Clinical and Histopathological Findings in a Patient of Darier-White Disease with Acrokertasosis Verruciformis of Hopf.

Darier disease (DD) is a rare genodermatoses characterized by greasy hyperkeratotic papules in seborrheic regions and nail and oral changes. Histologically, it presents as suprabasal clefts with acantholytic and dyskeratotic cells. Acrokertasosis verruciformis of Hopf (AKVH) is considered an allelic variant with clinical overlap where Church spires are seen histologically without dyskeratoses. Patients are susceptible to various viral and bacterial skin infections requiring prevention and treatment of infection. Nonspecific treatment includes patient counseling on exacerbating factors. Although there are no curative treatments for DD, topical corticosteroids and systemic retinoids may be used to control inflammation and hyperkeratosis. We are reporting a rare case with clinical and histological findings of DD with AKVH in a 17-year-old boy with keratotic papules, presented on the hands and feet, nose, and ears without mucosal involvement.

Incorporating and Emphasizing Sexual Health in Medical Curriculum of Nepal: Need of the Hour.

Sexual health requires a positive and respectful approach to sexuality and sexual relationships. It is one of the most neglected parts of an individual's health. Sexual health is not adequately covered in the medical education curriculum of Nepal. There is a lack of clinicians practising sexual medicine, which provides a fertile field for quacks in this arena. Sexual health needs to be included and incorporated into medical education. The policymakers and stakeholders need to address this need in sexual health urgently and effeciently. Comprehensive sexual education should be included for children, adolescents and young adults. Keywords: medical education; Nepal; sexual health.

Alopecia associated with the use of selective serotonin reuptake inhibitors: Systematic review.

We aimed to systematically review published cases of alopecia (hair loss) associated with selective serotonin reuptake inhibitors (SSRIs). Four electronic databases were searched up to November 16, 2021. Thirty-eight publications describing 71 patients with a total of 81 episodes of alopecia met inclusion criteria. Patients' age ranged from 7 to 85 years and 80.3% were female. Alopecia most commonly affected scalp (98.6%). Reported time to onset ranged from 3 days to 5 years (median: 8.6 weeks). Discontinuation of the suspected SSRI led to recovery in 63.0% of episodes. Clinicians should be aware of this possible adverse effect of SSRIs.

Patterns and barriers of teledermatology in resource-limited settings in COVID-19 pandemic: A descriptive cross-sectional survey of Nepalese dermatologists.

Background: The COVID-19 pandemic has limited in-person consultations and disturbed easy health care access. Teledermatology (Td) is used to provide services in such situations. Objective: To find the pattern and barriers of Td during the COVID-19 pandemic in resource-limited settings. Methods: An online survey focused on dermatologists and residents in dermatology in Nepal was conducted. The online form with the prepared questionnaire was sent to the potential participants. Results: A total of 86 responses were received, with 60% response rate. Approximately 62.8% (n = 54) of the participants were involved in COVID-19 care. The most common method used was a store-and-forward technique. Approximately 90% of the participants used smartphones for Td, and Viber was the most commonly used application. The straightforward diagnoses in Td were fungal infections, acne, alopecia, pyoderma, and viral infections. The common barriers were poor image quality, inability for further test, and unsuitability for all patients. The majority of the participants believed that there is a need for guidelines for Td. Limitations: A small sample size and associated technical difficulties. Conclusion: Td has proven to be an excellent tool; however, it may never replace the in-person consultation. A newer guideline must be prepared to regulate Td in the future.

Rupture Uterus in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

INTRODUCTION: Rupture uterus is an obstetric catastrophe with poor maternal and fetal outcome. The objective of the study is to determine the prevalence of rupture uterus in pregnancy. METHODS: This was a descriptive cross sectional study conducted in a tertiary care centre from January 2016 to December 2016 after taking ethical approval (Approval No. F-NMC-510/76/77) from Institutional Review Committee. Convenience sampling method was used. Data were entered in the Microsoft Excel sheet and obtained data was analysed using Statistical Package for Social Sciences version 18 software for central tendency and frequencies. RESULTS: Out of total 1559 deliveries, prevalence of rupture uterus was found to be 12 (0.0077%). Previous lower segment caesarean scar rupture was the most common risk factor noted in 7 (58.3%) cases. A total of seven patients (58.3%) required intensive care unit admission and blood transfusion. Other maternal complications were surgical site infection 2 (16.67%), sepsis 2 (16.67%), paralytic ileus 1 (8.3%), pelvic collection 1 (8.3%) and vesico vaginal fistula 1 (8.3%). Two maternal deaths (16.67%) and perinatal death was noted in 8 (66.66 % ) cases. CONCLUSIONS: Rupture uterus most commonly occurred in scarred uterus. Identification of high risk pregnancy, judicious caesarean section, proper labor monitoring, early diagnosis and prompt management are essential in reducing its occurrences.

Oral Isotretinoin Therapy in Recalcitrant Molluscum Contagiosum in an Immunocompromised Patient.

Molluscum contagiosum is a viral infection caused by the Poxvirus characterized by multiple umbilicated papules. It is common in children and can be present at any body site. Severe molluscum is common in immunocompromised patients. We report a 20-year-old HIV-positive individual with widespread molluscum contagiosum, recalcitrant to topical therapy, under antiretroviral therapy, who was treated with oral isotretinoin and had a dramatic outcome. Although studies are needed to confirm the effectiveness of oral isotretinoin therapy in molluscum contagiosum, its easy availability, cost, and excellent safety profile appear to offer a promising therapeutic option.

Misuse of Topical Corticosteroids in Dermatological Disorders in Tribhuvan University Teaching Hospital.

BACKGROUND: Topical corticosteroids are one of the most commonly used drugs in dermatology. Their improper use lead to serious adverse effects. However, it's commonly misused by patients and chemists in Nepal. The main objective of the study was to determine the pattern of misuse of topical corticosteroids, its adverse effects, and factors associated with its misuse. METHODS: This was a hospital-based, descriptive study conducted in a tertiary center of Nepal for three months. Patients meeting the inclusion criteria were enrolled in this study. Purposive sampling technique was used. Ethical approval was taken prior to study. Informed consent was taken from patients and interviewed using semi-structured questionnaire. The data was analyzed using Microsoft Excel and SPSS software. RESULTS: Two hundred sixteen patients comprised the study population where males (54.5%) outnumbered females. The mean age was 28.72 years with 21-30 years as the most frequent range. Beclomethasone dipropionate (27.3 %) and clobetasol propionate (26.9%) were the most commonly misused drugs. The most common purposes for the application of these drugs were fungal infections (66%), pigmentary disorders (15%), such as fairness cream, acne, etc. Over-the-counter sale of topical corticosteroids (62%) was significantly higher than other forms of prescription. Aggravation of fungal infections (61.6%), acneiform erruptions, striae, and steroid induced dermatoses were common adverse effects. CONCLUSIONS: Topical corticosteroids are common misused drug with high over the counter sales. It is advised that drug authority should take necessary actions for its unethical use. Besides, awareness programs should be conducted for its rational use in public.

Alopecia Universalis Associated with Hyperthyroidism Treated with Azathioprine and Hydroxychloroquine: A Case Report.

Alopecia universalis is an uncommon form of alopecia areata involving hair loss over the entire scalp and body. This condition is difficult to treat and sustain the growth of hair for longer duration. We report a case of alopecia universalis associated with severe hyperthyroidism. A lady in her fourth decade presented to us with gradual onset of alopecia universalis, who later found to have hyperthyroidism which was refractory to multiple treatment modalities. She was treated successfully with azathioprine and hydroxychloroquine. Alopecia universalis with less response to oral steroid therapy was successfully managed with azathioprine with hydroxychloroquine.

Carbamazepine-Induced Toxic Epidermal Necrolysis Managed by Mobile Teledermatology in COVID-19 Pandemic in Rural Nepal.

Toxic epidermal necrolysis is a life-threatening dermatological emergency with high mortality if not treated in time. Here we report a case of toxic epidermal necrolysis due to carbamazepine in rural Nepal in COVID-19 pandemic who was successfully treated with the help of mobile teledermatology. The clinical impression of toxic epidermal necrolysis was made from "WhatsApp" video calls using a smart phone. The supportive features were the history of starting of carbamazepine 2 weeks prior for seizure disorder, clinical findings in serial photographs of skin with 40 percent body surface area involvement of necrotic skin lesions and bulla, and involvement of oral mucosa and eyes. The patient was immediately asked to stop carbamazepine and was treated with intravenous fluids and systemic steroids along with symptomatic management. As the whole world was suffering from lockdown due to COVID-19 crisis, it was impossible for the rural area patient to visit a dermatologist. Thus, with the help of paramedics staff in a community health center and mobile teledermatology, the patient was diagnosed as carbamazepine-induced toxic epidermal necrolysis and treated successfully with good outcome.

Surgery of Kerion, a Nightmare for Nondermatologists.

Kerion is an inflammatory type of tinea capitis characterized by swelling and alopecia of the scalp, which could be mistaken as bacterial infection. It occurs most frequently in children. We report a 10-year-old child whose kerion was misdiagnosed as bacterial abscess and unnecessarily incised. Later, her condition was rediagnosed as kerion based on clinical appearance and potassium hydroxide wet mount. The lesions resolved completely with systemic antifungal treatment, griseofulvin, leaving residual scarring alopecia. The delay in the proper diagnosis and inappropriate treatment of this patient resulted in permanent scarring alopecia. Thus, clinicians must have a high index of suspicion for tinea capitis when dealing with inflammatory scalp lesions.

Erectile Dysfunction Secondary to Herpes Zoster.

Varicella Zoster is dermatomal neuropathic disease caused by reactivation of varicella zoster virus, characterized by vesico-bullous eruptions. The sacral dermatomal involvement in shingles is a rare phenomenon but well recognized cause of urinary retention, bladder dysfunction but rarely erectile dysfunction. We present a case of sacral herpes zoster with erectile dysfunction in a sexually active adult male. Keywords: Erectile Dysfunction; herpes zoster; Nepal.

The Increasing Scope of Teledermatology in Nepal.

Teledermatology is a rising subspecialty that uses information and communications technologies to diagnose, prevent, treat, and educate skin health. It is an innovative means for delivering quality dermatological care. It embraces the potentials for revolutionizing dermatologic consultation to remote locations in Nepal, where service by dermatologists is almost impossible. By adopting advances in telecommunication, wider and faster coverage of the internet and smartphones, computers, laptops, and high-resolution cameras, the era of teledermatology is changing even in lower-income countries like Nepal. It has emerged as a boon in skin healthcare to rural and even urban care in the recent coronavirus pandemic but would never replace traditional consultations. The challenges faced by teledermatology are lack of technical expertise and proper implementation of guidelines, diagnostic limitations, and various medico-legal aspects. This article presents a brief review of teledermatology in Nepal.

Tuberculosis and HIV co-infection; the deadly duos in vulva.

Human Immunodeficiency Virus induced immune suppression leads the way for various infections with tuberculosis being the most common. Tuberculosis of the vulva is an extremely rare entity and is seen in only 1-2% of genital TB with increased risk in HIV co-infection. The co-infection places an immense burden on health care systems and poses particular diagnostic & therapeutic challenges with high mortality and morbidity. We present, here, a rare case of a 47 years postmenopausal female, who presented with itchy ulcerating lesions in the vulva with diagnostic dilemma turned to be vulval tuberculosis and during investigations, was found to be co-infected with HIV. The early diagnosis of TB and HIV in atypical looking lesions of vulva with high index of suspicion could lead to improved outcome.