Journal Issue: Volume. 12 No. 1 (2014)
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Volume
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Issue Date
2014
Journal Title
Journal ISSN
ISSN 2091-0231 eISSN 2091-167X
Journal Volume
Articles
Management Of Childhood Lichen Planus
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2014) Thapa, DM; Malathi, M
Abstract:
Abstract
Childhood lichen planus (LP) is a rare entity, with less than 2–3% of all cases seen in patients under 20 years of age. LP in childhood is common in subtropical countries such as India. The most common clinical type of LP in Indian children is the classic form. Approximately 1–15% of patients with LP demonstrate nail involvement, but disease of the nails without skin involvement is rare. LP is diagnosed by historical and physical findings, biopsy results, and, in some cases, features on direct immunofluorescence (DIF). LP tends to have a chronic course. Depending on disease severity, however, LP may respond to a combination of topical or systemic therapies. The response to therapy may be similar to that seen in adults. Moderately potent or super potent steroids are the treatment of choice. Topical steroids can be combined with oral steroids in tapering doses over 2-12 weeks period. This is useful for children with widespread involvement or cutaneous LP lesions associated with significant morbidity. Intralesional steroid is effective for hypertrophic LP unresponsive to topical steroids. Topical steroids in adhesive base used several times a day for several months is a treatment of choice for symptomatic oral LP. Topical steroids in combination with systemic steroids can be given in a tapering dose over 3-6 weeks in very symptomatic cases in early stages. In severe unresponsive cases of both cutaneous and oral LP, oral retnoids are the preferred option. Treatment options for the nail LP in young children are oral steroids given as tapering dose over 4-12 weeks and oral retinoids. Intralesional steroids as nail matrix injection are the third option for older children. Most pediatric patients with LP respond to treatment with full clearance over 1-6 months. Poor response to treatment is a feature of hypertrophic LP and lichen planopilaris.
Keywords: Children, Lichen planus, Nail lichen planus, Oral lichen planus
Understanding Of Nepalese Patients With Vitiligo About Their Disease
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2014) Agrawal, S; Kumar, A; Shyngwa, PM
Abstract:
Introduction: Vitiligo, a pigmentary disorder, may influence considerably patients’ health-related quality of life (QoL) and psychological wellbeing. Previous reports indicated that the patients' illness understandings influence adherence behaviors and actions in various chronic dermatological conditions.
Objectives: To know the understanding of Nepalese patients with vitiligo about their disease by using illness perception questionnaire and also to investigate the potential factors that might influence it.
Material and Methods: The illness perception questionnaire consisting of 25 questions about causes, timeline, consequences and control of disease were given to 154 patients with vitiligo of 13 years or more age attending the dermatology OPD.
Results: A total of 146 patients completed the questionnaire. The belief about the causes of vitiligo was considered as “germs or virus” by 64.4% patients while half of the patients believed that vitiligo was due to “chance or fate”. Vitiligo was considered to be a serious condition (83.6%) and have had serious consequences on their life (63%). Approximately half of the patients believed that their disease had serious economic and financial consequences more so in female patients and in those with generalized disease. Although 43.8% patients believed that their illness was likely to be permanent rather than temporary, 75% patients believed that vitiligo would improve with the time and their treatments were effective (75.3%). However, females felt that there were very little that could be done to improve their vitiligo.
Conclusion: The knowledge about vitiligo is unsatisfactory and needs accessible, accurate, community based education about the natural history of vitiligo and the effectiveness of treatment.
Keywords: Illness perception questionnaire, Vitiligo
Cutaneous Maniestations In HIV Positive Paediatric Patients
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2014) Ullal, KR; Kondreddy, B; Kuruvila, M; Bhat, K
Abstract:
Background: Over the past decade Human Immunodeficiency Virus (HIV) infection has emerged as a major cause of severe illness and death in childhood in the United States and throughout the world. CD4 cell count and CD4 cell percentage are key markers for determining disease progress and the risk for opportunistic infection (OI) in HIV-infected patients.
Objectives: This study was carried out to analyze the cutaneous manifestations in HIV positive paediatric patients and to correlate their pattern and severity with CD4 count.
Material and Methods: This was a hospital based study wherein all HIV positive patients in the paediatric age group were screened for cutaneous manifestations over a period of two years, CD4 counts were estimated and their severity and atypical presentations were correlated with the CD4 counts.
Results: Out of the 104 children included in this study, 93 had cutaneous manifestations. Transplacental was the commonest mode of transmission. There was a significant risk of Grade III malnutrition (p=0.03). Dermatological manifestations were present in all with CD4 count less than 200. The highest mean CD4 count was for bacterial infections and the lowest was for oral candidiasis. The mean CD4 count for fungal infection, oral candidiasis and xerosis were statistically significant (p=0.001, 0.002, 0.025 respectively)
Conclusion: This study shows that the prevalence of mucocutaneous manifestations increases with advanced immunosuppression in pediatric age group and help in early recognition of the infection.
Pattern Of Sexually Transmitted Infections And Sexual Behavior In Patients With Genital Symptoms
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2014) Gyawalee, M; Pokhrel, DB
Abstract:
Background: Sexually transmitted infections are a major cause of acute illness, infertility, long-term disability, economic loss and death throughout the world. Despite the availability of effective treatment and preventive measures, incidence of STIs is increasing even in developed countries. STIs, acting as a facilitator for the spread of HIV have become a globally important issue at present context.
Objectives: To determine the pattern of sexually transmitted infections along with their sexual behaviour in patients presenting with genital symptoms.
Material and Methods: A cross sectional, descriptive study was carried out in the department of dermato-venereology, TUTH. During one year period, a total of 130 consecutive cases were enrolled in this study. The diagnosis of infections was made clinically with relevant laboratory investigations and they were interviewed for their sexual behaviour after taking consent and assuring confidentiality.
Results: The average age of this population was 27.84 years. Majority belonged to age group 15-24 years, with male to female ratio of 3.19:1. Many (52.3%) were married. The most common infection was condyloma accuminata (29.2%). The mean age of sex debut was 18.95 years and majority (50.8%) belonged to 15-19 years group. The median number of life time partners was 2.0. Only 43 (33.1%) were on monogamous relationship. The 15-34 age groups had maximum number of sexual partners. Married person living singly had more frequent extramarital contact. Only 10 (7.7%) used condom consistently.
Conclusions: Younger people should be educated about monogamous relationship along with correct and consistent use of condom for the prevention of STIs
Keywords: Sexually transmitted infections, Sexual behavior
Henoch-Scholein Purpura (HSP): A Clinico-etiological Study
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2014) Kareem, SN; Riyaz, N
Abstract:
Background: Henoch–Schönlein (HSP) is a small vessel vasculitis affecting skin and internal organs.
Objectives: To determine the age group affected, etiological factors, clinical features, complications and association with other diseases.
Methods: The study included 50 patients over a period of 3 years selected on the modified criteria by American College of Rheumatology. Clinical assessment was done and investigated for any focus of hidden infections especially Dental and ENT by respective departments. Associated conditions, complications and recurrence were also observed.
Results: All patients had palpable purpura (pruritic in 58% and with hemorrhagic bullae in 6%) with upper respiratory tract prodrome (44%), joint involvement (94%) and gastrointestinal symptoms (90%). Precipitating factors were sore throat (74%), caries tooth (44%), drugs (30%) and food (16%) in varying combinations. On investigation 56% had raised ESR and 22% were with abnormal peripheral smears. All biopsies showed leucocytoclastic vasculitis. Occult blood in stool was detected in 10% and 2% showed Streptococci in throat swab culture. Renal involvement was 54% (RBC and albumin-42%, RBC alone-12%). One patient had intestinal perforation. Bleeding time, Clotting time, Platelet count, Cryoglobulin, ANA, Rheumatoid factor, HBs Ag, VDRL and X-ray chest were within normal limits. LE cell test was negative. Follow up study showed recurrence in 98%.
Conclusion: HSP is a small vessel vasculitis in response to any unknown foreign or endogenous antigen. The age of onset varied from below 7 to 58 years, with most of them below 20. The most important clinical presentation was palpable purpura in lower extremities. GIT and joint involvement were more. Renal involvement found to be the most common complication.
Keywords: Abdominal Pain, Arthritis, Melena, Palpable Purpura, Renal Complications