COVID-19 and Skin (A New Chapter in Dermatology)

COVID-19 pandemic has spread all around the world. The new corona virus also poses novel challenge for all physicians including dermatologists. Dermatological conditions in COVID-19 can be associated with the infection itself, due to use of protective equipments like PPE kits, use of hand sanitizers. So with an understanding of COVID-19 and association of skin conditions , we can provide better treatment to our patients.

Papular Elastorrhexis: A Case Report of Rare Connective Tissue Naevus

Papular Elastorrhexis (PE) is a connective tissue naevus that presents with non-follicular, yellow or white oval papules(1-5mm), mostly on the proximal extremities and the trunk. It is diagnosed with good clinical acumen and histologically with fragmented or decreased dermal elastic fibers. PE is difficult for clinicians to diagnose because of the rarity of the disease and non-specific presentation. Here we report a rare case of PE.

Sexually Transmitted Infections in A Tertiary Hospital of Kathmandu: A Retrospective Study

Introduction: Sexually transmitted infections (STIs) are the diseases that are transmitted by sexual contact if a partner is infected with agent known to cause infection of genitalia. This group of diseases pose a huge public health problem. This study aims to provide an insight on the prevalence of STIs in a tertiary care center dedicated to civil servants. Methods: This is a retrospective cross-sectional study. All patients diagnosed with STI in a dermatology out-patient of Civil Service Hospital, a tertiary care hospital situated in Kathmandu over a period of two years from January 1 2018 to December 30 2019 were included in the study. The diagnosis was made by clinical and laboratory investigations. Results: The total number 157 cases of STIs were enrolled in this study, of which 119 (75.8%) were males and 38(24.2%) were females. The mean age of patients was 27.8±8.8 years, ranging from 15 to 60 years. Seventy three (46.5%) patients were married, while 81 (51.6%) patients were unmarried. Unmarried males were significantly more vulnerable to acquire STIs (p=0.005). Males were having significantly more premarital or extramarital sexual exposures as compared to females (p<0.001). The most common presentation was condyloma acuminata in 84(53.5%) patients. Consistent use of condom was reported only in 3 (2.5%) males and 1 (2.6%) females in this study. No association was noted between the education level attained to the practice of safe sexual methods (p=0.535). Conclusion: The proportion of males was higher than females in our study which might be due to the reluctances of female to see doctor for sexual problems. The level of education did not seem to make people aware of practicing safe sex. Sexual education seems must in all level of education.

Efficacy of Intense Pulse Light with Triple Combination Cream Versus Triple Combination Cream alone in the Treatment of Melasma

Introduction: Various studies explored the use of intense pulse light (IPL) therapy in treating melasma, but only a few randomized clinical trials have evaluated the combination of triple combination cream (TCC) with IPL so far. Objective: This study compared the efficacy and safety of the combination of IPL and triple combination cream with triple combination cream alone in treating melasma. Material and Methods: Sixty patients with melasma were enrolled in this assessor-blinded, parallel-group randomized controlled study. Thirty patients were treated with IPL (15J/cm2, two sessions at 2-week intervals) and TCC (Hydroquinone 2%, tretinoin 0.025%, fluocinolone acetonide 0.01%) at night and broad-spectrum sunscreen during day time whereas other groups received only TCC and broad-spectrum sunscreen. The median percentage reduction in melasma area and severity index (MASI) and physician’s global assessment scale was assessed at 12-week to determine the efficacy of the treatment. The incidence of adverse effects at each follow-up and relapse at 16-week were also noted during the study period as the secondary outcome measure. Results: The median reduction in MASI achieved at 12 weeks was 48% in the IPL+TCC group and 13.1% in the TCC group from the baseline. The incidence of relapse was seen in 7.14% and 13.04% patients in the IPL+TCC group and TCC alone group respectively at 16 weeks however, this difference was not statistically significant (p<0.05). Conclusion: Our study supports that IPL and TCC are more effective than TCC therapy alone in treating melasma.

Prevalence of Venereophobia among Patients of Non-Venereal Genital Conditions- a Cross-Sectional Hospital Based Study from Nepal

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.

Clinicoepidemiolgic Profile of Dermatophytosis in the Elderly: A Hospital Based Study

Introduction Superficial tinea infections are some of the most common dermatological conditions in the elderly. Recently, few studies done showed an abrupt increase in dermatophytic infection in adults; however, similar recent studies describing dermatophytosis in the elderly are lacking. The aims and objectives of this study were to identify the epidemiological profile of dermatophytoses among the elderly population. Materials and Methods This was a single centre, observational cross-sectional study conducted at a tertiary care Medical College Hospital in North India over 12 months including patients of dermatophytosis (KOH confirmed) aged 60 years or more. Results A total of 192 patients were enrolled, among which 68.7% were males. The extensive disease was present in 56.2%. History of topical steroid usage was present in 79.2%. The mean duration of disease was 23.8 weeks among which chronic disease was seen in 25%. Various other demographic characteristics were identified. Various risk factors for extensive disease, like gender, topical steroids use, urban residence, higher socioeconomic status, longer duration of disease, positive family history, diabetics, regular alcohol and tobacco consumption, were also noted in the present study. Conclusion The present concludes increased prevalence in women, delay in seeking treatment among them, a rising proportion of chronic and extensive dermatophytosis, rising atypical clinical presentation and higher predilection for tinea cruris and onychomycosis.

Dyslipidemia in Psoriasis: A Case - Controlled Study

INTRODUCTION: Psoriasis is a chronic inflammatory condition of skin which can be associated with other ailments including dyslipidemia which is an abnormal serum lipid profile. OBJECTIVE: The aim of present study was to determine correlation between dyslipidemia and Psoriasis of patients visiting the Out-patient Department of Patan Hospital METHODS: Ninety patients were selected for study. Among them 30 patients with psoriasis were taken as cases and 60 patients that matched for age and sex with Psoriasis patients were taken as controls. The lipid profile that comprised four parameters: serum High-density Lipoprotein, Low-density Lipoprotein, Total Cholesterol and Triglyceride were determined and compared for both case and control groups. RESULTS: More than 95% of the psoriatic patients had dyslipidemia. The odds of dyslipidemia among Psoriatic patients were 1.709 times higher compared to control group (p <0.001). Among the parameters, results showed High-density lipoprotein was significantly lower while Triglyceride was significantly higher among the cases compared to controls with p value of 0.012 and 0.001 respectively. The risk factors like smoking and alcohol were present in higher proportions among the patients with dyslipidemia but it failed to reach statistical significance. With increase in duration of Psoriasis and PASI scores, lipid parameters i.e., Total cholesterol, triglyceride and Low-density lipoprotein increased while High density lipoprotein decreased but this correlation was insignificant. CONCLUSION: This study showed Dyslipidemia is significantly higher among patients with Psoriasis especially lipid profile parameters Triglyceride and total cholesterol. Thus, timely screening and management of dyslipidemia among Psoriatic patients might be helpful in prevention of future cardiovascular events.

Melatonin - A Cutaneous Perspective

Melatonin (MLT) is an endogenous hormone secreted from the pineal gland, located deep in the brain in the epithalamus associated with numerous biological activities. The primary function of melatonin is to regulate sleep-wake cycles. However, research over the last few years has enlightened a range of functions associated with this molecule, including anti-inflammatory, direct and indirect antioxidant activity, regenerative tissue benefits, and preservation of mitochondrial function. Melatonin’s anti-inflammatory and antioxidant support, coupled with its mitochondrial modulation, makes it a vital molecule to use for skin health homeostasis. The cutaneous melatoninergic system’s widespread expression and pleiotropic activity provides for a high level of cell-specific selectivity. Several skin cells, including normal and malignant keratinocytes, melanocytes, fibroblasts and hair follicles, express melatonin receptors. Melatonin also has receptor-independent effects that protect against oxidative stress and can reduce ultraviolet radiation-induced damage. Several functions of melatonin in the skin have been experimentally implicated such as hair growth cycling, fur pigmentation, melanoma control, suppression of ultraviolet-induced damage to the skin cell. Melatonin may play a role in treating several dermatoses e.g., atopic eczema, psoriasis, melasma, ulcer healing, and malignant melanoma. There is a plethora of functional melatonin properties, which still await to be fully appreciated by dermatologists. The current review emphasizes few of the established uses and few emerging potentialities that render melatonin a promising candidate for managing several diseases.

Mixed Variant of Acrokeratosis verruciformis of Hopf: A rare entity

Acrokeratosis verruciformis of Hopf (AKV) is a rare autosomal dominant genodermatosis of unknown etiology. Here we present a case of a 20-year-female with multiple skin-colored flat papules over the dorsum of hands and feet interspersed with multiple hypopigmented macular lesions of 5 years duration. No family member showed a similar lesion. The presence of classical AKV with absent family history and definite histopathology findings make this case an unusual and rare entity.

Severity of Stress in Acne Patients Attending Dermatology Outpatient Department of Tertiary Hospital in Kathmandu

Introduction: Stress persists when a person is unable to cope with the situations of the past, present or future. Stress may be associated with physical and psychological abnormalities. Acne vulgaris is a chronic inflammatory disease of the pilo-sebaceous units with prevalence of more than 85% in adolescent age group. Materials and Methods: Three hundred one patients were recruited in the study. Inclusion criteria included new acne patients of age 16 years and above as well as those who were using but not improving with topical or oral acne therapies. Exclusion criteria included patients receiving sedatives, antidepressants, or glucocorticoids, patient suffering from chronic illnesses like diabetes, hypothyroidism, chronic kidney disease, migraine and other diseases. This questionnaire included biodata of the patients, clinical history and their perceived stress scale. Global Acne Grading System (GAGS) was used to assess acne severity in relation to stress using the Perceived Stress Scale (PSS). Results: The results indicated an increase in stress severity positively correlated with an increase in acne severity, which was statistically significant (p<0.01). Most of the patients were students. Subjects with higher stress scores, determined using the PSS, had higher acne severity when examined and graded using the GAGS. Conclusions: The results showed that there is a positive correlation between severity of stress and grade of acne. Stress management should be a part of acne management.