Acquired Lymphangiectasia of the Scrotum Successfully Treated with Radiofrequency Ablation: A Case Report with Dermoscopic Review.

Lymphangiectasia is dilatation of normal superficial lymphatic vessels due to damage or obstruction of deep lymphatic vessels leading to increased lymphatic pressure and engorgement of dermal lymphatics due to varying causes. Lymphangiectasia clinically presents as thick-walled, translucent vesicles and papules with chronic lymphedema rarely involving the scrotum. Here we report a patient with acquired lymphangiectasia of the scrotum secondary to surgery for hydrocele successfully treated with radiofrequency ablation. We highlight the use of dermoscopy as a non-invasive diagnostic tool in lymphangiectasia.

Sporotrichoid lymphocutaneous pattern in a fish-merchant under immunosuppressant medications: Clues to differential diagnoses.

Sporotrichoid-lymphocutaneous-pattern is classically seen in sporotrichosis, though also present in other infections like atypical mycobacteriosis and leishmaniasis. Cutaneous atypical mycobacterial infection presents as localized lesions in immunocompetent and is widespread in immunosuppressed patients. Here, we present a case of sporotrichoid-lymphocutaneous infection due to atypical mycobacteria, in a fish-seller under immunosuppressants.

Assessment of Vitamin D Level in Patients with Psoriasis and Its Correlation with Disease Severity: A Case-Control Study.

Background: Chronic plaque psoriasis is a chronic inflammatory skin disorder. Vitamin D has been shown to have effects on keratinocyte differentiation as well as immune regulation in the skin. Objective: The main objective of this study was to assess the 25hydroxyvitamin D [25 (OH) D] level in patients with psoriasis in comparison with healthy control subjects. Materials and Methods: This case-control study included 180 persons (120 cases and 60 age- and sex-matched control subjects) from outpatient department of BPKIHS, a tertiary care hospital in eastern Nepal. Severity of psoriatic skin lesions was assessed using psoriasis area severity index (PASI) scoring. Serum vitamin D level was assessed by chemiluminescent immunoassay. Results: The mean serum 25(OH) D levels in psoriatic patients and controls were 19.57 ± 6.85 ng/mL and 23.63 ± 6.40 ng/mL, respectively. The difference was statistically significant even after adjusting for confounding factors in a multivariate analysis (aOR 2.929, 95% CI 1.376-6.230). Low serum 25(OH) D levels were negatively associated with the severity of disease (r= -0.628, P= 0.01). Conclusion: Serum 25(OH) D levels are significantly lower in psoriatic patients than in healthy control subjects. Deficiency of serum 25(OH) D was associated with severity of disease with an inverse relationship with PASI score.

Vitamin D level in patients with moderate-to-severe acne: A case-control study combined with prospective study following oral isotretinoin treatment.

BACKGROUND: Vitamin D may have an important role in the pathogenesis of acne vulgaris (AV) as it has an immunomodulatory effect and regulates the proliferation and differentiation of keratinocytes. Oral isotretinoin used in the management of moderate-to-severe acne binds to the retinoid receptor which can form a heterodimer with vitamin D receptor (VDR) and may decrease the level of vitamin D by increasing catabolism. Two studies published so far investigating the effect of oral isotretinoin on serum vitamin D level are contradictory to one another. OBJECTIVE: This study aimed to compare the serum vitamin D levels in patients with moderate-to-severe acne and age- and sex-matched healthy controls and to determine the serum level of vitamin D in patients with moderate-to-severe acne following 3 months of oral isotretinoin treatment. METHODS: A total of 120 patients with moderate-to-severe acne and 90 age- and sex-matched healthy controls were enrolled in the study. The patients were treated with oral isotretinoin at 0.50-0.75 mg/kg/day and serum vitamin D was measured at baseline and 3 months after the treatment. RESULT: Serum vitamin D was insufficient and deficient in 90.50% of cases in comparison with 43.33% of controls (p = 0.001). Serum vitamin D had an inverse correlation with the severity of acne. Following 3 months of oral isotretinoin, there was no significant change in serum vitamin D level (p = 0.127). CONCLUSION: Vitamin D was low in patients with moderate-to-severe acne in compared with control. Vitamin D level did not change with short-term therapy with oral Isotretinoin.

COVID-19 pandemic lockdown-Is it affecting our skin hygiene and cosmetic practice?

BACKGROUND: Orders such as self-isolation, quarantine, social distancing, and lockdown implemented as a protective measure against COVID-19 has allowed people to devote their excess leisure time to their appearance, cosmetics, and hygiene. OBJECTIVE: To assess the skin care routine regarding hygiene and cosmetic practices among female users of social media during the COVID-19 pandemic. METHOD: A cross-sectional study was done among 300 female social media users using purposive sampling. A self-administered questionnaire that included questions related to hygiene practices such as hand washing, use of hand sanitizers, bathing, hair washing, and use of certain cosmetics before and during the pandemic was used to collect all relevant data. RESULT: Handwashing after returning home and shaking hands with others increased during the pandemic as compared with prior practices. The frequency of using a hand sanitizer had also increased during the pandemic. There was a statistically significant decrease in the frequency of the hair removal and visits to beauty salons during the pandemic. Cosmetics were used less, although face creams and lip balm were used more. Even though most of our respondents thought pandemic practices were convenient to use, more than half of them said they wished to go back to their pre-pandemic routines once the pandemic was over. CONCLUSION: The study revealed an increase in washing behavior, use of facial cream, and lip balms. Moreover, a decrease in using make-up cosmetics, hair removal, and beauty salon visits during the pandemic.

Awareness, acceptability, and satisfaction of teledermatology consultation among social-media users in Nepal.

BACKGROUND: Teledermatology refers to the use of telecommunication in consulting one's skin problem to a dermatologist at distance. AIMS: This study aims to identify the awareness, acceptability, preferred technical tools, willingness to use, comfortability, and satisfaction of teledermatology among social-media users in Nepal. METHODS: It was an exploratory cross-sectional study performed on 360 social-media users, subjected to web-based interview based on pretested proforma containing questions to address: awareness of telemedicine, type and tools preferred for teledermatology, willingness to use, comfortability, and satisfaction of teledermatology services. RESULTS: Most of the participants (60.8%) were initially unaware of telemedicine. Despite this, the majority (81.9%) were willing to use the services after being aware, mostly during the follow-up (36.6%). Most of the participants (61.1%) preferred the hybrid model for teleconsultation, while mobile was the preferred technical tool (68.1%) mostly because of its compatibility (84.1%) and portability (56.3%). The majority of the participants felt that teledermatology consultation would be beneficial (77.2%) and they mostly preferred it directly from a dermatologist (85.6%). About two-thirds (64.2%) also believed that teledermatology consultation would eliminate the need for a face-to-face consultation. The majority would be comfortable (68.1%) if their skin lesions are photographed and sent to a dermatologist and would be satisfied (62.5%) with the consultations, through Wi-Fi and mobile data both (55.6%), and via Facebook (97.2%) and Viber (70.8%). CONCLUSIONS: Despite being unaware of telemedicine, the participants were willing to use teledermatology consultation and thought that they would be comfortable and satisfied with it.

Prevalence and risk factors of striae gravidarum in a cohort of multiracial postpartum Nepalese population.

BACKGROUND: Striae gravidarum (SG), popularly called as stretch marks, is a common pregnancy-related asymptomatic skin condition, but is a cosmetic concern for females. A few epidemiological studies have been reported from Asian countries. However, no such study has been done in Nepal. AIMS: This study was aimed to know the prevalence and risk factors associated with SG in a cohort of multi-ethnic postpartum Nepalese women who had delivered after completion of 36 weeks. PATIENTS/METHOD: A cross-sectional comparative study was conducted among 420 postpartum females who had delivered after completion of 36 weeks of gestation. Data were collected in the form of a questionnaire and relevant physical examination was done. The severity of SG was assessed by using Davey's scoring. RESULT: Out of 420 females, 260 (62%) had SG while 160 (38%) did not. According to the results of logistic regression analysis, young age (<25 years), large abdominal circumference (>100 cm), increased weight gain during pregnancy (>15 kg), presence of family history of SG, gestational diabetes mellitus, altered bowel movement, and presence of striae on the breasts, thighs, and buttocks were found to be independent risk factors for SG. CONCLUSIONS: Future expectant mothers must be informed about the risk factors of SG development. They need to be made aware that SG can be prevented by considering the modifiable risk factors, such as excessive weight gain. They should also be informed that SG is permanent and currently there is no definite treatment.

Exploring Pseudoainhum in Camisa syndrome.

Immediate treatment of Camisa syndrome with systemic retinoids or surgery helps to prevent loss of digits. Here, we report a case of Camisa syndrome with pseudoainhum in the fifth toe leading to amputation as timely treatment was not sought.

Clinical approach to a child with poikiloderma: A case report.

There are various causes of childhood poikiloderma. A proper history and clinical examination may help to get conclusion and narrow down the differentials for the causes of poikiloderma.

Intralesional Bleomycin for the Treatment of Resistant Palmoplantar and Periungual Warts.

INTRODUCTION: Periungual, palmar, and plantar warts are difficult to treat with poor treatment response. Intralesional (IL) bleomycin has shown promising results for their treatment in a few reports. However, we need further evidence before opting it for treating difficult sites and resistant warts. Hence, we conducted this study to assess the efficacy and safety of IL bleomycin for the treatment of resistant palmoplantar and periungual warts. METHODS: In this retrospective study, we included all patients who were given IL bleomycin for warts over a year. Maximum three sittings of bleomycin (1 mg/ml) were given monthly, and they were followed up for 3 months after the procedure. The response was categorized as complete, near-complete, significant, moderate, mild, and no clearance for 100%, 75-99%, 50-74%, 25-49%, 1-25%, and 0% clearance, respectively. RESULTS: Out of 29 patients, follow-up details were available only in 19 patients (53 warts). The mean duration was 2.5 ± 1.47 years. The number of past interventions ranged from 2-4. Wart clearance after the first intervention was complete in 36.84%, near-complete in 26.31%, significant in 26.31%, and moderate in 10.53%. Wart clearance after the last intervention was complete in 89.47% and near-complete in 10.52% of patients. However, during 3 months of follow-up after the last injection, 15.78% had a recurrence. None of them had severe local and systemic side effects. CONCLUSIONS: IL bleomycin could be a better treatment option for the treatment of resistant and difficult warts. However, we observed a higher recurrence rate even in a shorter follow-up. Hence, we need further studies with larger samples.

Impact of Social Media and Photo-Editing Practice on Seeking Cosmetic Dermatology Care.

BACKGROUND: The use of social media and photo-editing practice has grown enormously over the past decades. Photo editing can alter a person's desire to look better in photographs posted on social media platforms. OBJECTIVE: To assess the cosmetic dermatology seeking behavior of social media users and those who edit photographs before posting them on social media platforms. METHODS: A validated self-administered structured questionnaire via Google form was sent to 550 social media users in Nepal. It included 5 sub-headings: use of social networking sites, photo-editing practices, awareness and motivation about cosmetic dermatology care, cosmetic dermatology care seeking behavior and self-esteem. RESULTS: Facebook and Instagram were the preferred social networking sites for posting photographs. One-fourth of the participants edited >40% of the total photos posted in social media. Hiding skin lesions was the most common reason (36.3%) for photograph editing. Fifty percent of the respondents felt the need to look better; repair skin damage; be able to look good without make up; look younger; feel happier and improve total quality of life as a "lot and top" motivation for using the cosmetic dermatological procedures. A majority preferred to seek cosmetic dermatology care from non-dermatologists because they felt dermatologist visit was not needed, the services were costly and they could not visit due to their busy schedule. On multivariate analysis, respondents who were aware of skin care favored seeking cosmetic dermatology care from dermatologists. CONCLUSION: Higher investment in social media and photo-editing practices might be associated with increased non-dermatologist seeking behavior.

Co-occurrence of progressive hemifacial atrophy due to morphea with homolateral segmental vitiligo: A case report.

Simultaneous occurrence of progressive hemifacial atrophy due to morphea and homolateral segmental vitiligo, younger onset, rapid progression followed by stabilization and dermatomal distribution suggests a possible relationship between them.

Rare occurrence of lepra type 1 reaction in pure neuritic leprosy: A case report.

Type 1 reaction in pure neuritic leprosy usually occurs in the form of neuritis. The development of new skin lesion during reaction is rare. Clinicians should be aware about occurrence of type 1 reaction in pure neuritic leprosy.

Milker's nodule: An under-reported and under-diagnosed occupational infection.

Single or multiple minimal painful nodulo-ulcerative lesions over hand in dairy farm worker suggest likelihood of Milker's nodule.Use of personal protective equipment and antiseptics suffice treatment without unnecessary investigation and medicine.

Psychological Impact of Alopecia Areata.

INTRODUCTION: Alopecia areata is one of the commonest causes of nonscarring alopecia. Since hair is a vital part with very high cosmetic concern, hair loss might have a significant negative impact on patient's life. Hence, we aimed this to investigate depression and anxiety in patients with alopecia areata. METHODS: In this cross-sectional study, a total of 75 consecutive eligible patients of alopecia areata were interviewed over one-year period in the dermatology outpatient department. We recorded the relevant history and examination details in the present proforma. Nepali versions of Beck Depression Inventory and Beck Anxiety Inventory were used for the assessment of depression and anxiety, respectively. Data analysis was done with Statistical Package for the Social Sciences version 11.5. RESULTS: Among 75 patients, the prevalence of depression and anxiety were 66.7% and 73.3%, respectively, with median depression score = 5 (IQR = 0.0-10.0) and median anxiety score = 5 (IQR = 0.0-11.0). Out of all depressed patients, 82.0% had minimal and 18.0% had moderate depression. However, none of them had severe depression. Likewise, out of all patients with anxiety, 89.0% had mild and 11.0% had moderate anxiety, but none of them had severe anxiety. CONCLUSION: Anxiety and depression are common psychological problems in patients with alopecia areata. Because of their direct impact on treatment outcome, we, treating dermatologist, must be aware of them, and we should counsel our patients for consultation with the psychiatrist on time for their maximum benefit.

Kaposi Varicelliform Eruption in a Patient with Pemphigus Vulgaris: A Case Report and Review of the Literature.

Haemorrhagic crusted lesions over pre-existing pemphigus vulgaris erosions should arouse suspicion of Kaposi varicelliform eruption (KVE). Immediate treatment with antivirals helps to prevent mortality and morbidities. Here, we report a case of a 67-year-old male who developed haemorrhagic crusted lesions on pre-existing pemphigus lesions during his hospital stay and obtained almost 90% resolution of cutaneous lesions of Pemphigus vulgaris as well as Kaposi varicelliform eruption within 2 weeks of acyclovir treatment along with the continuation of systemic steroids. We also highlight the review of the literature of other reported cases with its management.

Hyperhidrosis Prevalence: A Disease Underreported by Patients and Underdiagnosed by Physicians.

BACKGROUND: Hyperhidrosis (HH) is a disorder characterized by excessive sweating beyond required for normal thermoregulation, as a result of the excessive functioning of the sudomotor sweat control system. HH is broadly classified into 2 categories: primary HH and secondary. Our aim was to study the prevalence of HH in patients attending dermatological outpatients. METHODS: Randomly selected 832 attendees of dermatology outpatient department were requested to fill out a questionnaire for their presenting concerns to attend, the demography information (age, gender, and occupation), and presence of excessive visible sweating symptoms after the informed, written, and understood consent. This questionnaire was then evaluated by the researchers. And those who had a history of excessive sweating were evaluated in detail about HH by another questionnaire. RESULTS: The overall prevalence of HH was 17.9% (149/832), whereas only self-reported prevalence was 10.2% (85/832) in the dermatology outpatients. Of 149 patients, 110 (73.8%) were of primary HH followed by 39 (26.2%) of secondary HH. CONCLUSION: This study showed a higher prevalence of HH in the attendees of dermatology outpatients of a tertiary care center but estimates that this disease affects a much larger proportion of individuals in the Nepalese population.

Study on Serum Vitamin D in Alopecia Areata Patients.

BACKGROUND: Alopecia areata is the commonest cause of non-scarring alopecia. Few previous studies have found correlation between AA and vitamin D deficiency, suggesting that vitamin D deficiency can be a risk factor for Alopecia areata. To compare serum vitamin D level between Alopecia areata patients and healthy controls; and to assess the relation between serum vitamin D levels and AA disease severity. METHODS: This case control study included 30 newly diagnosed Alopecia areata patients. Thorough history was taken, detail examination was done and relevant findings were recorded in the standardized pro-forma. Their serum vitamin D (25-hydroxyvitamin D) levels were determined by competitive chemiluminescence methods; and were compared with that of age and sex matched healthy controls. Chi square test and Spearman's rho correlation test were used for the inferential statistics using SPSS version 11.5. RESULTS: There were 30 AA patients with mean age 28.37+10.07 years. Mean Severity of Alopecia Tool score was 3.56+3.50. Prevalence of 25-hydroxyvitamin D [25(OH)D] deficiency was significantly higher in AA group (83.3%) compared to the control group (53.3%) (P=0.01). Similarly, serum 25(OH)D level was reduced more in Alopecia areata group (12.84, IQR=8.87-20.47) than the control group (29.5, IQR=19.85-41.27) (P=0.06). There was inverse co-relation between serum 25(OH)D level and SALT score. CONCLUSIONS: Prevalence of serum 25(OH)D deficiency was significantly higher in Alopecia areata group compared to the control, with inverse co-relation between its level and Alopecia areata disease severity.

Risk factors and self-perception for facial aging among Nepalese population.

BACKGROUND: Facial appearance has increasing importance to individuals and women, in particular. Till date, there are no reports of the extrinsic factors influencing skin aging in Nepalese population. OBJECTIVES: To assess the risk factors and self-perception for facial aging in Nepalese population. METHODS: A cross-sectional study was conducted among 110 attendees aged 30-70 years visiting the dermatology outpatient department of B.P. Koirala Institute of Health Sciences. An interview of the attendees was conducted to establish their perceived risk factors and age knowledge based on a questionnaire. The facial wrinkling was estimated by facial wrinkle scores using standardized visual assessment method by a dermatologist who was blinded with regard to all risk factors and age of the subjects. RESULTS: Around 50% of attendees were conscious about facial health, 53% perceived their facial age as their chronological age, 39% used some facial care products, and 68% were aware of the risk factors for facial aging. The major perceived risk factors were unhealthy eating habits, stress, less exercise, dehydration, diseased state and sleeping habits. A significant association was found between increasing age, place of birth in hills or mountains and sun exposure with high wrinkling score. CONCLUSION: Facial skin wrinkles can be considered as a marker for intrinsic aging. Though the main factor responsible for extrinsic aging is ultraviolet radiation, identification of the factors may help in motivating the individuals for the adoption of a range of healthy behaviors for facial age in Nepalese population that may provide important public health benefits.