Introduction. Periungual, palmar, and plantar warts are difficult to treat with poor treatment response. Intralesional (IL) bleomycin has shown promising results for their treatment in a few reports. However, we need further evidence before opting it for treating difficult sites and resistant warts. Hence, we conducted this study to assess the efficacy and safety of IL bleomycin for the treatment of resistant palmoplantar and periungual warts. Methods. In this retrospective study, we included all patients who were given IL bleomycin for warts over a year. Maximum three sittings of bleomycin (1 mg/ml) were given monthly, and they were followed up for 3 months after the procedure. The response was categorized as complete, near-complete, significant, moderate, mild, and no clearance for 100%, 75–99%, 50–74%, 25–49%, 1–25%, and 0% clearance, respectively. Results. Out of 29 patients, follow-up details were available only in 19 patients (53 warts). The mean duration was 2.5 ± 1.47 years. The number of past interventions ranged from 2–4. Wart clearance after the first intervention was complete in 36.84%, near-complete in 26.31%, significant in 26.31%, and moderate in 10.53%. Wart clearance after the last intervention was complete in 89.47% and near-complete in 10.52% of patients. However, during 3 months of follow-up after the last injection, 15.78% had a recurrence. None of them had severe local and systemic side effects. Conclusions. IL bleomycin could be a better treatment option for the treatment of resistant and difficult warts. However, we observed a higher recurrence rate even in a shorter follow-up. Hence, we need further studies with larger samples.

Introduction: Psoriasis is a chronic, recurring inflammatory disease affecting the skin, joints and nails that has a significant negative impact on the quality of life. Efficacy of combination of methotrexate/narrowband ultraviolet B (NBUVB) phototherapy in the treatment of psoriasis has been rarely assessed. Objectives: To compare the therapeutic efficacy of methotrexate plus NBUVB phototherapy combination vs.  methotrexate  in  the  treatment  of  moderate  to  severe  chronic  plaque  psoriasis. Material and methods: Seventy-nine patients with chronic plaque-type psoriasis (body surface area involvement >2%) were randomized to receive either methotrexate/NBUVB phototherapy (group A) or methotrexate (group B). End point of treatment was 75% reduction in Psoriasis Area and Severity Index (PASI75) Score or up to 12weeks, whichever was earlier. Patients were then followed up for a period of 12 weeks for assessment of adverse effect, DLQI and relapse.Results: Of 79 patients, 69 completed the treatment period and follow-up. PASI 75 was achieved in 35/39(89%) patients in group A and 34/40(85%) patients in group B (P=0.052). The mean number of weeks (P = 0.031), the mean cumulative dose of NBUVB (8.2±3.5J/cm2)) and the mean number of phototherapy sessions (12±3)) required to achieve PASI 75 were less in group A compared with group B. There was no significant difference in the number of patients who relapsed during the follow- up period (P = 0.68). Conclusion: Combination of methotrexate and NBUVB phototherapy provides more rapid clinical improvement compared with methotrexate monotherapy in the treatment for chronic plaque-type psoriasis.NJDVL Vol. 13, No. 1, 2015 Page: 12-23

Introduction: Thyroid hormone disorder (THD), a major health problem, is associated with a wide range of diseases. One of the organs, which  shows this wide range of clinical signs is the skin. Some dermatological findings may be the first symptoms of THD. Therefore, this study was planned to determine various cutaneous manifestations of THD that can be used as a diagnostic marker for THD. In Nepal due to lack of awareness, thyroid diseases may go unnoticed .So, cutaneous manifestations help in early diagnosis and treatment of THD. Objectives: To identify cutaneous manifestations of THD and to evaluate dermatological manifestations specific for THD.  Materials and methods: Seventy six patients with diagnosis of THD attending endocrine clinic of Internal Medicine Department in BPKIHS, Dharan were consecutively assessed for cutaneous changes by detailed history and clinical examination. As a control group, 26 age and  sex matched individuals without THD were included to assess frequency of cutaneous manifestation in normal individuals.  Results: Fifty five (72.3%) cases and 4(15.4%) control had skin changes. This observation was statistically significant with OR-14.4(95% CI4.43 – 46.78) and p<0.001.Hair changes (OR-2.100, 95% CI 0.647-6.821 and p=0.210) and nail changes (OR-1.818, 95% CI 0.371-8.902 and p=0.726) had no statistically significant association with THD. Conclusion: THD may present as or be associated with many changes in skin, hair and nails.

Lichen striatus is a rare dermatitis characterized by lichenoid papules arranged in a linear band along the Blaschko's line. Extremities are commonly affected sites. Sometimes, abdomen, buttocks and thighs may also be involved in a single extensive lesion. But, multiple lesions involving many Blaschko's lines are rare with only few publications till now. Hence, we are reporting a case of 14-year-old male presented with lichen striatus over left upper and lower extremities as well as left side of trunk.

Introduction: Cicatricial alopecia (CA) comprises a group of disorders characterized by permanent destruction of the hair follicle and fibrosis on histopathologic examination. The similarities in the clinical presentation of various types of this disorder cause difficulty in prompt diagnosis, so histopathological assessment plays a pivotal role in the diagnosis. Objectives: This study aimed to assess the clinical variants of cicatricial alopecia and compare the histopathology of the various subtypes. Materials and Methods: In this cross-sectional study, 22 patients of cicatricial alopecia were enrolled and punch biopsies from the active site were taken for histopathological examination. Statistical analysis and correlation of clinical and histopathological features were done. Results: Out of the 22 patients, 10 cases (45.45%) were confirmed as Lichen Planopilaris (LPP), seven (31.81%) as Discoid Lupus Erythematosus (DLE), two (9%) as Morphea, one (4.5%) each as Pseudopelade, Central Centrifugal Cicatricial Alopecia (CCCA) and Dissecting cellulitis (DC). There was a fair agreement between clinical and histopathological diagnoses (Kappa=0.384). The age ranged from 10 years to 60 years with the mean age of 32.32 ± 15.51 years. Conclusion: There is high clinical and histopathological variability and similarities among the variants of CA, which represents a true diagnostic challenge. A precise and early diagnosis is possible if the clinico-histopathological correlation is employed.