Browsing by Author "Khadka, Dhan Keshar"
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Publication Clinico-Histopathological Study of Cicatricial Alopecia in a Tertiary Care Center(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2022) Bista, Muna; Khadka, Dhan Keshar; Upadhyaya, ParichaAbstract: Introduction: Cicatricial alopecia (CA) comprises a group of disorders characterized by permanent destruction of the hair follicle and fibrosis on histopathologic examination. The similarities in the clinical presentation of various types of this disorder cause difficulty in prompt diagnosis, so histopathological assessment plays a pivotal role in the diagnosis. Objectives: This study aimed to assess the clinical variants of cicatricial alopecia and compare the histopathology of the various subtypes. Materials and Methods: In this cross-sectional study, 22 patients of cicatricial alopecia were enrolled and punch biopsies from the active site were taken for histopathological examination. Statistical analysis and correlation of clinical and histopathological features were done. Results: Out of the 22 patients, 10 cases (45.45%) were confirmed as Lichen Planopilaris (LPP), seven (31.81%) as Discoid Lupus Erythematosus (DLE), two (9%) as Morphea, one (4.5%) each as Pseudopelade, Central Centrifugal Cicatricial Alopecia (CCCA) and Dissecting cellulitis (DC). There was a fair agreement between clinical and histopathological diagnoses (Kappa=0.384). The age ranged from 10 years to 60 years with the mean age of 32.32 ± 15.51 years. Conclusion: There is high clinical and histopathological variability and similarities among the variants of CA, which represents a true diagnostic challenge. A precise and early diagnosis is possible if the clinico-histopathological correlation is employed.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 Methotrexate plus narrow band ultraviolet B (NBUVB) versus methotrexate alone in the treatment of moderate to severe plaque psoriasis: A randomized clinical trial(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2015) Khadka, Dhan Keshar; Agrawal, S; Dhali, T KAbstract: Introduction: Psoriasis is a chronic, recurring inflammatory disease affecting the skin, joints and nails that has a significant negative impact on the quality of life. Efficacy of combination of methotrexate/narrowband ultraviolet B (NBUVB) phototherapy in the treatment of psoriasis has been rarely assessed. Objectives: To compare the therapeutic efficacy of methotrexate plus NBUVB phototherapy combination vs. methotrexate in the treatment of moderate to severe chronic plaque psoriasis. Material and methods: Seventy-nine patients with chronic plaque-type psoriasis (body surface area involvement >2%) were randomized to receive either methotrexate/NBUVB phototherapy (group A) or methotrexate (group B). End point of treatment was 75% reduction in Psoriasis Area and Severity Index (PASI75) Score or up to 12weeks, whichever was earlier. Patients were then followed up for a period of 12 weeks for assessment of adverse effect, DLQI and relapse. Results: Of 79 patients, 69 completed the treatment period and follow-up. PASI 75 was achieved in 35/39(89%) patients in group A and 34/40(85%) patients in group B (P=0.052). The mean number of weeks (P = 0.031), the mean cumulative dose of NBUVB (8.2±3.5J/cm2)) and the mean number of phototherapy sessions (12±3)) required to achieve PASI 75 were less in group A compared with group B. There was no significant difference in the number of patients who relapsed during the follow- up period (P = 0.68). Conclusion: Combination of methotrexate and NBUVB phototherapy provides more rapid clinical improvement compared with methotrexate monotherapy in the treatment for chronic plaque-type psoriasis. Keywords: DLQI, Methotrexate, NBUVB, PASI, Psoriasis