Background:In 1769, William Cullen introduced the word “urticaria” (transient edematous papules, plaque with itching). Urticaria affects 15-25% of people at least once in their life time. It is a clinical reaction pattern triggered by many factors causing the liberation of vasoactive substances such as histamine, prostaglandins and kinins. Urticaria is classified according to its duration into acute (< 6 weeks duration) and chronic (>6 weeks duration). Various clinical investigations may be initiated to diagnosis the cause.Aims:To evaluate the types of chronic urticaria with reference to etiology from history and investigations.Materials and Methods:A total of 150 patients with chronic urticaria of more than six weeks were studied. Autologous serum skin test (ASST) was performed after physical urticarias were excluded. Standard batteries of tests were performed after ASST in all patients; and other specific investigations were done where necessary. Skin prick test was done in idiopathic urticaria.Results:The study sample consisted of 62 male and 88 female patients with a mean age of 21-40 years. About 50% of patients showed an ASST positive reaction, 3.9% were positive for antinuclear antibody (ANA), IgE titer was elevated in 37%, H. pylori antibodies was positive in 26.7%. Thyroid antibodies were positive in 6.2%. Giardia and entamoeba histolytica was reported in 3.3% on routine stool examination and on urinalysis 8% had elevated WBC counts; 12% showed para nasal sinusitis, with maxillary sinusitis of 7.3%. Random blood sugar was high in 5.3%. Four patients had ASOM, two had positive KOH mount for dermatophytes, abdominal USG showed cholecystitis in two patients. Recurrent tonsillitis was noted in two patients. Urticaria following intake of NSAIDs was observed in four patients and with oral contraceptive pills in one patient. Contact urticaria to condom (latex) was seen in one patient. Cholinergic (4.7%) and dermographic (4.7%) urticaria were the predominant physical urticarias. Prick test was performed in idiopathic urticaria with maximum reactions to food antigens (25%) where brinjal was the commonest, 9% to dust in which spider web was the most common, 8% to pollen where parthenium and amaranthus were the commonest, followed by A. flavus in fungi, pigeon in epithelia and cockroach in insects.Conclusion:Nearly half of the patients had chronic autoimmune urticaria on the basis of ASST. A significant number of them had serological makers of autoimmune activity. ASST provides an easy, inexpensive investigation in CU and helps direct attention to underlying systemic auto immune diseases. The presence of these auto antibodies was significantly associated with more frequent and longer lasting urticarial attacks. Exhaustive work ups with extensive laboratory diagnostics, challenge tests, and prick testing should be reserved for individual cases following detailed history.

BackgroundMolluscum contagiosum is one of the commonest cutaneous viral infections in children. All treatment modalities are associated with substantial pain, tissue destruction, and frequent recurrence. ObjectivesTo compare the efficacy and side effects of KOH 5% solution with tretinoin 0.05% cream for the treatment of molluscum contagiosum in children. MethodsFifty patients were randomly divided into 2 groups; 25 each for 5% KOH solution and 0.05% tretinoin cream. The given medication was applied at bed time over molluscum lesions. The assessment of response and side effects were performed weekly for 4 weeks. ResultsAt the end of 4 weeks, the mean lesion count decreased from 9.48±3.00 SD to 1.67±0.58 SD and from 8.35±2.82 SD to 2.00±1.00 SD in patients treated with 5% KOH solution and 0.05% tretinoin cream respectively. ConclusionThe result of both KOH and tretinoin showed good response, well tolerated by children but between the two, KOH showed fast recovery and most lesions were resolved before 4 week. The side effects could be minimized if applied as stated above. On the other hand, tretinoin showed delayed response and even some of lesion extended beyond 4 week but the side effect were less, and hence can be used in recurrent cases.

BackgroundPityriasis rosea is an acute, self-limiting disease, probably infective in origin, affecting mainly children and young adults, characterized by distinctive skin eruptions and minimal constitutional symptoms. Both oral Erythromycin and oral Acyclovir have been used in its management. ObjectivesTo compare the effectiveness of oral Erythromycin and oral Acyclovir in the treatment of Pityriasis rosea. MethodForty two patients with clinical diagnosis of Pityriasis rosea were enrolled. They were randomized into two groups. One group was given high-dose oral Acyclovir and another group oral Erythromycin in standard dose. The participants were evaluated one, two, four, six and eight weeks and six months after commencement of the study. ResultsForty two patients including 26 males and 16 females completed the study. After 8th week, all patients showed complete response in both the groups. The response to oral Acyclovir compared with that to oral Erythromycin was better and was statistically significant in 1st, 2nd, 4th and 6th weeks. ConclusionAlthough it is a self-limiting disease which resolves within three weeks to three months, this study reveals that both oral Acyclovir and oral Erythromycin are helpful in decreasing the severity and duration of Pityriasis rosea. Moreover, the study also indicates that oral Acyclovir is more effective than oral Erythromycin in reducing the severity and duration of Pityriasis rosea.

Introduction: Acne vulgaris is seen in nearly 100% of individuals at some time during their lives. Treatment is essential to prevent physical and psychological scarring. Systemic treatments such as Azithromycin and Doxycycline are used in routine clinical practice worldwide. Objectives:To compare the efficacy of Azithromycin and Doxycycline in the treatment of acne vulgaris Methods:Sixty six patients with acne vulgaris fulfilling the selection criteria, visiting the out patients department of Dhulikhel Hospital, Kathmandu University Teaching Hospital, between December 2009 to June 2010, were selected for this open prospective study. They were assigned to two treatment groups; first group received oral pulse therapy of Azithromycin and the second group oral Doxycycline daily, for a period of three months.Results: Overall zero grades were achieved by 22/35 (62.9%) of patients in Azithromycin group and 23/31 (74.2%) of patients in Doxycycline group. However, no statistically significant difference in the effectiveness of the two drugs was seen. Doxycycline was found to be less expensive than Azithromycin. More (statistically significant) side effects were observed with Doxycycline than Azithromycin. Conclusion:Both drugs were effective in reducing the severity of acne vulgaris. The comparative efficacies of the drugs were not statistically significant. Azithromycin was shown to have fewer side effects and its compliance is better due to ease of administration (pulse dose). However, as both drugs have similar efficacy, Doxycycline can be used as an alternative drug or for patients in whom cost is a problem as it is less expensive than Azithromycin.

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We present a case of persistent and progressive Bowen's disease (squamous cell carcinoma in situ) in right inner thigh, skin type V in 65 years age female from Ramechap in 2014. Treatment with imiquimod 5% cream was effective when applied once a day for three consecutive days for three month followed by maintenance with cryothrerapy for further three month.