Journal Issue: Volume: 18, No. 1 (2020)
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Volume
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Issue Date
2020
Journal Title
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ISSN 2091-0231 eISSN 2091-167X
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Articles
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
A Hospital Based Study of Association of Chronic Spontaneous Urticaria with Autologous Serum Skin Test
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2020) Giri, Uma; Kayastha, Bhaskar MM; Shakya, Nabin Bhakta
Abstract:
Introduction: Chronic Spontaneous Urticaria (CSU), is spontaneous occurrence of wheals for more than 6 weeks. CSU patients with autoreactivity as indicated by positive Autologous serum skin test (ASST) have severe disease requiring higher doses of antihistamines and even immunomodulatory agents.
Objective: The objective of this study was to observe the association between CSU and ASST.
Materials and Methods: Over a period of one year, 104 CSU patients were enrolled in the study. Autologous serum skin test was done using 0.05 ml of patient’s serum, with 0.05 ml of histamine as positive control and normal saline as negative control. Prevalence of positive ASST in CSU patients was determined. Clinical and demographic characteristics were compared in both ASST positive and negative patients.
Results: The ASST was positive in 68 patients (65.4%). Mean age (SD) of the patients in ASST positive group was 33.78 (14.38) versus 35.64 (14.47) in ASST negative group (p=0.533). Male:Female ratio in ASST group was 1:2.7 versus 1:1.1 in ASST negative group (p=0.033). Patients with positive ASST had significantly longer duration of wheals (p=0.002), generalized distribution (p=0.020) and high rmean urticaria activity score, 4.66 versus 3.28 in ASST negative patients, p<0.001. Angioedema was more common in ASST positive patients (p < 0.001).
Conclusion: ASST was significantly positive in CSU patients and more common in females. ASST positive patients had more severe clinical manifestations and it can be a simple test to detect severe form of CSU.
Keywords: Angioedema, Chronic Urticaria, Histamine, Skin Tests
Prevalence of Hepatitis C among Lichen Planus Patients
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2020) Sharma, Rabindra; Paudel, Sushil
Abstract:
Introduction: The association between hepatitis C virus (HCV) infection and lichen planus (LP) has been studied widely. Extrahepatic manifestations including lichen planus are common among patients infected with HCV. The prevalence of HCV among lichen planus (LP) seems to vary geographically.
Objective: This study was carried out to determine whether an association exists between LP and HCV infection.
Materials and Methods: A total of 68 lichen planus (LP) patients identified clinically and histopathologically were screened for anti-HCV from blood samples.
Results: Among the 68 patients of LP only 2 (2.94%) female patients had HCV infection.
Conclusion: This study reveals very few patients of lichen planus being infected with HCV which is in line with a similar study done earlier in Kathmandu. Thus due to limited evidence to support an association between HCV and LP routine HCV screening is not recommended at this geographic location.
Keywords: Hepatitis C, Lichen Planus, Nepal
Non-Veneral Genital Dermatoses: A Study from Western Nepal
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2020) Kumar, Ajay; Pun, Jenny; Neupane, Deepika; Subedi, Saujan; Mohammad, Asim; Sathian, Brijesh
Abstract:
Introduction: The etiology of dermatoses involving genital areas could be venereal or on-venereal. These disorders are responsible for mental distress and guilt which can be minimized by appropriate diagnosis and information to the patients.
Objectives: To assess the clinical pattern and prevalence of various non venereal genital dermatoses in a referral center.
Materials and Methods: This was a hospital-based descriptive study involving patients with non-venereal diseases visiting outpatient clinics of Department of Dermatology. After informed consent, all the parameters were recorded in a proforma and analyzed.
Results: Total of 70 patients with non-venereal genital dermatoses were included. Mean age of the patients was 33 years. Majority were male, married and had history of irregular use of contraceptives. Duration of symptoms ranged from one to 36 months with mean of four months.
Total 19 types of non-venereal skin diseases were noted with major complaint of itching in genitalia in 22 (31.4%). Primary site of involvement/complaint was vulva in 19 (27.1%), scrotum in 17 (24.3%), groin in 18 (25.7%) and penile area in 14 (20.0%). The most common final dermatological diagnosis in majority was fungal infections and neurodermatitis in 12.9% each. Extramarital relationship was reported by 37 out of 70 patients (52.9%), while 31 patients correlated their symptoms with sexual exposure.
Conclusions: Itching was the most common presenting complaint with infective etiology. The current study highlighted the relevance of addressing non-venereal genital dermatoses in order to avoid the general misconception that all genital lesions are sexually transmitted.
Keywords: Neurodermatitis, Sexually Transmitted Diseases, Dermatitis, Allergic Contact
Blistering Diseases in a Tertiary Care Hospital: A 10-year Audit
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2020) Parajuli, Niraj; Lama, Laila; Karki, Anupama; Shrestha, Rushma; Tiwari, Sumida; Kayastha, Bhaskar MM
Abstract:
Introduction: Cutaneous blisters can occur in variety of conditions. They are broadly classified as immunobullous or non-immunobullous. Immunobullous blistering diseases can further classify as intraepidermal or subepidermal. Non-immunobullous blistering disease are commonly due to infections, drugs among others. Some of the blistering disease carry significant mortality and morbidity. There are only limited data on blistering diseases from Nepal, so this study will provide details on the prevalence of this rare dermatological disease from one of the tertiary care referral hospital in the country.
Objective: To assess the clinical pattern and prevalence of various blistering diseases in a tertiary care referral hospital.
Materials and Methods: All of the data were obtained from the admission register maintained at department of dermatology and venereology, National Academy of Medical Sciences. All the patients admitted with blistering disease from year April 2008 till March 2018 were included. The details including age, sex, type of blistering disease and length of hospital stay were recorded.
Results: A total of 710 patients were admitted in the dermatology ward over the period of 10 years. There were a total of 193 blistering disease admitted during this period. Autoimmune blistering disease was diagnosed in 59 patients whereas 100 patients had non-immunobullous disease. The age grouped range from 4- 93 years with the mean age of 43± 19.71 years. The average number of hospital stay of all blistering diseases was 11.73±11.36 days.
Conclusion: Blistering diseases are one of the most common conditions requiring admission in dermatology ward. Some of these diseases carry a significant morbidity and mortality. So, prompt diagnosis and treatment is of utmost importance.
Keywords: Autoantibodies, Fluorescent Antibody Technique, Pemphigoid, Bullous, Pemphigus, Skin Diseases, Vesiculobullous,