Browsing by Author "Shrestha, Dwarika Prasad"
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Publication Clinical Profile and Treatment Outcome of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis at a Tertiary Hospital of Nepal(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2025) Khadka, Anupa; Mishra, Punam; Chapagain, Laxman; Gartaula, Manisha; Gupta, Pooja; Shrestha, Dwarika PrasadAbstract: Introduction: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe forms of severe cutaneous adverse reactions (SCAR) with high morbidity and mortality. Due to its rarity and severe acute nature, there is limited data from controlled trials. This study seeks to contribute to the existing knowledge on the etiology and treatment outcomes of SJS/TEN. Objectives: To assess the clinical profile and treatment outcomes of SJS and TEN patients. Materials and Methods: A retrospective analysis of patients’ admissions and discharge records was done from April 2020 to November 2024. The variables analyzed included the clinical types (SJS, TEN, SJS/TEN overlap), causative drugs, treatment undertaken, mean duration of hospital stay, and treatment outcome. Results: Among 27 patients, SJS accounted for 81.48% (n=22), TEN 14.8% (n=4), and SJS/TEN overlapped 3.70% (n=1) of the cases. Non-steroidal anti-inflammatory drugs (NSAIDs) were the most commonly implicated culprit drugs, followed by amoxicillin. The mean time of appearance of the lesion after the medication was 29.14±22.93 days. All the patients received steroids-hydrocortisone 81.48% (n=22); hydrocortisone and dexamethasone 7.40% (n=2) and methylprednisolone 7.40% (n=2) with supportive management. The mean duration of hospital stay was 12.03±10.52 days, and the recovery rate without complication was 88.89% (n=24). Conclusion: SJS is the most common clinical type in the SJS-TEN spectrum. NSAIDs and antibiotics were the common causes of SJS/TEN. Corticosteroids proved beneficial in managing SJS/TEN in our patients.Publication Clinico-Histopathological Consistency in Dermatological Disorders in a Tertiary Care Hospital of Kathmandu(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2024) Shrestha, Akankshya; Gurung, Tsering Dolma; Joshi, Deepak Raj; Shrestha, Dwarika PrasadAbstract Introduction: A skin biopsy for histopathological examination is one of the most reliable investigations for confirming clinical diagnosis. When there is alignment of clinical and histopathological diagnosis, it demonstrates clinico-histopathological consistency. There is limited reported data on clinico-histopathological concordance in the context of Nepal. Objectives: To determine the consistency of clinical and histopathological diagnosis of dermatological disorders. Materials and Methods: A retrospective study was conducted on 551 patients who underwent skin biopsy at the Department of Dermatology and Venereology, Tribhuvan University Teaching Hospital, for a period of 1 year. Both inpatients and outpatients who had undergone a skin biopsy were included in the study. Demographic data, clinical and histopathological diagnoses were noted on a proforma sheet. Histopathological diagnoses, both definitive and descriptive, were deemed consistent when they aligned with the clinical diagnoses. Conversely, if either definitive or descriptive histopathological diagnoses were not concordant with the clinical diagnoses, they were categorized as inconsistent. Results: The mean age of patients was 41.42 (±18.42) years. The male to female ratio was 1:1.5. Out of 551 cases who underwent skin biopsy, clinico-histopathological consistency was found in 64.43% of cases (355), whereas clinico-histopathological inconsistency was present in 35.57% (196). The maximum concordance was present in eczematous disorders (58.06%), followed by immunobullous disorders (47.22%), and vasculitis (45.45%). Conclusion: The overall clinico-histopathological consistency was 64.43%. Both experienced dermatologists and pathologists need to assist each other in providing a better understanding of the diagnostic process. This study emphasizes need for this cooperation and will aid in evaluating clinico-histopathological consistency.Publication Management of Telogen Effluvium: A Survey among Dermatologists and Dermatology Residents of Nepal(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2025) Sharma, Ashu; Khadka, Anupa; Gurung, Tsering Dolma; Shrestha, Dwarika PrasadAbstract: Introduction: Telogen effluvium (TE) is a common form of non-cicatricial alopecia, marked by excessive shedding of hairs in the telogen phase. Despite its prevalence, there is no consensus on the best approach to diagnosing, investigating, and managing TE, leading to varying practices among dermatologists. This study aims to understand current practices in Nepal regarding the diagnosis and treatment of TE. Objectives: To explore the management modalities of TE among the dermatologists and dermatology residents of Nepal Materials and Methods: An online, questionnaire-based survey was conducted among Nepalese dermatologists and dermatology residents. The questionnaire consisted of twelve multiple-choice questions related to TE. The responses were recorded and analyzed. Results: A total of 150 responses were recorded, with 53.33% attending 5-10 hair loss patients weekly. Most (94%) diagnosed TE based on history and clinical examination, and 82% commonly ordered thyroid function tests. Iron and vitamin deficiency was identified as the leading cause by 78%, and 53.33% felt no treatment was necessary. Counseling (92.66%) and iron/vitamin supplements (88%) were the most frequent management strategies. TE was reported to have a "moderate" impact on Quality of Life (QoL) by 69.33%, and 50.67% of participants reported a “good level” of satisfaction among patients with the outcomes of their treatments. Conclusions: Telogen Effluvium is one of the most common causes of hair fall, with a moderate impact on the quality of life. Most dermatologists agree on many aspects of TE management. A consensus management guideline of TE would be handy.Publication Patch Testing in Allergic Contact Dermatitis(Nepal Health Research Council, 2023) Sharma, Rashmi; Shrestha, Dwarika PrasadAbstract Background: Allergic contact dermatitis is one of the most common forms of skin diseases that require medical intervention. Appropriate detection of allergens by patch test and accurate avoidance of them is the key to management. The objective of this study is to determine the types and frequency of allergens responsible for Allergic contact dermatitis in a tertiary hospital of Nepal. Methods: Altogether 120 patients with Allergic contact dermatitis were enrolled in the study. Patch test was performed to find out the most common inciting allergen, utilizing the Indian Standard Series of allergens approved by The Contact and Occupational Dermatoses Forum of India. Results were read at 48 and 96 hours. Grading of the reactions was done based on the criteria of the International Contact Dermatitis Research Group. Pattern of reactivity of different allergens was assessed. Results: Of all the patients, 63 (53%) showed positivity to at least one allergen. Nickel sulfate was the most frequent sensitizing agent in 22 (18%) cases, followed by Fragrance mix in 11(9%) and Paraphenylenediamine in 7 (6%) cases. Out of all positive results, Grade 1 positivity was seen in 44 (51%), Grade 2 positivity in 41(47%) and only 2 (2%) cases showed Grade 3 positivity. Mercaptobenzothiazole, Balsam of Peru, Nitrofurazone and Wool Alcohol did not show positive results in any of our patients. Conclusions: Patch testing helps in the treatment, long term remission, and patient counseling for prevention. Larger scale studies are required to know the sensitivity to allergens in Nepalese population. Keywords: Allergens; allergic contact dermatitis; nickel; patch test.Publication 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 PrasadAbstract: 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.