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Background: Melasma is a common acquired facial hypermelanosis. While mostly diagnosable clinically, Wood’s lamp and dermoscopy can aid in differentiating melasma types based on pigment distribution. Aims: To study the clinico-dermoscopic distribution of melasma and compare it with Wood’s lamp finding. Methods: A total of 140 patients with melasma attending the Dermatology OPD of a tertiary care hospital over a duration of 12 months were included in this cross-sectional analytical study. Patients were subjected to clinical examination, Wood’s lamp examination, and dermatoscopic examination. Noted findings were recorded and analyzed for descriptive values and associations. Results: Among 140 patients, 123 were females and 17 were males, with a mean age of 33.49 ± 7.65 years. Clinically, 78 (55.7%) had centrofacial distribution, 55 (39.3%) had malar distribution, and 7 (5%) had a mandibular distribution of lesions. Wood’s lamp examination showed epidermal type in 64 (47.71%), mixed type in 60 (42.9%), and dermal type in 16 (11.4%). Dermoscopic examinations revealed an epidermal pattern in 79 (56.42%), a dermal pattern in 6 (4.2%), and a mixed type in 55 (39.28%). The most common dermoscopic finding was an exaggerated pseudoreticular network, followed by reticuloglobular pattern, arciform structures, and patternless hyperpigmentations, respectively. The association between color on clinical examination and melasma type by dermoscopy was significant (Cramer’s V = 0.535, P-value = 0.000). The degree of agreement between Wood’s lamp examination and dermoscopic examination was significant with a moderate agreement, (κ = 0.548 P < 0.0005). Conclusion: Although dermoscopy can be used more effectively, both Wood’s lamp and dermoscopy can aid in the diagnosis and determination of pigment distribution in melasma, promising effective intervention, and prognosis assertion.

Background: Alopecia areata (AA) is one of the most common forms of alopecia presenting to the dermatology out patient department (OPD) worldwide as well as in Nepal. It is mostly diagnosed clinically. Treatment depends on the extent, location, and severity of the condition. Various treatment options available are topical, intralesional, and oral medications. Bimatoprost is a relatively newer treatment modality in AA. Aim and Objective: To compare the efficacy and safety of topical bimatoprost 0.01% solution versus clobetasol propionate 0.05% cream in scalp AA. Materials and Methods: A total of 50 patients attending the dermatology OPD of a tertiary hospital between March 2018 and February 2019 were included in this prospective non-randomized open-label clinical trial. Patients were divided into two groups i.e., Group A- topical bimatoprost solution 0.01% and Group B- topical clobetasol propionate cream 0.05%, and followed up at weeks 4, 8, and 12. The improvement was analyzed subjectively by hair regrowth and objectively by Severity of Alopecia Tool (SALT) score. Side effects, nature of terminal hair and onset of initial response were also recorded. Results: Out of 50 patients, 27 were males and 23 were females with a mean age of 28.5 ± 9.34 years and mean duration of disease of 18.67 ± 46.1 weeks. Hair regrowth rate and reduction in SALT score from baseline were seen more in clobetasol group compared to bimatoprost (p = 0.282 and P = 0.246, respectively). Side effects were seen more in the clobetasol group compared to bimatoprost group (p = 0.002). Onset of cosmetically acceptable hair regrowth was seen earlier in the bimatoprost group (p = 0.017) and also the nature of regrown hairs was more pigmented in bimatoprost group (p = 0.024). Conclusions: There is no significant difference in hair regrowth between clobetasol and bimatoprost in the treatment of AA on scalp at the end of 12 weeks, although bimatoprost has an advantage of lesser side effects, more rapid response and growth of more pigmented hairs.

Abstract Introduction Menstrual hygiene management can be challenging in low-income settings and among school-aged girls due to traditional beliefs, lack of knowledge and information on best hygienic practices, and limited access to appropriate and affordable menstrual hygiene products. An alternative method for menstrual hygiene management, instead of sanitary pads or tampons, is the vaginal menstrual cup. As evidence on the use of menstrual cups is relatively limited, this study aimed to explore the acceptability and feasibility of using vaginal menstrual cups among school-aged girls in Thokarpa, Sindupalchowk, Nepal. Methods This is an exploratory study based on four focus group discussions with a purposive sample of 28 schoolgirls between 13 and 19 years of age who were provided with vaginal menstrual cups in Thokarpa, Sindupalchowk, Nepal. The data were collected between February and March 2019, i.e. approximately three months after the distribution of the menstrual cup. Participants were included in the study if they had started their menstruation and never given birth. Conventional content analysis was applied. Results Most participants perceived the menstrual cup positively. Not missing a single class in school due to problems related to menstrual hygiene management was described as a major benefit. The participants found using the menstrual cup easy and convenient, and described economic and environmental advantages of using it. Cleaning the menstrual cup did not cause any problems, according to the participants. Discomforts mentioned by the participants were: pain when inserting the menstrual cup, feeling the menstrual cup sticking out of the vagina, feeling a constant urge to urinate and leakage. Concerns were related to the size, shape and texture of the menstrual cup, and that it may “get stuck” in the vagina, while relatives were said to be concerned about the use of the menstrual cup leading to reduced fertility or losing virginity. Conclusion The use of vaginal menstrual cups for menstrual hygiene management among schoolgirls in Thokarpa, Sindupalchowk, Nepal, appears feasible and acceptable, as it involves practical, economic and environmental advantages. However, the scale-up of menstrual cups will require resolving described concerns and discomforts and fostering peer and family support.

Background: Police officers are regarded as role model of discipline throughout the world. They serve a vital role in maintaining safety and harmony. During their duty, they are exposed to sun radiation which is non–intentional type sun exposure (NISE). The objective of our present study was to evaluate their knowledge and practice regarding ultra violet radiation, photo protection, sunscreens and sun- related photodermatosis. Methodology: Traffic police officers, working at different locations in Kathmandu, were included in this cross sectional study. They were asked to fill the structured questionnaires and then interviewed and examined by dermatologist to assess their knowledge, behaviour and practice in relation to ultra violet radiation and photoprotection. Result: Mean age of 265 respondents was 27.1 years. Respondent with graduation and post-graduation had knowledge and practice toward ultraviolet radiation, followed those with higher secondary education. Regarding the practice for photo protection, only 59.6% had knowledge about sunscreen, 39.6% had knowledge about ultraviolet radiation and 24.9% had knowledge about Ultra Violet Index .Similarly skin problems like melasma, premature wrinkles, and hardening of skin, polymorphic light eruption, burning foot syndrome, dermatophytes, and varicose vein were present. Conclusion: Traffic police officers showed good practices in term of wearing hat, clothes that cover most of the body parts but poor practice over sunscreen, ultraviolet radiation and ultraviolet index. Lectures & seminar regarding the awareness and photo protection practice should be recommended.

Xanthomas are subcutaneous lipid deposits containing macrophages loaded with cholesterol and cholesterol esters. Although quite common in adults, xanthomas in pediatric population are infrequent and when present, may represent a cutaneous manifestation of underlying lipoprotein disorders which most often are familial. We report a case of eleven-year-old female child, with multiple eruptive xanthomas of skin since two years of age, a positive family history and deranged lipid profile consistent with possible familial Hypercholesterolemia.

Background: Police officer serves a vital role in maintaining safety and serve are role model for discipline throughout the world, they are non–intentional type sun exposure(NISE).The objective of our present study was to evaluate photo protector practice, knowledge in response to Ultra violet Radiation ,Sunscreens and sun related photodermatosis. Methodology: A cross sectional study was conducted in traffic police officer at different locations at Kathmandu. Data was collected by using self-administered questionnaires and interviewed by Dermatologist to establish their knowledge and behaviour and practice in relation to ultra violet radiation and photo-protection. Result: Out of 265 participants, mean age was 27.1 years. Respondent with graduation and master degrees had knowledge and practice toward UVR, follow by higher secondary education. Regarding the practice for photo protection only 59.6% had knowledge about sunscreen, 39.6% knowledge about Ultraviolet Radiation and 24.9% had knowledge about Ultra Violet Index .Skin problem like melasma, premature wrinkles, and hardening of skin, polymorphic light eruption, burning foot syndrome, dermatophytes, and varicose vein. Conclusion: Traffic police officers showed good practices in term of wearing hat, clothes that cover most of the body parts but poor practice over sunscreen, UVR, UVI. Lectures & seminar regarding the awareness and photo protection practice should be recommended. With lack of awareness among police officers and providing sunscreen for free should be considered by Police authorities. Similarly lectures & seminar on sun protection should be provided in regularly.

Background: Occupational dermatitis among cement workers is a major occupational health concern and skin contact with cement has been associated with contact dermatitis, which ranges from cement burns to cumulative irritant contact dermatitis. Objective: The objective of this study was to investigate the prevalence and severity of occupational cement contact dermatitis amongst cement workers in Nepal which is the first of its kind. Methods: A cross sectional descriptive study amongst patients in construction site and hardware shops within the Kathmandu valley were selected. A structured questionnaire was used to evaluate the demographic data and work-related activities of these cement workers. A complete skin examination was conducted and skin manifestations were assessed by a dermatologist. The data collected was compiled and appropriate statistical tools was used to find out the significance of variables. Result: Out of the total number of workers screened 164/377 (43.50%) had hand contact dermatitis. There were males 148(90.2%) and females16 (9.8%) and the age ranged from 15-51 years ( mean 27.41± 7.68 years).The duration of the disease ranged from 1-360 months (median 36months (IQR=60).The most common site of lesion was palms (62.8%) followed by tip of the fingers in 39.0% patients and the most common morphology of the lesion was erythema seen in 59.1% followed by scaling seen in 51.8 % patients. Conclusion: The issue of contact and irritant hand eczema amongst cement workers in Nepal has had a considerable morbidity. Identification of these patients with adequate treatment, test of the suspected allergens and counseling could further help the patients involved.

To determine the clinical profile and patterns of lupus nephritis patients in Eastern Nepal, we studied 38 patients fulfilling the 1982 revised criteria of American College of Rheu-matology for systemic lupus erythematous (SLE), followed up from January 2004 to January 2008. Arthritis was a common initial feature in addition to variable cutaneous, cardiac, pulmonary and neuropsychiatric manifestations. Renal biopsy showed grade 1 changes in 5 (13.5%) patients, grade 2 changes in 13 (35.1%) patients, grade 3 changes in 9 (24.3%) patients, grade 4 changes in 7 (18.9%) patients, grade 5 changes in 2 (5.4%) patients, and grade 6 changes in 2.7% patients. Antinuclear antibody (ANA) assay and anti-ds DNA were positive in 78.4 and 81.1%, respec-tively. We conclude that mesangial proliferative glomerulonephritis (grade 2) was the most common pattern of lupus nephritis encountered in our study. Timely diagnosis and treatment may improve the overall patients′ survival.