IntroductionPost-kala-azar dermal leishmaniasis (PKDL) is a cutaneous complication appearing after treatment of visceral leishmaniasis, and PKDL patients are considered infectious to sand flies and may therefore play a role in the transmission of VL. We estimated the risk and risk factors of PKDL in patients with past VL treatment in south-eastern Nepal.MethodsBetween February and May 2010 we traced all patients who had received VL treatment during 2000–2009 in five high-endemic districts and screened them for PKDL-like skin lesions. Suspected cases were referred to a tertiary care hospital for confirmation by parasitology (slit skin smear (SSS)) and/or histopathology. We calculated the risk of PKDL using Kaplan-Meier survival curves and exact logistic regression for risk factors.ResultsOut of 680 past-treated VL patients, 37(5.4%) presented active skin lesions suspect of PKDL during the survey. Thirty-three of them underwent dermatological assessment, and 16 (2.4%) were ascertained as probable (2) or confirmed (14) PKDL. Survival analysis showed a 1.4% risk of PKDL within 2 years of VL treatment. All 16 had been previously treated with sodium stibogluconate (SSG) for their VL. In 5, treatment had not been completed (≤21 injections). Skin lesions developed after a median time interval of 23 months [interquartile range (IQR) 16–40]. We found a higher PKDL rate (29.4%) in those inadequately treated compared to those who received a full SSG course (2.0%). In the logistic regression model, unsupervised treatment [odds ratio (OR) = 8.58, 95% CI 1.21–374.77], and inadequate SSG treatment for VL in the past (OR = 11.68, 95% CI 2.71–45.47) were significantly associated with PKDL.ConclusionThe occurrence of PKDL after VL treatment in Nepal is low compared to neighboring countries. Supervised and adequate treatment of VL seems essential to reduce the risk of PKDL development and active surveillance for PKDL is needed.

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Background Patch testing has previously been shown to influence the quality of life, although a very few studies have shown if this is dependent on the result of the patch tests. Objective To assess the impact of patch testing on the quality of life (QOL) in patients with hand eczema (HE). Methods A total of 50 patients diagnosed of hand eczema at the time of patch testing, aged 16 years and above participated in this study. Detailed demographic information and diagnosis of hand eczema were collected on the day of the patch test. After six weeks, the patients were asked about the hand eczema, knowledge of their allergies and change in their life style to avoid the relevant allergens demonstrated on the patch test. Dermatology Life Quality Index (DLQI) was used to measure the QOL on both occasions. Results The patch test positivity was found in 68% of patients to one or more allergens. The sum score of DLQI at baseline was 12.16 ± 5.58 with median 12.0. HE had most impact on symptoms and feelings. Patients with both positive patch test (mean baseline= 11.94± 5.88; mean at six weeks=2.81± 2.01; P<0.001) and negative patch test (mean baseline=12.63± 5.03; mean at 6 weeks=5.4± 3.56; P=0.001) showed significant improvement in DLQI scores, however it was more improved in patients with positive patch test than in patients with negative patch test. Conclusions Hand eczema had an appreciable impact on the QOL. Patch testing had been beneficial to most patients in improving patient quality of life considerably. DOI: http://dx.doi.org/10.3126/kumj.v11i3.12506 Kathmandu Univ Med J 2013; 43(3):216-220

Background: The cutaneous manifestations of lupus erythematosus (LE) specific skin disease consists of acute cutaneous LE (ACLE), Subacute cutaneous (SCLE) and Chronic cutaneous (CCLE). Objective: To evaluate the spectrum of cutaneous manifestation in patients of LE. Methods: A case series of 41 clinically diagnosed cases of LE attending the outpatient department of Dermatology, BPKIHS were evaluated for the specific and non-specific skin changes. Results: All the patients enrolled in the study were female,with the age ranging from 14-64 years. ACLE was detected in 22/41(78.04%). Malar rash was the frequent skin lesion. CCLE was seen in 6/41 (14.63%) patients with classical discoid lesions (localized and generalized) in 4/6(66.66%) and 2/6(33.33%) respectively. Non specific skin lesions were found in 30/ 41(73.17%) of patients. Mucosal ulcers were seen in 23/41(56.09%), Facial telangiectasias 20/41(48.78%), Raynaunds phenomena 22/41(53.65%), Chronic urticaria 9/41(21.95%), Nail changes 12/41(29.26%) and non scarring alopecia was seen in 6/41(14.63%) patients. Eye involvement was seen in 3/41(7.3%), cutaneous vasculitis in 5/41(12.19%) and scaring alopecia in 3/41(7.3%) patients. Conclusion: The cutaneous manifestations of patients with lupus erythematosus (LE) are very frequent, show a great variety and can occur at any stage of the disease.