Introduction: Smoking is a risk factor for development of psoriasis. The severity of psoriasis has also been associated with smoking. Smoking may be an important modifiable factor in psoriasis treatment. Reduction or cessation of smoking in psoriasis patients is relevant as psoriasis is also associated with cardiovascular disease. Objectives: This study aims to determine the association between smoking and severity of psoriasis, and to investigate the frequency of concomitant cardiovascular risk factors in our psoriasis patients. Method: A 6-month prospective, controlled study. Consecutive patients with chronic plaque psoriasis attending Dermatology Clinic, Kuala Lumpur Hospital were screened. Smokers were identified, age, gender and ethnic matched non-smokers were recruited. Patients were evaluated for Psoriasis Severity Index (PASI) and body surface area (BSA) affected by psoriasis. Results: A total of 89 chronic plaque psoriasis patients were screened. Twenty four smokers and 24 matched non-smokers were included in the study. There were no significant differences in the presence of medical co-morbidities, blood pressure, body mass index (BMI), age of psoriasis onset and duration of disease in both groups. The mean age patients started smoking was 20.2±5.6 years, the mean duration of smoking was 16.3±11.1 years, the number of cigarette per day 11.9±6.1 sticks and the number of cigarette pack years was 10.7±9.2. BSA affected by psoriasis and PASI score were significantly higher in the subjects who smoked compared to the non smokers. Conclusion: Smoking is associated with more severe psoriasis in terms of BSA and PASI. Cardiovascular risk factors are common in psoriasis patients. These patients (smokers and non-smokers) require interventions to reduce their cardiovascular risks.

Background: The association between chronic hepatitis C infection with lichen planus (LP) remains controversial. Geographical and immunogenetic factors may play a role in this association. Objectives: We sought to compare the prevalence of hepatitis C in patients with LP with healthy blood donors at our centre. Materials & Methods: We conducted a retrospective study in Hospital Kuala Lumpur, Malaysia. All patients with biopsy- proven LP who had undergone hepatitis C serology screening from January 2007 to June 2012 were recruited. The prevalence of Hepatitis C seropositivity among healthy blood donors in Malaysia was used as comparison. Results: Thirty five patients with LP were included in the study. Majority of the patients were Indians (71.4%) followed by Malays (14.3%), Chinese (8.6%) and other ethnicity (5.7%). 82.6% of patients had classical cutaneous LP out of which 17% had oral involvement. Anti-HCV was reactive in 2.9% patients. Among the healthy blood donors, anti-HCV was positive in 1.5% of patients. There was no significant difference between the prevalence of hepatitis C seropositivity between the two groups (p=0.431). Conclusion: There is no significant association between chronic hepatitis C infection and LP among our patients. We recommend screening for hepatitis C in LP patients should be limited to those with risk factors.

Introduction: Our country is fast becoming a developed country with improved life expectancy. The healthcare system should be prepared to manage medical conditions which are prevalent in the older age group. Skin diseases are commonly observed in the geriatric population. We seek to characterize the dermatological conditions affecting patients at the extremes of age. Methods: To determine the types of dermatological diseases affecting patients over 80 years of age, and to determine their clinical characteristics and comorbidities. Objectives: Subjects with photodamage were older, and had lower education and employment rates compared to subjects without photodamage. There was no significant difference in knowledge on the harmful effects of sun exposure and on sun protection or in sun avoidance behaviour (other than use of protective sunglasses) between the two groups, though more patients with photodamage felt that they take adequate sun protection measures. Of note, only a low percentage of subjects in both groups (24.5% of subjects with photodamage and 23.1% of subjects without photodamage) practise regular use of sunscreen. Methods: This was a retrospective study conducted at the Dermatology Unit, University Kebangsaan Malaysia Medical Center (UKMMC). All patients aged ≥80 years who attended the Dermatology Clinic UKMMC in 2015 were identified from the clinic database. Their clinical notes were reviewed. Demography, clinical characteristics and dermatological diagnosis were recorded and analyzed using SPSS Version 22. Results: One hundred and three octogenarians were included in the study. Fifty one (49.5%) were females, and 52 (50.5%) were males. The age ranged from 80 to 89 years. The majority were Chinese, 76 (73.8%), 16 (15.5%) were Malays, 6 (5.8%) were Indians and remaining 5 (4.9%) were of other ethnicities. The most commonly seen diseases were endogenous eczema 46 (44.7%), cutaneous malignancy 10 (9.7%), psoriasis 8 (7.8%), bullous pemphigoid 7 (6.8%) and fungal infection 6 (5.8%). More than half of patients [25 (24.3%)] with endogenous eczema had unclassified eczema. Other conditions were seborrheic keratosis 5 (4.9%), adverse drug eruption 5 (4.9%), viral infections 4 (3.9%) and lichen amyloidosis 3 (2.9%). Comorbidities of the patients were 48 (46.6%) hypertension, 29 (28.2%) diabetes, 25 (24.3%) atherosclerosis related disease, 22 (21.4%) dyslipidemia, 9 (8.7%) chronic lung disease and 9 (8.7%) non-skin malignancy.Conclusions: Eczema is very common in elderly patients. In the majority of patients the clinical features of eczema are often not typical of endogenous eczema subtypes. We propose the term senectus eczema as a diagnosis, however its clinical characteristics has yet to be clearly delineated. Skin cancers, psoriasis, bullous pemphigoid, fungal infections, drug eruption and viral infection are other conditions which should not be missed in assessing these patients.

Traditional and Complimentary Medicines (TCMs) can potentially cause Adverse Cutaneous Drug Reactions (ACDRs). The aim of this study was to describe the characteristics of ACDRs due to TCMs and compare with those due to conventional medicine. This was a retrospective study with 134 cases being diagnosed with ACDR at the Dermatology Clinic of a tertiary hospital in Kuala Lumpur. Most (82.1%) ACDRs were caused by conventional drugs, while 17.9% were due to TCMs. Majority (70-75%) of the ACDRs were of mild to moderate severity. The most common ACDR to TCM was Exfoliative Dermatitis (ED) and Acute Generalized Exanthematous Pustulosis (AGEP) (both 16.7%) while maculopapular rash was the most common reaction for conventional medications (25.5%). The onset of adverse reaction to TCM was about 4 weeks (60.2%) while reactions due to conventional medication was earlier (1 to 6 days, 65.4%; p<0.05). The odds of developing delayed ACDR was 14 times more with TCM compared to conventional medicine (p<0.05). This study showed that ED and AGEP were the most common ACDR manifestations of TCM while macuplopapular rash was the most common manifestation of conventional medications. However, most of these reactions were of mild to moderate severity. ACDR due to TCM may manifest long after the initiation of these products and hence its use should be routinely inquired when patients present with skin problems. All suspected cases of ADRs to TCM should be reported to the Malaysian Adverse Drug Reactions Advisory Committee (MADRAC) for continuous pharmacovigilance of these products.