Introduction: Obesity can have many effects on skin physiology. It is involved in dermatologic diseases like acanthosis nigricans, acrochordons, keratosis pilaris, hirsutism, and striae distensae. Objectives: To determine the proportion of various cutaneous manifestations in obese patients. Materials and Methods: This cross-sectional study was conducted at the Outpatient Department of Dermatology in a tertiary care hospital. Any patients over 18 years old with a BMI greater than or equal to 30 kg/m2 attending the dermatology OPD were included. The history-taking and examination were done, and the preformed proforma was completed. Statistical analysis was done using Microsoft Excel 2016 and SPSS Version 20.0 for Windows. Results: Our study included 226 patients. The mean age of patients in our study was 37.45± 13.60 years. There were more females than males in our study. The mean BMI of patients in our study was 32.09±1.81. According to BMI, most patients fell into grade I obesity (89.4%), followed by grade II obesity with 10.6%, and there were no patients with grade III obesity. Acrochordons was the most common dermatosis seen in the study, followed by acanthosis nigricans. The dermatoses that showed a statistically significant relationship with obesity grades were plantar hyperkeratosis (P = 0.001) and lymphoedema (P = 0.0036). Conclusion: Skin diseases are so common among obese patients that they can be considered a marker for obesity.
Introduction: Acne is one of the common problems in the adult female population. Androgen excess, indicated by high serum testosterone levels, has been implicated as a cause for adult-onset acne, though studies correlating testosterone levels with acne severity have shown varying results. Objectives: To assess serum testosterone levels in adult acne patients and correlate it with acne severity. Materials and Methods: This was a single-center, hospital-based, cross-sectional, descriptive study conducted in the Department of Dermatology and Venereology, Tribhuvan University Teaching Hospital (TUTH) from June 2023 to May 2024. All the adult female acne patients fulfilling the inclusion criteria visiting the Outpatient Department (OPD) were included in the study. Acne severity was assessed using the Adult Female Acne Scoring Tool (AFAST: score A and score B). Serum testosterone was measured using a chemiluminescent assay (CMIA), and the correlation of serum testosterone levels with the severity of acne was analyzed. Results: Among 51 female adult acne participants, the mean age of patients was 30.56 ± 0.74 years, median duration of acne of 7 months (1-180 months). The majority of participants had late-onset acne at 72.5% (n=37). Grade 2 acne was the most common, with the cheeks being the most frequently affected area. The mean serum testosterone level was 42.30 ± 15.71 ng/dl; none of the patients exceeded the normal range (5.17-77ng/dl). No significant correlation was observed between serum testosterone levels and acne severity according to the AFAST Score A (p=0.643) and Score B (p=0.830). The study’s findings should be interpreted cautiously due to its small sample size and lack of a control group, resulting from financial limitations. Conclusion: Serum testosterone levels are not a reliable marker of androgen excess in adult females with acne, and there is no significant correlation between serum testosterone levels and acne severity in this sub-population.
Mycosis fungoides is a rare malignant skin neoplasm. It is the most prevalent primary cutaneous T-cell lymphoma. Hypopigmented mycosis fungoides, a variant, has been observed in Asian and dark-skinned individuals. We present a case of a twenty-four years old Nepalese woman with multiple asymptomatic hypopigmented macules on her arms, thighs, abdomen and back. The patient was treated with topical steroids, oral steroids, and topical psoralen with UVA phototherapy for suspicion of vitiligo and Pityriasis lichenoides chronica. After multiple biopsies, histopathology revealed an epidermis with focal subtle vacuolization in junctional zone and epidermotropic small and slightly enlarged lymphocytes with irregular nuclei. Immunohistochemistry showed increased CD4:CD8 ratio. Hypopigmented mycosis fungoides occurrence is infrequent not only in our region but also in Western literature. Recognizing hypopigmented mycosis fungoides as a rare condition and including it in the differential diagnosis of hypopigmented dermatological conditions can aid physicians in early diagnosis and reduce morbidity and mortality through appropriate management and care.
Introduction: Skin biopsy punch is a common instrument used by dermatologists in day-to-day practice. The use of this device is associated with minimal complications. However, we cannot deny the possibility of adverse effects. We aimed to grade and track therapeutic skin punch biopsy wounds over 3 months using the Southampton Wound Grading System (SWGS). Materials and Methods: Selected patients in whom skin punch biopsy could be used therapeutically were enrolled. The procedures were performed under local anesthesia with suturing whenever needed. Immediate complications were noted, with follow-ups after 1 week, 1 month, and 3 months. The complications were noted, and the wounds were graded. Results: A total of 56 lesions from 45 patients underwent five procedures (punch excision, narrow hole extrusion technique, pinch-punch excision, enucleation of corn, and punch grafting). The most common immediate complication was a dog-ear defect; surgical wound dehiscence predominated at one week and one month, while post-inflammatory hyperpigmentation and hypertrophic scars were most common at three months. SWGS grades after one week were IC (67.86%), 0 (17.86%), IA (12.50%), and IIC (1.78%); after one month, 0 (64.29%) and IC (35.71%); after three months, 0 (76.79%) and IC (23.21%). Inferential analysis showed that larger punch sizes were associated with higher complication rates (p=0.049), and sutured wounds had more complications than non-sutured wounds (p=0.0028). Conclusion: There were predominantly minor complications like dog-ear defect and mild erythema, with no postoperative infections. Larger punch sizes and suturing were associated with more complications, underscoring careful punch selection and closure technique.
Tinea barbae is a rare dermatophyte infection of the beard and mustache region, often seen in agricultural workers due to zoonotic transmission. Its inflammatory form, kerion barbae, can mimic bacterial infections, granulomatous dermatoses, or even malignancy, leading to misdiagnosis. We report a case of a 55-year-old male farmer from rural Nepal who presented with a one-month history of nodulo-ulcerative and pustular lesions over the chin and beard area. Clinical examination revealed an indurated plaque with purulent discharge, crusting, and easily pluckable beard hairs. Pus culture grew Staphylococcus aureus, while the potassium hydroxide mount and periodic acid–Schiff stain were negative for fungal elements, whereas fungal culture was unavailable. Despite antibiotic therapy, only partial improvement was achieved. Considering kerion barbae, oral itraconazole was initiated, resulting in rapid clinical improvement and complete resolution within four weeks. This case highlights the possible misdiagnosis of kerion barbae, particularly when complicated by bacterial superinfection, as false-negative KOH and PAS results are not uncommon. Kerion barbae should be considered in rapidly enlarging nodulo-ulcerative beard lesions unresponsive to antibiotics, especially in resource-limited settings. A therapeutic trial of antifungal therapy is justified to avoid misdiagnosis and prevent sequelae such as scarring and alopecia.
Melasma is a common pigmentary disorder characterized by dark patches on the face, neck, and sternum, most frequently affecting women of reproductive age. Beyond its cosmetic impact, melasma can significantly affect self-esteem and quality of life. Its development involves multiple factors, including genetic predisposition, hormonal influences, ultraviolet radiation, and skin barrier dysfunction. Diagnosis relies on clinical examination, supported by dermoscopy, Wood’s lamp examination, histopathology, and advanced imaging, which also help differentiate it from other pigmentary disorders. Management has evolved considerably, with topical agents and chemical peels remaining first-line options, either alone or in combination. Advances in laser and light-based therapies have expanded treatment choices, while newer modalities such as platelet-rich plasma and microneedling offer less invasive yet effective alternatives. Combination approaches often provide superior outcomes. This review summarizes current knowledge on pathogenesis, diagnostic tools, and therapeutic strategies, aiming to guide clinicians toward effective, individualized, and sustainable management of melasma.
Frank’s sign is a diagonal crease of the earlobe that runs from the tragus across the lobule to the posterior margin of the auricle. Commonly referred to as the diagonal earlobe crease (DELC), it has been considered a potential marker of diabetes, cardiovascular disease, and other metabolic conditions. Since both the heart and the earlobe are supplied by end arteries, it was once believed that DELC and heart disease might develop concurrently, as collateral circulation is limited when vascular damage occurs. Some studies have also suggested an association with aging and polycystic ovarian syndrome. Early diagnosis is essential in order to provide effective therapy, reduce mortality, and improve quality of life. However, further research is required to better establish the diagnostic significance of Frank’s sign and its clinical applications. Here, we report five cases of DELC with varied associated disorders.
Background: Persons with albinism (PWAs) are at heightened risk for ultraviolet-induced skin malignancies. Despite the protective efficacy of sunscreen, its utilization among Nigerian PWAs remains suboptimal. Objectives: To evaluate the effect of structured health-education intervention on sunscreen awareness, adoption, and adherence barriers among PWAs in southwestern Nigeria. Methods: A quasi-experimental pre-post study was conducted among PWAs attending a community outreach program in Ile-Ife, Nigeria. Participants received targeted health education on photoprotection and sunscreen use. Data were collected using interviewer-administered semi-structured questionnaires. Changes in awareness, use, and adherence were analyzed using McNemar’s test and logistic regression. Significance was set at p < 0.05. Results: Among 43 participants (mean age: 35.3 ± 10.8 years; 60.5% female), pre-intervention sunscreen awareness was 58.1%, with only 4.7% reporting consistent use. Post-intervention, awareness increased significantly (p < 0.001), and occasional use rose from 23.3% to 37.2% (p = 0.032). However, consistent use remained low (14.0%), hindered by cost (55.8%), limited availability (39.5%), and reapplication challenges (32.6%). Older age and indoor occupations predicted lower adherence (p < 0.05). Conclusion: Health education significantly improved sunscreen awareness but had a limited impact on adherence. Addressing structural and behavioural barriers through subsidized access and context-specific interventions is critical to improving photoprotection among PWAs in Nigeria
Introduction: Sexually transmitted infections (STIs) directly affect sexual and reproductive health through stigmatization, infertility, cancers, and troubles during pregnancy, like perinatal infections. Even though Nepal is regarded as a "low-incidence" country for HIV infection, recent sero-prevalence data indicate that the number of STI/HIV infections has increased significantly. Since health care workers deal with HIV and STIs regularly and are a susceptible group, it is expected that they have good knowledge and practice about the transmission of HIV and STIs. Materials and Methods: This is a descriptive cross-sectional study conducted at the Department of Dermatology and Venereology of KIST Medical College and Teaching Hospital, Nepal. Any healthcare worker and medical students of the age group 15 to 49 years working and studying respectively in the institute were included in the study. Frequency and percentage of the data were calculated. A chi-square test was applied to determine the association between two categorical variables, and p p-value less than 0.05 was considered significant. Results: Out of 142 participants, 97.2% recognized HIV and 92.3% recognized syphilis, but only 73.3% identified hepatitis B as an STI, and just 12.7% recognized trichomoniasis. This data shows a gap in knowledge of non-HIV STIs. Except for the practice of using masks and gloves in the workplace, all other variables show statistically significant differences between designations. Conclusions: The majority of the participants knew HIV, syphilis, and gonorrhea as STIs. But knowledge was not satisfactory with respect to symptoms of STIs/HIV/AIDS and the disease course of STIs/HIV/AIDS.
Generative AI tools are transforming academic publishing, offering efficiency, language support and assistance in complex tasks. NJDVL encourages its responsible use while emphasizing that AI is a tool, not an author. Human accountability, transparency and ethical oversight remain paramount. Full disclosure and human oversight ensure accountability, transparency and integrity, allowing AI to enhance rather than compromise scholarly rigor.
Drug Reaction with Eosinophilia and Systemic Symptoms syndrome is a rare, severe cutaneous adverse reaction characterized by widespread rash, fever, hematologic abnormalities, and potential multi-organ involvement. It is most often associated with anticonvulsants, sulfonamides, and allopurinol, while anti-tubercular drugs are rarely implicated. We report the case of a 66-year-old female with a history of tuberculous pericardial effusion who developed recurrent diffuse erythematous, non-blanchable maculopapular rashes with facial edema and systemic symptoms following re-exposure to anti-tubercular therapy. Her symptoms were temporally related to ATT administration, strongly supporting a diagnosis of ATT-induced DRESS syndrome. The patient’s past medical history included hypothyroidism and cerebrovascular accident, but no significant drug allergies. Clinical evaluation revealed fever, facial swelling, generalized pruritic rash, and systemic complaints without significant abnormalities on chest or abdominal examination. Prompt discontinuation of ATT and supportive management led to clinical improvement. This case underscores the importance of early recognition of DRESS, even with uncommon culprits such as anti-tubercular drugs. Given the global prevalence of tuberculosis, ATT-induced DRESS poses unique therapeutic challenges, particularly in balancing drug hypersensitivity management with effective tuberculosis treatment. Clinician awareness and timely intervention remain key to improving outcomes in this potentially life-threatening condition.
Introduction: Hirsutism is a common clinical condition with multifactorial etiology, ranging from endocrinological abnormalities to benign idiopathic causes to, rarely, severe malignant disorders. It negatively impacts the quality of life and self-esteem of affected women, necessitating proper etiological diagnosis and management. Aims and objectives: To evaluate etiology of hirsutism and study clinical manifestations and biochemical characteristics associated with it. Materials and Methods: After obtaining approval from Institutional Ethics Committee, a cross-sectional observational study was conducted at the tertiary care hospital for 2 years. Detailed history, clinical examination, assessment of hirsutism as per modified Ferriman Gallwey score, investigations including hormonal assays and radiological examination were done for all patients. Data were analyzed using appropriate statistical tests. Results: Among 43 women, 65.11% had mild hirsutism, 25.58% had moderate, and 9.30 % had severe hirsutism. Menstrual irregularities were noted in 58.14%, and 13.95% had a family history of hirsutism. Acne (65.11%) and seborrhea (51.16%) were the most common cutaneous findings. 16.28 % and 27.91% women were overweight and obese, respectively. Insulin resistance (Homeostasis Model Assessment of Insulin Resistance i.e., HOMA IR index >2) was present in 46.51% patients, with PCOS (Polycystic Ovary Syndrome) being the leading cause, and showed significant correlation with BMI (p = 0.001). LH/FSH ratio >2 (i.e., ratio of Luteinizing Hormone to Follicle-Stimulating Hormone) was present in 39.53% and 46.5 % recorded positive findings of polycystic ovarian morphology by radiological examination. Conclusion: The most common cause of hirsutism in our study was found to be PCOS, followed by idiopathic hirsutism. Diligent assessment of hirsute women with particular attention to metabolic components such as insulin resistance, as indicated by the HOMA-IR index, must be undertaken to identify the root cause and tailor appropriate interventions.
Café au lait macules (CALMs) are common, benign, light-brown skin patches that usually appear in childhood. Typically under 2 cm in size and found on sun-protected skin, they are present in about 2–3% of newborns and a third of school-aged children. While single CALMs are harmless, multiple lesions may signal underlying disorders like neurofibromatosis type I (NF1) or McCune-Albright syndrome (MAS). A case study of a 3-year-old boy with enlarging CALMs highlights the need for clinical, dermoscopic, and histological assessments to rule out associated syndromes such as NF1, MAS, segmental neurofibromatosis, and Watson syndrome, though the child showed no signs of these. CALMs carry no risk of malignancy, but cosmetic concerns often lead to treatment. High-fluence Q-switched 1,064-nm Nd:YAG laser therapy has proven safe and effective, achieving over 75% clearance in about half of patients with minimal side effects, making it a valuable option for managing these lesions.
Aplasia Cutis Congenita (ACC) is a rare congenital condition characterized by localized or widespread absence of skin at birth. It most commonly affects the scalp and can be classified into different subtypes based on clinical presentation and associated anomalies. The exact etiology remains unclear, with genetic predisposition, vascular compromise, teratogen exposure, and maternal factors being implicated. This case is of a preterm male neonate, born at 35 weeks of gestation to a 40-year-old primigravida mother with a history of hypothyroidism and long-term thyroxine use. The mother conceived via in vitro fertilization (IVF) after undergoing extensive fertility treatments. At birth, the neonate exhibited two well-demarcated skin defects over the left posterior parietal triangle of the scalp, without involvement of deeper structures. Clinical diagnosis of non-syndromic membranous scalp ACC was made. Conservative management with saline cleansing and topical antibiotic application was adopted. The lesions healed completely by six months with residual atrophic scarring and a ‘hair collar sign’. This case highlights a rare instance of isolated ACC in a neonate with a unique maternal history of hypothyroidism, prolonged thyroxine use, and IVF-conceived pregnancy. The successful conservative management further supports its role in appropriately selected cases.
Lamellar ichthyosis is an autosomal recessive type of ichthyosis characterized by abnormal skin scaling, ectropion and ear abnormalities. Pseudoainhum is the appearance of constriction bands around digits which can lead to autoamputation of digits. Here we report a case of Lamellar ichthyosis with Pseudoainhum, which showed reversal of Pseudoainhum with 6 months of acitretin therapy.
Demodex mites are microscopic arachnids that inhabit hair follicles and sebaceous glands on the face. Their prevalence increases with age and certain conditions like obesity, diabetes, and immunosuppression. While usually harmless commensals, they become pathogenic when their density exceeds 5 mites/cm² or when the skin’s balance is disrupted, leading to demodicosis. This condition manifests with various skin and ocular symptoms, including rosacea-like eruptions, blepharitis, and chalazion. Diagnosis relies on mite density assessment through methods such as standardized skin surface biopsy and dermoscopy. Factors such as prolonged mask use during the COVID-19 pandemic and immune reconstitution diseases influence mite proliferation. Treatment involves topical agents like permethrin and ivermectin, oral ivermectin or isotretinoin for resistant cases, and adjunctive therapies including intense pulsed light and microblepharoexfoliation. Management should be individualized based on severity and resistance to optimize outcomes.
Porokeratosis is a chronic and progressive disorder of keratinization. Punctate porokeratosis is grossly described as multiple minute keratotic projections over the palmoplantar region. On histology, it is characterized by the presence of cornoid lamellae. Here, we report a case of localized punctate palmoplantar porokeratosis in a 28-year- old male, considering its rarity of pitted presentation.
Wolf’s isotopic response describes the phenomenon where a new, different skin disorder occurs at the site of a previously healed skin lesion. The most common primary and secondary diseases are herpes zoster and granuloma annulare, respectively. Psoriasis vulgaris is rare as a secondary disease, with only two cases reported. Here, we report another rare case of psoriasis vulgaris following a herpes zoster.
Acute Generalized Exanthematous Pustulosis (AGEP) is a rare, severe adverse cutaneous drug reaction characterized by fever and numerous sterile, non-follicular pustules on an erythematous base that manifests 2 to 14 days after drug exposure. While systemic antibiotics, particularly beta-lactams and macrolides, are frequently implicated, they can also be triggered by other drugs, including hydroxychloroquine, antifungals, antivirals, antineoplastics, and herbal remedies like Ginkgo biloba, curcumin, etc. This case series reports three unusual instances of AGEP after intake of tablet paracetamol, native medicines, and syrup azithromycin. All three patients met the EUROSCAR diagnostic criteria for AGEP, with scores indicating a definite diagnosis. Treatment included the withdrawal of the offending drug, symptomatic management, topical and systemic steroids, resulting in the resolution of lesions within a week. This series emphasizes the necessity of considering rare and less common etiologies, highlighting that drugs like paracetamol, native medicines, and azithromycin, while infrequently associated, can still provoke AGEP. Comprehensive evaluation of all possible triggers is crucial for accurate diagnosis and effective treatment.
