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.

Background: Primary cutaneous lymphomas are a distinct group of rare lymphoid neoplasms with absence of extracutaneous lymphomas at the time of presentation. They are rare in Nepal and no data on cutaneous lymphoma have been published from this country till date. Methods: This retrospective study included 15 cases of cutaneous lymphomas retrieved from the records of department of Dermatopathology, DI Skin Hospital and Referral Centre, Bansbari, Kathmandu, Nepal. Patients were diagnosed according to the current WHO classification for cutaneous lymphoma. Results: A total of 15 cases were studied with median age of 45 years (range: 22 to 81 years) and male to female ratio of 1.5:1. Primary cutaneous lymphomas constituted 13 cases out of 15 and the most common type of cutaneous lymphoma was mycosis fungoides and variants 5 (33%), followed by CD30 positive primary cutaneous anaplastic large cell lymphoma constituting 2 (13%). T-cell cutaneous lymphoma constituted 13 (87%) and B-cell cutaneous lymphoma 2 (13%). Conclusions: Cutaneous T-cell lymphomas were more frequent than cutaneous B-cell lymphomas in Nepalese patients. Mycosis fungoides and variants are commonest type of primary cutaneous lymphomas. Keywords: Histopathology; mycosis fungoides; primary cutaneous t-cell lymphoma; WHO classification.

We describe a case of a 5-year-old boy who presented with multiple mild itchy and painful blisters predominantly over his trunk and limbs for one year with multiple tense bullae with hypopyon signs resulting in a half-and-half appearance of the blisters. A skin biopsy showed subepidermal separation with predominantly neutrophils and eosinophils in the bulla cavity and mixed infiltrate in the papillary dermis. We would like to report a case of chronic bullous disease of childhood and review its differentials for diagnostic approaches to blistering disease in children.

Introduction: Melasma is the most common cause of facial melanosis and one of the most common diseases presenting to the Dermatology department. It can lead to psychological and emotional distress for the patients and can hamper their quality of life. So, this study was done to assess the quality of life among patients with melasma so that the need for couseling of these patients could be assessed along with medical treatment. Materials and Methods: This was a hospital based cross sectional study with 205 clinically diagnosed cases of melasma during the study period of one year. Melasma area severity index (MASI) score was recorded for each patient. Melasma quality of life was evaluated using the Melasma related Quality of Life (MELASQOL) score. MASI score and MELASQOL score were correlated using the Chi square test and socio-demographic details were also recorded. Results: The mean MASI score in our study was 14.39 and the mean MELASQOL score was 34.98. The correlation of the MASI score with the MELASQOL score was found to be statistically significant (p value = 0.000). Conclusion: MELASQOL score can be used to assess the quality of life in patients with melasma and the impairment in quality of life depends upon the MASI score.

Background: Teledermatology has become a popular alternative tool for providing dermatology services during the COVID-19 pandemic worldwide. Despite being a rising health care modality, it helped to deliver uninterrupted services. The study aimed to determine the implementation, utilization, and acceptance of teledermatology services during the pandemic. Objectives: The aim was to assess the satisfaction of patients utilizing teledermatology services and to obtain their clinical and epidemiological data. Methods: This was a retrospective, observational, single-center study on patients using teledermatology services. Demographic data was analyzed and a questionnaire survey was conducted through phone calls regarding their experience of the service. Results: The mean age of the patients was 33.48 ? 17.89 years. Out of 122 teleconsultations, 89 patients could be contacted again for feedback, among which 81 (91%) found the service easy to use, 75 (84.3%) were able to express their problems similarly to visits in person, 49 (55.05%) regarded teleconsultation as the same as an in-person visit, 80 (89.9%) were satisfied, and 85 (95.5%) agreed to use the service in the future. Superficial fungal infection was the most common diagnosis (24.6%). Newly registered patients were more satisfied in comparison to follow-up patients (96.36% of new cases vs. 79.41% of follow-up cases, p = 0.01). Conclusion: Teledermatology was well accepted by the patients in the current scenario. Telehealth services have a promising role in the future in fulfilling public health demands.

The COVID-19 pandemic has caused nationwide lockdown, which led to the disruption of health services. Despite being a rising health care modality in Nepal, virtual dermatology services became an effective tool to provide dermatologic care through web-based consultations throughout the country. Therefore, we assessed the implementation of teledermatology services at our center to provide uninterrupted health services across the country during the pandemic. This study aimed to evaluate the clinicodemographic profile of patients using teledermatology services and patient acceptance of this service. A retrospective, single-center, observational study was carried out. Clinicodemographic data from the patients using teledermatology services were obtained and analyzed. A set of questionnaires regarding patients’ acceptance of teledermatology services were administered to the patients through a survey via telephone calls, and the obtained data were interpreted. A total of 122 teleconsultations were carried out within the country. The mean age of patients was 33.48 (SD 17.89) years. Of these 122 patients, 79 (64.8%) were from outside and 43 (35.2%) were from inside the city where the institute is located. The average distance from the institute to the patients’ residence was approximately 144.84 (SD 157.20) km, and the mean travel time was approximately 385.31 (SD 889.52) minutes. In total, 89 patients could be contacted, of whom 81 (91%) found the service easy to use, 75 (84.3%) were able to express their problems in a manner similar to that during direct visits, 49 (55.05 %) thought that the teleconsultation was the same as an in-person visit, 80 (89.9%) were satisfied, and 85 (95.5%) agreed to use teledermatology services in the future. Superficial fungal infection was the most common diagnosis (24.6 %). Newly registered patients were more satisfied than follow-up patients (96.36% vs 79.41%, respectively; P=.01). This study highlights the importance of virtual dermatology services to deliver dermatologic care during the pandemic in Nepal. In the future, this program has a promising role in providing health care services to meet the medical needs of patients.

Introduction: Tinea capitis is a common dermatophyte infection of the scalp and hair shaft, most commonly observed in children. Trichoscopy is nonivasive tool which helps in early diagnosis and prompt treatment of tinea capitis. Objectives: This study was carried out with the aim to describe the trichoscopic features of tinea capitis and to find out its different clinical variants with the aid of trichoscopy. Materials and Methods: This is a hospital based cross sectional descriptive study conducted from 1st January 2019 to 31st December 2019. All patients clinically diagnosed with tinea capitis were included in the study. Result: A total of 50 patients with tinea capitis were recruited. The most common age group was found to be 6-10 years (52%) and 27 patients (54%) were female. Majority of the population were students, i.e. 46 patients (92 %). Family history was positive in 38% of cases. The clinical variants seen were black dots in 20 patients (40%), followed by gray patch in 15 patients (30%), kerion in 8 patients (16%) and combined type (both gray patch and black dots) in 4 patients (8%). The most common trichoscopic feature were black dots in 40 (80%), followed by comma hairs in 38 (76%), corkscrew hairs in 33 (66%), and broken hairs in 24 (48%). Conclusion: This study highlighted that the use of trichoscopy as non-invasive tool helped in diagnosing the cases of tinea capitis without the use of wood’s lamp and laboratory investigations.

Telemedicine has the potential to deliver high-quality, affordable health care to underserved populations that otherwise would not have adequate access to care. The authors provide a snapshot of several telemedicine initiatives that have used information and communication technologies to connect patients with health care providers across various Asian countries with differing socioeconomic statuses. They highlight several factors thought to contribute to the success of telemedicine programs, such as financial sustainability, ease of use, and utilization of existing resources. Challenges these programs have faced include lack of technological infrastructure, limitations in funding, and conflicting health system priorities.

Abnormalities of facial pigmentation, or facial melanoses, are a common presenting complaint in Nepal and are the result of a diverse range of conditions. The objective of this study was to determine the frequency, underlying cause and impact on quality of life of facial pigmentary disorders among patients visiting the Department of Dermatology and Venereology, Nepal Medical College and Teaching Hospital (NMCTH) over the course of one year. This was a cross-sectional study conducted at the Department of Dermatology and Venereology, NMCTH. We recruited patients with facial melanoses above 16 years of age who presented to the outpatient department. Clinical and demographic data were collected and all the enrolled participants completed the validated Nepali version of the Dermatology Life Quality Index (DLQI). Between January 5, 2019 to January 4, 2020, a total of 485 patients were recruited in the study. The most common diagnoses were melasma (166 patients) and post acne hyperpigmentation (71 patients). Quality of life impairment was highest in patients having melasma with steroid induced rosacea-like dermatitis (DLQI = 13.54 ± 1.30), while it was lowest in participants with ephelides (2.45 ± 1.23). Facial melanoses are a common presenting complaint and lead to substantial impacts on quality of life. Accurate diagnosis and management can prevent or treat many facial melanoses, including those that lead to substantial loss of quality of life, such as melasma with steroid induced rosacea-like dermatitis. Health care systems in low and middle-income countries should dedicate resources to the identification, prevention and treatment of these conditions to improve quality of life.

Background: The skin is a heterogeneous organ, capable of producing various types of skin tumors. The incidence of skin cancers, including melanoma and non-melanoma has been reported to have risen in many parts of the world. In Asian and African countries, individuals with pigmented races have a much lower incidence of skin cancers despite sunny hot weather. This study is aimed to analyze age, sex and site wise of distribution of skin cancers. Materials and Methods: The study included a total of 60 patients with histopathologically proven skin cancers from January 2015 to December 2018 in the department of pathology, DI skin health and referral centre, Kathmandu, Nepal. Results: A total of 60 cases of histopathologically proven skin cancer constituted 3.69% of total skin biopsies. Patient age ranged from 15 to 88 years with mean age being 61 years. The majority of the patients were in the age group of 61-70 yrs. The male to female ratio is 1:1.3. Basal cell carcinoma was the most common skin cancer constituting 43.4%, followed by squamous cell carcinoma (28.3%). The most common site of skin cancer is head & neck (73.3%), followed by lower extremities (8.3%). Other skin cancers were Bowen’s disease, melanoma, verrucous carcinoma, keratoacanthoma, trichilemmal carcinoma, extramammary Paget’s disease, Non-Hodgkin lymphoma and metastatic tumor. Conclusions: The most common type of skin cancer is basal cell carcinoma, followed by squamous cell carcinoma and head & neck being the commonest site.

Background: Cryosurgery is the well-aimed and controlled destruction of diseased tissue by application of cold. It has been shown to be effective and efficient in various skin diseases. We studied the indications and outcome of this modality of treatment in our set up. Materials and Method: All patients who were subjected to cryosurgery for different clinical indications were included in the study. Results: There were total of 133 patients. Commonest age group presentation (between 16 to 25 years) constituted about 42%. 52% of patients were students. There were total of 91% who were from Kathmandu remaining 9% were from outside of Kathmandu Valley. Cryosurgery was indicated commonly in warts for 82% patients followed by 12% for keloid & hypertrophic scar, benign conditions in 4% and in premalignant conditions for 2% patients. Number to treatment (or sessions) for indicated disease with resolution of disease was single in 81% patients followed by between 2 to 5 treatment session in 14% and more than 5 treatments was necessary in 5%. Side effects like pain was seen in 64% patients, erythema in 8% and blistering 4%. 24% patients did not have any side effect. Conclusion: Cryotherapy is considered as one of the effective modality of treatment for various skin conditions with various limitations. Further prospective clinical trial with large population group should be carried out.

Telemedicine is now also being used in many developing nations to deliver healthcare to distant communities. With increasing penetration and decreasing costs of information technology services, several telemedicine projects have been initiated in Nepal. Besides the difficulties in building infrastructure and technologically connecting with remote geographical locations, networking with beneficiary communities and ensuring sustainability of services remains a major challenge. Community Health Education and Services by Telehealth (CHEST Nepal), a non-profit organisation, has developed a unique model for tele-health and implemented it in two distant comminties. Unique features of this model are a hospital to community network, complete ownership of the community, including decisionmaking and revenue generation and maximum utilization of teleconferencing infrastructure by providing other educational and vocational training services in addition to teledermatology.

Introduction: Leprosy is a chronic infectious disease affecting mainly cutaneous and peripheral nervous system. Histopathology is an important tool to diagnosis leprosy in situation where it mimics other clinical condition. This study was conducted to know the correlation between clinical and histopathological diagnosis of Leprosy. Material and Methods: This was a retrospective study and patients were enrolled in whom leprosy was clinically diagnosed or suspected and histo-pathological examinations were carried upon. Results: A total of 71 patients were studied. Of them 48 patients (67.6%) were males and rest 23 (32.39%) patients were females. Mean age of patients at presentation was 37.85 +/- 2.021 years. Clinically in 42 patients (59.1%) type of leprosy could not be specified. Borderline tuberculoid was diagnosed in 7 patients (9.8%), Tuberculoid in 6(8.5%), Relapse in 3(4.2%), lepromatous in 6(8.5%) and Borderline, borderline lepromatous 1(1.4), Indeterminate 1 patient (1.4%). In 7% cases, Hansens disease was considered as differential diagnosis along with other clinical conditions. In 47% cases, data was not available. On histopathological evaluation on skin biopsies, epidermal changes seen were 29.5%. Of the total 71 patient, dermal changes seen were granuloma (42%), dermal infiltrate (11%), adnexal infiltrate (7%), nerve infiltrate (11%), adnexal with nerve infiltrate (6%), perivascular with adnexal infiltrate (20%) and nonspecific (3%). Dermal infiltrates in 46.4% cases constituted of lympho-histiocytes. In 48 patients (69%) leprosy was histopathologically confirmed and in rest 31% cases diagnoses was non-specific in 20 patients (28.1%), vasculitis, Dariers and Fungal infection 1 patient each (1.4%). Borderline Tuberculoid (BT) and TT was the most common diagnosis among leprosy patients around 29.2% each, followed by Indeterminate 25%, LL 8.3%, BL and and Pure neural 4.1% each. When clinical diagnosis and histopathological diagnosis was correlated it was found that the parity was seen in TT as 66.6%, BT 42.9%, LL 16.7%. Where Hansen’s disease was kept as differential diagnosis two patients had leprosy. Conclusion: The study being retrospective the uniformity in clinical diagnosis and histopathological evaluation couldnot be assessed. With the limitations this study still give information about the importance of histopathology to diagnose Leprosy and for proper treatment category and decrease the burden of the disease in the society.