NepMed Repository :: Browsing by Author "Paudel, Upama"

Browsing by Author "Paudel, Upama"

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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 Binod
Abstract: 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, steroids
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, Upama
Abstract: 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.
Clinico-bacteriological Study and Antibiotic Sensitivity Pattern in Pyodermas at a Tertiary Care Hospital of Kathmandu
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2024) Rayamajhi, Buddha; Das, Anil Kumar; Paudel, Upama
Abstract: Introduction: Pyodermas are common cutaneous bacterial infections caused mainly by Staphylococci. The causative organisms and their antibiotic sensitivity patterns are changing periodically. Objectives: The study’s objectives were to determine the clinical and bacteriological profile in pyodermas and the antibiotic sensitivity pattern of isolated organisms. Materials and Methods: It was a descriptive study conducted at the Department of Dermatology and Venereology and Department of Microbiology, Tribhuvan University Teaching Hospital, from October 2020 to September 2021, in patients with pyodermas. After history taking and examination,the swab was sent for culture and sensitivity. The details of isolated organisms and antibiotic sensitivity patterns were recorded. Results: Eighty-five patients were included in this study, 55(64.7%) males and 30(35.3%) females. The typical age group affected was 15-24 years. Lower extremities were the most common sites involved. Primary pyodermas were more common than secondary pyodermas, 45(52.9%) vs 40(47.1%).Folliculitis was the most common diagnosis in 22(25.9%) patients. Staphylococcus aureus was the most common organism isolated in 46(54.1%) cases, among which 41 isolates were methicillin-sensitive while 5 isolates were methicillin-resistant. The second most common organism was coagulase-negative Staphylococciin 25(29.4%) cases. Staphylococcus aureus was most sensitive to cephalexin and cloxacillin in 41(89.1%) cases. Coagulase negative Staphylococci were most sensitive to gentamicin in 25(100%) and ciprofloxacin in 24(96.0%) isolates. Conclusion: The change in the drug sensitivity pattern in the isolates of pyoderma warrants regular monitoring and judicious use of antibiotics to prevent the further disastrous development of drug-resistant strains of organisms.
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, Saraswoti
Abstract: 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, Nepal
Impact of Chronic Urticaria on Quality of Life in a Tertiary Level Hospital in Nepal
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2020) Das, Anil Kumar; Paudel, Upama; Brar, Navjot; Karn, Ashish
Abstract: Introduction: Most healthcare providers recognize that urticaria is frequently difficult to treat but many do not realize the substantial negative impact, chronic urticarial (CU) has on patient’s quality of life (QoL). The questionnaire specifically developed to measure health related quality of life in chronic urticaria is the Chronic Urticaria Quality of Life (CU-Q2oL) questionnaire. This questionnaire has helped to define the effects and impact on patients. Objective: To assess the impact of chronic urticaria on quality of life at tertiary level hospital in Nepal. Materials and Methods: This was a hospital based cross-sectional study conducted in the Department of Dermatology and Venereology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal, over a period of one year involving 230 patients in the study. A detailed history along with the complete cutaneous examination was carried out in all patients. Results: All the 230 patients (100%) had symptoms of wheals and pruritus while eye swelling and lip swelling was present only in 20% and 25% respectively. Highest Mean scores were seen of pruritus (4.34) and wheals (4.29). Highest mean score was achieved by domain of pruritus (4.31) followed by domain of sleep (2.31), life activities (2.22), limits (2.05), looks (1.76) and swelling (1.4). Conclusion: Chronic Urticaria impacts the quality of life by affecting various aspects in patient’s life. CU-Q2oL questionnaire could reveal the involvement of various such aspects, which were seldom realized by the patients themselves. Patients had worst quality of life with symptoms of pruritus and wheals. Keywords: Angioedema, Chronic Urticaria, Quality of life
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, Sudip
Abstract: 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 health
Pattern of Inappropriate use of Topical Corticosteroid and Cutaneous Adverse Effects at a Tertiary Level Hospital in Kathmandu
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2024) Bhandari, Sabina; Paudel, Upama
Abstract: Introduction: Topical corticosteroids are anti-inflammatory, immunosuppressive, and anti-proliferative drugs with profound efficacy. As it provides rapid relief, it is used for a wide spectrum of dermatological conditions. Rampant use of topical corticosteroids due to their easy availability gives rise to difficult-to-treat cutaneous adverse effects. Objectives: To determine the pattern of inappropriate use of topical corticosteroids and cutaneous adverse effects Materials and Methods: This was a hospital based cross-sectional prospective study conducted among 84 participants in the Department of Dermatology, Tribhuvan University Teaching Hospital, Kathmandu, from October 2020 to September 2021. Ethical clearance was obtained from the Institutional Review Committee. The participants fulfilling the inclusion criteria were included in the study. Results: Out of 84 cases, 59.5% were females and 40.5% were males. The mean age of participants was 30.4±9.1years. Dermatophytoses (71.4%) were the most common cause of inappropriate use of topical corticosteroids. The most common adverse effect was tinea incognito (23.8%). The most potent class (60%) of topical corticosteroids were misused. Most of the participants used topical steroids either for the duration of 1 week to 1 month ( 23.8%) or for more than 12 months (23.8%). Conclusion: Inappropriate topical corticosteroid use is a common problem due to its easy accessibility, resulting in several difficult-to-treat cutaneous adverse effects. So, awareness-raising activities regarding the proper use of corticosteroids have to be conducted.
Patterns and Outcomes of Cutaneous Adverse Drug Reactions in a Hospital Based Study
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2017) Paudel, Upama; Parajuli, S; Pokhrel, DB
Abstract: Introduction : Drug reactions are one of the common reasons for admission in the Dermatological beds. Data on the culprit drugs and patterns of reaction are very scarce in Nepal. Objective:To determine the patterns of drug reactions admitted in Tribhuwan University (TU) Teaching hospital, the causes of drug reactions, duration of hospital stay, duration of steroid use and the outcome of the treatment. Material and Methods: This was a retrospective study done in TU Teaching Hospital. The admissions and discharge record of admitted patients from 15th April 2008 to 14th April 2012 were analyzed for the variables mentioned above. Results: There were 61 new patients of drug reactions; however only files of 42 patients could be studied.The mean age of the patients was 32.26 ± 15.26 with male to female ratio of 1.8:1. Stevens Johnson’s syndrome (35.7%) was the commonest cause of admission followed by drug induced erythroderma (16.7%) and toxic epidermal necrolysis (11.9%). Carbamazepine, Phenytoin and allopurinol were the most common drugs for the reactions. The median time for the appearance of the lesions was 20.07 days. The median duration of hospital stay was 7 days. Steroids were used for initial treatment for around 4.9 ± 1.7 days. 83.3% of the patients improved while 11.9% succumbed despite optimal management. Conclusion: Severe drug reactions were the common reasons for admissions in our hospital. Anti-epileptics were the leading cause for the reactions. Steroids were used for initial period and rapidly tapered off in short duration. Overall, the outcomes of the treatment were good. Keywords: cutaneous drug reactions, steroids, steven-johnson syndrome, toxic epidermal necrolysis
Prevalence of Venereophobia among Patients of Non-Venereal Genital Conditions- a Cross-Sectional Hospital Based Study from Nepal
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2021) Paudel, Vikash; Chudal, Deepa; Paudel, Upama; Shrestha, Dwarika Prasad
Abstract: Background Venereophobia is the fear of getting venereal diseases or sexually transmitted diseases. This study was carried out to determine the prevalence and describe the varying clinical pattern of dermatoses among patients with venereophobia in non-venereal genital conditions. Materials and Methods This was a hospital-based, prospective, cross-sectional observational study conducted in a tertiary center in Kathmandu, Nepal, over a period of one year. A nonprobability purposive convenient sampling technique was used to select the samples. Two hundred patients were enrolled in the study. Ethical approval was taken prior to the study. A detailed history along with a complete cutaneous examination was carried out in all patients and recorded in preformed proforma. Patients with symptoms and clinical signs of sexually transmitted infections were excluded from the study. Results The prevalence of venereophobia among non-venereal dermatosis was 18%. The mean age of the patient with non-venereal genital dermatosis was 29.5 ± 15 years. The male to female ratio was 17:2. About 72% of the total patients were married. The most common symptoms of patients with venereophobia were genital itching, whereas about 44% were asymptomatic. The common dermatological disorders associated with venereophobia were pearly penile papules, genital vitiligo, irritant contact dermatitis. Three fourth of the patient with venereophobia had multiple sexual exposures. Conclusions Venereophobia is an important issue to be focused on patients with genital dermatosis and a significant number of patients might have venereophobia even in non-venereal genital dermatoses. A proper genital and psychiatric evaluation might prevent misdiagnosis and complications.
Recurrent Angioedema: A Case Series of C1 Esterase Inhibitor Deficiency
(Perinatal Society of Nepal (PESON), 2025) Paudel, Upama; Parajuli, Sudip; Chapagain, Laxman; Sharma, Ashu
Abstract: 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.

Browsing by Author "Paudel, Upama"

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