious in removal of blue and black colored tattoos with an average of 7.9 and 9.5 sessions respectively. However, red mixed with blue and or green tattoos were relatively resistant to treatment and required average 10.33 treatment sessions. Melasma and freckles both responded to the therapy but recurrence rate was high. Conclusion Our results indicate that QS Nd: YAG laser is an effective modality for pigment disorders among Nepalese population. Nevus and melasma respond well but recurrence rate of melasma is high. Blue tattoos respond well while mixed colored tattoos are quite resistant to Nd: YAG laser alone. Transient pain and temporary hyperpigmentation are common side effects. KEY WORDS Laser, melasma, nevus, tattooPublication Triiodothyronin, Thyroxine and Thyrotropin in Vitiligo(Kathmandu University, 2011) Subba, K; Karn, D; Khatri, RABSTRACT Background Vitiligo is a common pigmentary disorder of the skin, affecting individuals globally. Not only is this ailment psychologically incapacitating, it also has a high incidence of autoimmunity, signifying that its manifestations may be the portrayal of dysfunction of immune system. Objective The aim of this study is to find out the situations of abnormal thyroid function test (TFT) in vitiligo patients. Methods A prospective cross sectional study was conducted at the Dhulikhel Hospital, KUTH, Dhulikhel during November 2008 to January 2011 with the objective to assess the thyroid function tests in vitiligo patients. Results Total 66 vitiligo patients with male 30 (45%) and female 36 (55%). Total 26 (39.39%) vitiligo patients have been found to have abnormal thyroid function test. Among them 10 had abnormal T3, seven had abnormal T4 and 12 had abnormal TSH level. Thyroid function test were normal in other vitiligo patients. Total seven vitiligo had high level of T3 than normal value, four male and three female. Two had higher level of T4 above 2.0 ng/dl and all were male, while five had abnormally low level of T4 with three male and two female. There were seven vitiligo patient with increased T3 level and three with decreased T3 level, among them six were males and four were females, the age group was ranged from seven to 68 years old. The T4 level were found abnormal in seven vitiligo patients among which five were males and two were females with the age group ranging from 7 to 51 years. Conclusions There has been significant association of thyroid disorder in the patient with vitiligo. Therefore, patient with vitiligo need to undergo thyroid function test to rule out the thyroid disorder and prevent from long-term complications. KEYWORDS thyroid, thyroxin, thyroid function test, vitiligo