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Background: Chronic Kidney Disease is a serious, long-term illness that is increasing rapidly worldwide. Hemodialysis is the treatment option for the patients with this disease, which affects their daily life in both positive and negative perspective. This study was undertaken to explore the lived experiences of patients with hemodialysis in Chitwan. Methods: Qualitative descriptive phenomenological study was used and a total twelve patients receiving hemodialysis from 11th August 2019 to 9th September 2019 were selected purposively for the study. Data were collected using in-depth interview guidelines and analyzed using Colaizzi’s seven steps of analysis. Results: Five themes and eighteen subthemes were extracted from the study. They were i) perception about chronic kidney disease (irremediable condition, lethal illness and strenuous ailment with living in confinement) ii) pathway to illness identification (symptoms experience, diagnostic journey and treatment options iii) meaning of living with hemodialysis (renewed hope of survival, uncertainty of life, restricted lifestyle and substandard quality of living) iv) impact of hemodialysis on daily life (soothing effect on body, physical discomfort due to side-effects, mental anguish, social detachment, breach in relationship and economic adversity) and v) journey towards adaptation (acceptance of illness and inability of coping). Conclusions: Patients perceive hemodialysis as a hope for survival and tool for relieving their physical tribulations. But they also experience various physical, psychological, social and financial troubles in their daily life. Hence, it is mandatory for health care providers to understand their experiences to provide them need based holistic care. Nepal government also needs to formulate health policy addressing the need of hemodialysis patients.

Zinc is a micronutrient used over the years for many dermatological conditions such as infections, inflammatory dermatoses, pigmentary disorders, neoplasias etc. It is used in both elemental as well as salt form, either in topical or in oral form as a therapy. An average adult weighing 70 kg has a body zinc content of 1.4–2.3 gm. The role of zinc in deficiency disorder like acrodermatitis enteropathica is already established and used widely as treatment. Zinc has been identified as effective in the treatment of various disorders but it cannot be used as the replacement for proven first line treatment. Zinc can be used as adjuvant therapy in many dermatological disorders. This is a narrative review where various use of zinc as therapy in dermatological disorders is highlighted.

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: An adverse cutaneous reaction caused by a drug is any undesirable change in the structure or function of the skin, its appendages or mucous membranes and it encompass all adverse events related to drug eruption, regardless of the etiology. Methods: This is a retrospective descriptive cross-sectional study done fom April 2017 to March 2019 at dermatology department of Kathmandu Medical College Teaching Hospital. Sample size was calculated as 42 with prevalance of severe cutaneous drug eruption as 3%. After the medication history was taken, all suspected causative drugs were discontinued. For the initial 5 to 7 days, all patients were treated with intravenous corticosteroids and oral antihistamines. Follow up after one week, 2 weeks and one month were suggested for assessment of outcomes. Results: Out of 42 patients, 22 (52.38%) were females and 20 (47.62%) males. Most were in age groups 16-39 & 46-60 counting to 14 (33.33%) in each group. Acute morbilliform eruption was the most common presentation 20 (47.6%) followed by Steven Johnson Syndrome-Toxic Epidermal Necrolysis in 16 (38.1%). The most common offending drug group in this study was antileptics 9 (21.43%), followed by NSAIDs 8 (19.05%), antibiotics 7 (16.67%), allopurinol 4(9.52%%). Patients were discharged after 7 days with tapering dose of oral prednisolone upto 6 weeks for all patients. However, three patients died due to Toxic Epidermal Necrolysis along with comorbid conditions like intracerebral hematoma, COPD with pneumonia. Conclusion: Adverse cutaneous drug reactions should be recognized early for timely intervention. Previously sensitized patients should be made aware about fatal outcomes, symptoms, cross reactivites as well as over the counter preparations.

Background: Dermatophytosis are the most common types of cutaneous fungal infection seen in human and animals affecting skin, hair and nails caused by dermatophytes. The diagnosis of dermatophytes is based on the clinical observation and laboratory diagnosis by direct microscopic examination and fungal cultures. The present study is undertaken to isolate different type of dermatophytes causing fungal infection.Methods: A prospective cross-sectional study design was used in a total of 90 clinically suspected cases of dermatophytic infection attending the out patient department of Kathmandu Medical College and Teaching hospital (KMCTH). Skin scraping, hair and nail samples were collected from the patients and were processed by direct microscopy and culture using standard protocol. Dermatophytes were identified based on the microscopic arrangement of microconidia and macroconidia.Results: Dermatophytosis was more common in the age group of 21-40 years and was more predominant among male with male to female ratio of 1.7: 1. Among the total clinically suspected cases of dermatophytosis, 53 were positive in direct microscopy and only a total of 20 were positive by culture. Most common clinical type observed in our study was Tinea corporis(25%) followed by Tinea cruris. Trichophyton rubrum(50%) was the commonest aetiological agent in majority of clinical types followed by Trychophyton mentagrophytes(35%). Conclusions: The study highlighted T. corporis followed by T. cruris and T. unguim as the most common clinical pattern of dermatophytosis with a male predominance and 21-40 years being the most affected age group. T. rubram was the most common aetiological agent causing dermatophytosis.Keywords: Dermatophytes; dermatophytosis; epidermophyton; tinea; trychophyton.

DOI: https://doi.org/10.3126/njdvl.v17i1.23291 Corticosteroids are over the counter and cheaper drugs available in every medical stores in Nepal. Iatrogenic Cushing syndrome due to topical steroids application is a very rare phenomenon in adults.A 32 year female from Janakpur presented with complaints of swelling of face, weight gain, excessive facial hair and fatigue since two years that gradually increased over last one year. She had a past medical history of on and off application of multiple potent topical corticosteroids for disseminated Tinea infection. She was obese with moon facies, buffalo hump and multiple striae over her abdomen. Her blood pressure was raised and her blood sugar was in pre-diabetic range. Laboratory studies were consistent with iatrogenic Cushing syndrome. Patient recovered after discontinuation of topical corticosteroids and treatment with antifungals.Although iatrogenic Cushing syndrome following application of topical corticosteroid is a rare phenomenon in adults, this can happen in a setup like ours where corticosteroids are prescribed as over the counters and patients have very little knowledge about their use. Therefore, we emphasize that patients and pharmacist should be well educated about the consequences of their prolong application and their side effects. Keywords: Adrenocorticotropic hormone, Clobetasol, Pituitary-adrenal system

INTRODUCTION: Chronic urticaria (CU) is a common skin disorder affecting 15– 20% of the people in the general population. It is a frequent disease which presents with wheals, angiooedema or both and lasts for over six weeks or more. OBJECTIVES: To determine the etiology of IgE specific allergens in the causative of CU in the Nepalese population. MATERIALS & METHODS: A prospective cross sectional study was carried out between November 2014- October 2016 on all patients diagnosed as having CU. Blood samples were taken from all patients and asemiquantitative determination of IgE antibodies against a panel of individual allergens was done and data analyzed and interpreted in terms of numbers and percentages. RESULTS: Three hundred and fourteen patients were included in the study with 56% (175) being female and 44% (139) being male. The age of the patients ranged from 5years to 84 years with a mean of 37.33± 14.39 years. The duration of the disease also ranged from 0.15 to 20 years in which 116(36.9%) patients presented with disease of less than 6 months duration while 163(51.9%) patients had the disease for more than 6 months. Two hundred and seventy nine patients (88.9%) showed a positive test to the allergens amongst which most were allergic to plants which included weeds and grass.CONCLUSION: In patients with CU whenever possible it is advisable to send the patient for serum allergy test to determine the causative agent, the avoidance of which can help in the management of urticaria in troublesome patients.Journal of Universal College of Medical Sciences (2017) Vol.05 No.01 Issue 15, Page: 33-36

Piebaldism is a rare autosomal dominant disorder characterised by a congenital white forelock and multiple symmetrical hypopigmented or depigmented macules. We present a case of an 18 year old male with a typical clinical presentation, followed by a concise review of the literature discussing the genetics, clinical features, diagnosis, and management of the condition. This is the first case of Piebaldism to be reported from Nepal with a good cosmetic surgery outcome.DOI: http://dx.doi.org/10.3126/jkmc.v3i2.11233Journal of Kathmandu Medical CollegeVol. 3, No. 2, Issue 8, Apr.-Jun., 2014Page: 88-91

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.

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Background: Melasma is an acquired chronic hypermelanosis of sun-exposed areas which significantly impacts quality of life. There are few epidemiological studies in medical literature concerning the disease, even less in the Nepalese population. Aims: The present study aimed to investigate the epidemiology of melasma in Nepalese patients and to focus on the clinical manifestations and factors that precipitate this condition. Materials and Methods: A semi-structured questionnaire was administered to melasma patients treated at a dermatology clinic between 2015 and 2016. Melasma was classified on Wood’s light examination, and the patients were thoroughly examined. Various precipitating and etiological factors for melasma were also documented. Results: We assessed 138 patients, of whom 25 (18.1%) were males and 113 (81.9%) were females. Most of the patients 63 (45.7%) reported their melasma of less than 1-year duration. The most commonly reported trigger factors were prolonged, intense sun exposure 113 (83.3%), stress 48 (34.8%), pregnancy 42 (30.4%), contraceptive pills 8 (5.8%) and over the counter steroids use in 6 (4.3%) patients. Housewives and the unemployed constituted 63 (45.7%) of patients followed by service holders and business associated in 22 (15.9%) of patients. Family history was seen in 47 (34.1%), and a history of previous treatment sought was seen in 62 (44.9%) patients. The maximum number of respondents 91 (65.9%) had Fitzpatrick type III followed by type IV in 42 (30.4%) patients, and 5 (3.6%) had type V skin photo type. Preferred facial topographies were malar 125 (90.6%), central facial 46 (33.3%), forehead 40 (29.0%), and mandibular 19 (13.8%). The pigmentation on woods lamp showed epidermal in 90 (65.2%) followed by dermal in 29 (21.0%) and mixed in 19 (13.8%) patients. Conclusions: Melasma is more common in females with a strong history of intense sunlight exposure, pregnancy, and stress being the most common provoking factors. A multifactorial etiology has to be sought for in depth for all patients presenting with melasma.

Nepal Journal of Dermatology, Venereology & Leprology, Vol.14(1) 2016, pp.1