Cutaneous Leishmaniasis in Natives of Central Region of Nepal.

We report two cases of cutaneous leishmaniasis in natives of central region of Nepal. The first patient in our series, an adult female, presented with a small nodule on the philtrum of upper lip and the second case, a male child, presented with two crusted plaques on forehead. The final diagnosis was based on histopathological findings; however, species characterization was not possible because of its unavailability in the country. These patients responded well to the treatment with Miltefosine (First case) and Fluconazole (second case). Moreover, these cases sparks a question about the origin of diseases in this region and calls for further research in future to find out the cause and prevalence of this disease in Nepal. This case report also emphasizes to consider cutaneous leishmaniasis as differential diagnosis for granulomatous presentations in our context.

Assessment and Comparison of Quality of Life in Patients with Melasma and Vitiligo.

Background Melasma is an acquired hyperpigmentary condition that is characterized by development of irregular brown to black macules occurring predominantly on the face. Vitiligo is an acquired depigmenting skin disease characterized by progressive loss of inherited skin colour, which leads to appearance of white patches. Both the conditions occur more frequently in people with racially pigmented skin resulting in psychological morbidities and impacting the quality of life. Objective To evaluate and compare the quality of life in patients suffering from melasma or vitiligo, which represent two opposite ends of pigmentary disorders using the Dermatology Life Quality Index (DLQI). Method This was a hospital based cross sectional study that was conducted at the Department of Dermatology and Venereology, Tribhuwan University Teaching Hospital from September 2016 to August 2017. The study population included adult patients of either sex with melasma or vitiligo, who consented to participate in the study. Result There were a total of 100 patients each in both melasma and vitiligo groups. While females outnumbered their male counterparts by a ratio of 9:1 in melasma, the gender distribution was more equal in vitiligo. Melasma had a mean DLQI score of 5.64 ± 5.41 and a median score of 4 while vitiligo had a mean DLQI score of 4.13 ± 3.74 and a median score of 3. Conclusion Melasma patients had a higher impairment in quality of life compared to vitiligo patients. The quality of life in both the conditions varied based on age, gender, duration and distribution.

Apocrine carcinoma developing in a naevus sebaceous of scalp.

Apocrine skin carcinoma is an aggressive cutaneous tumour. We report a case of apocrine carcinoma developing in a naevus sebaceous of scalp in a 45 years old male. Malignant transformation of Naevus sebaceous is a rare complication usually found in elderly patients. Most of these tumours are basal cell carcinoma or squamous cell carcinoma. Only few cases of apocrine carcinoma on naevus sebaceous have been previously reported. This report highlights the potential of naevus sebaceous for malignant transformation.

Onychomycosis: clinical pattern and prevailing fungi in Kathmandu.

Onychomycosis is a chronic mycotic infection of finger and toe nails that affects the quality of life in a significant proportion. The study was aimed to identify the clinical patterns and etiological agents of onychomycosis. The study population comprised of the suspected cases of onychomycosis, attending the outpatients department of Dermatology of Tribhuvan University Teaching Hospital, Kathmandu, during November 2006 to March 2008. Detailed history was taken and clinical pattern was noted. Nail sample was obtained from patients with suspected onychomycosis and was subjected for direct microscopy and fungal culture. After first inoculation, the culture tubes were examined every day for one week and thereafter weekly and the fungus was identified. A total of 218 patients were included in the study. The age of the patients ranged from 4 to 88 years with mean of 32.8 +/- 15.4. Maximum of the patients were in the age group of 21-30 years. M: F ratio was 1.05:1. Duration of the disease varied from 1 month to 15 years. Direct microscopy was positive in 64.22% and culture was positive in 41.7%. Dermatophytes were isolated in 54.9%, yeasts in 39.6% and non-dermatophyte molds in 5.5%. As a whole, Trichophyton rubrum was the most common fungal isolate (82%). Yeast infection was more common in females. Yeast was significantly more commonly implicated as a pathogen in finger nail onychomycosis. Dermatophytes were more frequently isolated from toe nail onychomycosis. In conclusion, T rubrum was the most common fungal isolate.

Onychomycosis: a clinico-epidemiological study.

Onychomycosis is a common nail disorder. Far more than being a simple cosmetic problem, infected nail serves as a chronic reservoir, which can give rise to repeated mycotic infections. The study was undertaken to determine the various clinical patterns of onychomycosis. This prospective cross sectional study was conducted in clinically suspected patients of onychomycosis attending out patients department of dermatology, T.U. Teaching hospital between August 2006 and July 2007. Various data were obtained and clinical patterns were noted. Out of 182 clinically suspected patients of onychomycosis, 52.7% were males with male: female ratio of 1.1:1. Onychomycosis was predominant among the younger patients with slight male preponderance. Fingernails were more frequently involved in females whereas toenails in males. The most common clinical type was distal and lateral subungual onychomycosis. 58.2% had other concomitant fungal infections apart from onychomycosis. Onychomycosis could serve as a good reservoir for recurrent cutaneous superficial fungal infections. Hence, adequate treatment of onychomycosis can prevent from these recurrent cutaneous superficial fungal infections.

Cutaneous leishmaniasis: report of rare cases in Nepal.

Cutaneous leishmaniasis is rare in Nepal although visceral leishmaniasis (kala azar) is common in the Terai region. In country like ours where tuberculosis is more prevalent cutaneous leishmaniasis is very likely to be mistreated as cutaneous tuberculosis, especially lupus vulgaris. Here we report a series of four cases of cutaneous leishmaniasis who presented in the out patient department at TUTH in the year 2006.

Herpes zoster in a five month old infant subsequent to intrauterine exposure to varicella infection.

Herpes zoster is characterized by painful vesicular eruption in a dermatomal distribution of sensory nerves as a result of reactivation of latent herpes zoster virus in posterior root ganglia. The primary varicella infection is usually acquired in childhood and reactivation usually is seen in elderly. In rare instances herpes zoster can also occur in infancy as a result of reactivation of primary varicella infection acquired in utero or in early infancy. Here, we report a rare case of herpes zoster in a 5 month baby who acquired primary infection in utero from mother who had varicella infection at 6 months of gestation.