Eczema, Psoriasis and Acne: Dermatology Treatment in Pokhara
Eczema, psoriasis, and acne are three of the most common chronic skin conditions worldwide, and all three are frequently mismanaged in Nepal — either under-treated due to limited specialist access, or inappropriately treated with combined corticosteroid-antifungal preparations that damage the skin barrier over time. Each condition has a distinct pathophysiology, specific diagnostic criteria, and an evidence-based treatment ladder. A&B International Hospital’s dermatology team provides structured, specialist management for all three conditions in Pokhara.
What Is Atopic Eczema and How Is It Treated?
Atopic eczema (atopic dermatitis) is a chronic inflammatory skin condition characterised by dry, itchy, inflamed skin. It is part of the atopic triad alongside allergic rhinitis and asthma, and is driven by a combination of a defective skin barrier (often involving mutations in the filaggrin gene) and an overactive Th2 immune response.
Diagnosis is clinical: itchy skin with characteristic distribution (flexural creases — the inner elbows, behind the knees, around the neck — in adults; face and extensor surfaces in infants), chronic or relapsing course, onset in childhood (though adult-onset is possible), and a personal or family history of atopy.
Trigger identification is the first step in management. Common triggers include certain soaps and detergents (which damage the skin barrier), synthetic fabrics, dust mites, pet dander, sweat, stress, and specific foods in a minority of children. Triggers are individual and require systematic identification rather than blanket avoidance.
Emollient therapy is the foundation of eczema treatment regardless of severity. A bland, unfragranced moisturiser applied liberally and frequently (at least twice daily and after every wash) maintains the skin barrier and reduces the frequency of flares. In Nepal’s dry season (October–April), skin hydration decreases and emollient use must increase correspondingly.
Topical corticosteroids are the first-line anti-inflammatory treatment for eczema flares. They must be of appropriate potency for the site and severity — mild steroids (1% hydrocortisone) for the face and skin folds; moderate to potent steroids (betamethasone valerate, mometasone furoate) for the trunk and limbs in adults. The widespread fear of topical steroid use in Nepal leads to under-treatment and prolonged suffering. Appropriately used, topical steroids applied to inflamed skin are safe. The risk arises from prolonged use of potent steroids on thin skin (face) without medical supervision.
Topical calcineurin inhibitors (tacrolimus, pimecrolimus) are steroid-sparing alternatives particularly suitable for the face and skin folds where long-term steroid use is problematic. They are available in Pokhara through specialist prescription.
Antihistamines reduce itch (sedating antihistamines such as hydroxyzine at night) and may improve sleep in severe flares. For moderate to severe eczema not responding to topical treatment, systemic options — oral ciclosporin, azathioprine, and methotrexate — are used under specialist supervision. Dupilumab (a biologic targeting IL-4 and IL-13) is the most effective systemic option for severe atopic eczema but requires specialist access.
What Is Psoriasis and How Does Treatment Differ From Eczema?
Psoriasis is a chronic immune-mediated inflammatory skin condition characterised by well-demarcated, salmon-pink plaques with silver-white scale, most commonly on the elbows, knees, scalp, and sacrum. It is driven by a Th17-mediated immune response causing accelerated skin cell turnover. The cells are produced 10 times faster than normal and accumulate as the characteristic scale.
Unlike eczema, psoriasis has clear-cut margins and the scale is thick and silvery. Itch may be present but is less central than in eczema. The Auspitz sign — pinpoint bleeding on scale removal — is characteristic.
Nail psoriasis (pitting, onycholysis, oil spots) affects up to 50% of psoriasis patients and is a useful diagnostic clue. Scalp psoriasis extends beyond the hairline onto the forehead and behind the ears. Guttate psoriasis — small drop-like plaques — often follows a streptococcal throat infection, particularly in young patients.
Psoriatic arthritis, a destructive inflammatory joint disease, occurs in 10–30% of psoriasis patients. Any patient with psoriasis and joint pain should be assessed for this.
Mild localised psoriasis is treated with topical agents: potent corticosteroids (often combined with vitamin D analogues such as calcipotriol), coal tar preparations, and topical retinoids. Scalp psoriasis uses medicated shampoos and scalp applications.
Phototherapy (narrowband UVB) is effective for moderate plaque psoriasis and represents the bridge between topical and systemic treatment. PUVA (psoralen plus UVA) is an older phototherapy option.
Systemic treatment — methotrexate, ciclosporin, acitretin — is used for moderate to severe disease, extensive involvement, or psoriatic arthritis. Biologic agents (TNF-alpha inhibitors, IL-17 inhibitors, IL-23 inhibitors) represent the most effective systemic options for severe psoriasis but require specialist initiation and monitoring.
What Are the Treatment Options for Acne Vulgaris?
Acne vulgaris is a disease of the pilosebaceous unit — the hair follicle and associated sebaceous gland. It involves follicular hyperkeratinisation (plugging of the follicle), excess sebum production, colonisation by Cutibacterium acnes, and the resulting inflammatory response. This produces the spectrum of acne lesions: open comedones (blackheads), closed comedones (whiteheads), papules, pustules, nodules, and cysts.
Treatment selection is based on acne severity. Mild acne (comedones and a few inflammatory papules) is treated topically with adapalene (a topical retinoid that normalises follicular keratinisation) and/or benzoyl peroxide (which reduces C. acnes and prevents antibiotic resistance).
Moderate acne (more widespread papules and pustules) requires the addition of a topical or oral antibiotic. Oral doxycycline is the most widely used. Antibiotics should always be combined with benzoyl peroxide to reduce resistance, and should not be continued alone beyond 3–6 months.
In females with moderate to severe acne that correlates with the menstrual cycle, hormonal treatment (combined oral contraceptive pill with antiandrogen activity, or spironolactone) addresses the androgen-mediated sebum production underlying hormonal acne.
Severe nodular or cystic acne — particularly when causing or threatening scarring — requires oral isotretinoin (a systemic retinoid). Isotretinoin is highly effective, producing remission in 85–90% of patients after one course. It requires monitoring of liver function and lipids, and is strictly contraindicated in pregnancy (category X teratogen). In female patients of childbearing age, reliable contraception is mandatory throughout treatment and for one month after completion.
For Nepal’s variable climate — dry season cold and low humidity, hot pre-monsoon, wet monsoon — skincare routines must adapt. A non-comedogenic sunscreen is essential year-round. Thick, occlusive moisturisers worsen acne; lightweight, oil-free formulations are appropriate.
A&B International Hospital
Pokhara-02, Bindhyaabasini Way to Sarangkot
Phone: +977 061-412512
Website: abinthospital.com
Eczema, psoriasis, and acne are manageable conditions with the right specialist guidance. If you have been managing a chronic skin condition without adequate improvement, book a dermatology consultation at A&B International Hospital, Pokhara. ECHS polycards accepted.
