Browsing by Author "Parajuli, Sudip"
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Publication A Clinical Study of Steroid Induced Dermatoses(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2018) Parajuli, Sudip; Paudel, Upama; Poudyal, Amod Kumar; Pokhrel, Dinesh BinodAbstract: Introduction: Steroid induced dermatoses on face are one of the common presentations in Dermatological practice. Objectives: 1) Understand the clinical patterns of adverse effects of long term abuse of topical steroid on face and 2) Assess the factor which promotes its abuse. Materials and Methods: This was a descriptive exploratory cross-sectional study carried out from December, 2013 through November, 2014. A total of 39 patients fulfilling the inclusion criteria were enrolled into the study. All the study variables were recorded using preformed structured questionnaire and analyzed. Results: The following effects of steroid abuse on face were seen: pruritus (38.5%), burning (15.4%), eythema (74.4%), telangiectasias (66.7%), acneiform eruptions (59%), comedones (35.9%), xerosis (55.1%), photosensitivity (51.3%), rebound phenomenon (38.5%) and others (38.5%). Most of them used steroids on recommendation of their friends (38.5%) and pharmacists (20.5%). All of them used steroid for different dermatoses on their face. Limitations: This is a hospital-based small-scale study and might not be true picture of problem in the community. Conclusion: Long term use of steroid on face results in different clinical presentations. Most of the patients used steroid on recommendation of their friends facilitated by easy availability of the drug over- the -counter. Keywords: Comedones, erythema, non prescription drugs, papules, pustules, rosacea, steroidsPublication Clinical Characteristics and Pattern of Use of Topical and Oral Antifungal Drugs in Recalcitrant Dermatophytosis: A Hospital-Based Study(Institute of Medicine, Tribhuvan University, 2025) Parajuli, Sudip; Paudel, UpamaAbstract: Introduction Studies on clinical characteristics of recalcitrant dermatophytosis from Nepal are sparse. The objective of this study was to characterize recalcitrant dermatophytosis clinically and to see pattern of use of existing antifungals drugs in these patients. Methods This was a prospective observational study carried out in department of dermatology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal for a period of one year (December 2022 through November 2023). All the cases of recalcitrant dermatophytosis who visited dermatology outpatient department during this period were included in this study. The study variables included age, sex, occupation, site of involvement, prior use of topical drugs, oral terbinafine and oral itraconazole. Descriptive analysis of data was done using frequencies and percentages. Results Out of sixty cases of recalcitrant dermatophytosis, there were 32(53.3%) females and 28(46.7%) with mean age 34.47(SD +/- 11.96). Plaque (75%, n=45) presentation was the commonest type followed by annular (15%, n=9), polycyclic (6.7%, n=4), and patch type (3.3%, n=2). Multiple sites were involved in 35 patients (58.3%). Most of the patients had used topical corticosteroids (36.7%, n=22) at presentation. Sixteen patients had history of use of oral drugs prior to presentation without any improvement; Itraconazole (23.3%, n=14) was the most common drug used, followed by Terbinafine (1.7%, n=1). Conclusion: Plaque type of recalcitrant dermatophytosis in young female with multiple sites of involvement was the most common presentation. Many patients had used topical corticosteroid and topical antifungals while majority had never used oral drugs prior to presentation in hospital.Publication Compliance with Society Guidelines in COVID-19: A Survey on Members of Society of Dermatologists, Venereologists and Leprologists of Nepal(Institute of Medicine, 2023) Paudel, Upama; Parajuli, SudipABSTRACT Introduction: COVID-19 pandemic affected the practice of dermatologists of Nepal. The Society laid down the guidelines for safe practice in the interest of its members and patients based on the available evidence at that time. The aim of this study was to assess the compliance of members to its guidelines. Methods: This was a descriptive cross-sectional study carried out from 1st June 2020 to 1st July 2020 by circulating questionnaire via Google form to dermatologists who were members of Society of Dermatologists, Venereologists, and Leprologists of Nepal. The study variables included personal details of the participants and questionnaires related to guidelines. The responses of participants were collected, and descriptive analysis of the data was done. Results: Out of 200 members at the time of study who were sent the mail, only 90 (45%) members responded to the questionnaire. Out of all these respondents, 76 (84.4%) were following the guidelines laid down by the society. Only 43 (47.8 %) of the respondents had deferred patients of outpatient department as per the guidelines. Out of all respondents, 60 (66.7%) had attended dermatological emergencies and triage was done by 50 (55.6%) members. Conclusion: The study showed that most of the members who were responsive to the survey questions sent to them were compliant with the guidelines laid down by the society. Keywords: COVID 19 pandemic, compliance, guidelines, SODVELONPublication Depression, Anxiety, and Stress among Vitiligo Patients and Healthy Controls at A Tertiary Hospital: A Comparative Cross-Sectional Study(Institute of Medicine, 2025) Mishra, Vilok; Khadka, Anupa; Tulachan, Pratikchya; Parajuli, SudipABSTRACT Introduction: Vitiligo is often associated with stigma, leading to emotional distress and increased vulnerability to mental health disorders such as depression, anxiety, and stress. This study aimed to compare the levels of these psychological issues between vitiligo patients and healthy controls, while also examining the impact of socio-demographic and clinical factors. Methods: This hospital-based cross-sectional study included 42 vitiligo patients and 42 healthy controls. The Vitiligo Area Scoring Index (VASI) was used to assess the severity of vitiligo, and the Depression Anxiety Stress Scale (DASS-21), comprising three subscales: Depression (DASS-D), Anxiety (DASS-A), and Stress (DASS-S), was used to evaluate depression, anxiety, and stress. Descriptive statistics and non-parametric tests were used for data analysis. Results: Among vitiligo patients, 50% (n=21) exhibited depressive symptoms [median DASS-D score 9 (IQR 1.5-18.0)], compared to 19% (n=8) of controls. Anxiety symptoms were present in 54.8% (n=23) of the vitiligo group [median DASS-A score 8 (IQR 2.0-16.5)], compared to 21.4% (n=9) of controls. Stress was reported in 31% (n=13) of the vitiligo group [median DASS-S score 11 (IQR 2.0-16.5)], compared to 7.1% (n=3) in controls. Significant differences were found in depression, anxiety, and stress between the two groups (p = 0.005, p = 0.003, p = 0.02). A negative correlation between vitiligo duration and anxiety/stress was observed (p=0.03, p=0.01). Positive correlations existed among the DASS-D, DASS-A, and DASS-S scores. Conclusion: Patients with vitiligo were more susceptible to psychological distress, including symptoms of depression, anxiety, and stress, and experienced these issues at significantly higher rates compared to healthy controls. Keywords: Anxiety; depression; stress; vitiligo seekingPublication 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 Impact on Quality of Life in Chronic Pruritus in a Tertiary Level Hospital in Kathmandu(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2024) Panta, Arnab; Pokhrel, Dinesh Binod; Parajuli, SudipAbstract: Introduction: Chronic pruritus is a common complaint in various dermatologic as well as non-cutaneous conditions, and it leads to significant impairment in the quality of life of the individuals suffering from it. The 5-D Itch Scale is an internationally validated multidimensional tool for the assessment of the burden of itching, localization patterns, pruritus intensity and evolution, as well as impaired sleep, difficulty in performing daily household activities, and social obligations and responsibilities in school and work. Objective: To assess the impact on various aspects of quality of life in chronic pruritus in a tertiary level hospital in Kathmandu. Materials and Methods: This was a hospital-based descriptive cross-sectional study conducted in the Department of Dermatology and Venereology, Tribhuvan University Teaching Hospital, Kathmandu, over a period of one year (October 2020 through September 2021), involving 180 participants. The impact on quality of life was measured with the 5-D Itch Scale. Results: The mean total 5-D score was 17.06 ± 2.697 (range 8 to 25), showing a severe impact on the quality of life of participants. Pruritus was unbearable in 22.2% and of severe intensity in 47.8% of participants. The impairments in sleep were found to be the most disabling by 40.5% of participants, while the majority of participants (93.9%) had developed some form of disability in leisure or social activities due to chronic pruritus. Conclusion: Individuals suffering from chronic pruritus face severe deterioration in various aspects of quality of life.Publication Leprosy in Post Elimination Period: An Experience in a Single Tertiary Care Centre in Kathmandu, Nepal(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2019) Paudel, Upama; Parajuli, SudipAbstract: Introduction: Leprosy elimination was declared by Government of Nepal almost a decade back. Objective: To evaluate the clinical and epidemiological profiles of leprosy patients in post elimination period Material and Methods: Analysis of medical records of all clinically diagnosed and newly registered cases of leprosy attending Dermatology outpatient department of Tribhuvan University Teaching Hospital, Kathmandu, Nepal from 1st April 2017 to 31st March 2018 was done. Results: Hospital based prevalence of Leprosy was found to be 0.24%, with males outnumbering females (63.6% vs 36.4%).The most common age group affected was 45-59 years with hypo-aesthetic patches/plaques and erythematous anaesthetic /hypoaesthetic patches (36.4% each) being the most common presentation. Overall, borderline leprosy was the most common diagnosis (borderline tuberculoid ,29.5% , borderline borderline, 6.8%, borderline lepromatous,11.36%). Slit skin smear positivity was found in 50% of cases. Conclusion: Leprosy still remains a challenge for clinicians in Nepal though elimination has been achieved. A constant evaluation, monitoring and case detection should be still pursued with health education in order to make timely diagnosis and prevent deformities. Keywords: Leprosy, Nepal, Public healthPublication Recurrent Angioedema: A Case Series of C1 Esterase Inhibitor Deficiency(Perinatal Society of Nepal (PESON), 2025) Paudel, Upama; Parajuli, Sudip; Chapagain, Laxman; Sharma, AshuAbstract: We report a case series of recurrent angioedema, hereditary and acquired, diagnosed after a long period of time. The first and the second patient presented initially at the age of 13 years and were diagnosed finally at the age of 27 years and 18 years respectively. The third case is reported in an adult and was finally diagnosed as case of acquired angioedema. The patients were managed with danazol and tranexamic acid in absence of standard recommended drugs. The cases highlight the importance of diagnosing cases during childhood and emphasize the need of standard drugs in our scenario.Publication Severity of Stress in Acne Patients Attending Dermatology Outpatient Department of Tertiary Hospital in Kathmandu(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2021) Shrestha, Amrita; Pokhrel, Dinesh Binod; Parajuli, Sudip; Chapagain, Manisha; Shrestha, RabinaAbstract: Introduction: Stress persists when a person is unable to cope with the situations of the past, present or future. Stress may be associated with physical and psychological abnormalities. Acne vulgaris is a chronic inflammatory disease of the pilo-sebaceous units with prevalence of more than 85% in adolescent age group. Materials and Methods: Three hundred one patients were recruited in the study. Inclusion criteria included new acne patients of age 16 years and above as well as those who were using but not improving with topical or oral acne therapies. Exclusion criteria included patients receiving sedatives, antidepressants, or glucocorticoids, patient suffering from chronic illnesses like diabetes, hypothyroidism, chronic kidney disease, migraine and other diseases. This questionnaire included biodata of the patients, clinical history and their perceived stress scale. Global Acne Grading System (GAGS) was used to assess acne severity in relation to stress using the Perceived Stress Scale (PSS). Results: The results indicated an increase in stress severity positively correlated with an increase in acne severity, which was statistically significant (p<0.01). Most of the patients were students. Subjects with higher stress scores, determined using the PSS, had higher acne severity when examined and graded using the GAGS. Conclusions: The results showed that there is a positive correlation between severity of stress and grade of acne. Stress management should be a part of acne management. Keywords: Acne, Severity, StressPublication SODVELON News, Events and Transactions(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2012) Parajuli, SudipNA Keywords: SODVELON, Nepa