Introduction: Stevens Johnson syndrome (SJS), Stevens Johnson Syndrome - toxic epidermal necrolysis overlap syndrome (SJS-TEN overlap), toxic epidermal necrolysis (TEN) and drug-induced hypersensitivity syndrome (DHS) are well known severe adverse cutaneous drug reactions (SACDRs). All clinicians are responsible for the diagnosis and management of SACDR. Objective: To retrospectively review the clinical patterns, management strategies and outcome of 134 patients with severe adverse cutaneous drug reactions managed at the Department of Dermatology, Kuala Lumpur Hospital between 2006 and 2010. Results: The mean age of presentation was 44.8 years (13-83). The male: female ratio was 1:1. There were 68 cases (50.7%) of SJS, 10 cases (7.5%) SJS-TEN overlap, 32 cases (23.9%) TEN and 24 cases (17.9%) DHS. The five commonest drugs associated with SACDRs were allopurinol (26.9%), carbamazepine (13.4%), phenytoin (9.7%), non-steroidal anti-inflammatory drugs (11.2%) and co-trimoxazole (7.5%). The mean duration of drug exposure before the onset of reaction was 2.8 weeks. A hundred and thirty patients (97%) were managed as in-patient. The mean duration of in-patient stay was 12.4 days. All identified culprit drugs were withheld. Systemic corticosteroids was given to 96% cases of DHS with mean duration of 9.7 weeks; 52.9% of SJS with mean duration of 2.8 weeks; 60% of SJS-TEN overlap with mean duration of 2.3 weeks; and 62.5% of TEN with mean duration of 3.3 weeks. Thirteen patients (42%) with TEN were treated with intravenous immunoglobulin. Eight patients (6%) died, of which 7 were TEN and one DHS. Conclusion: SACDRs are life-threatening emergencies which not only results in significant morbidity and mortality; but also potentially increases the health care cost and burden. Clinicians should recognize high risk medications and prescribe them with great caution.

Background There is lack of data on the impact of acne vulgaris on the quality of life in Malaysia. Thus, this study was done to determine the impact of acne vulgaris on the quality of life in Sarawak, Malaysia and to examine its relationship with the severity of acne. Methods A cross-sectional study of 173 patients in 3 dermatology clinics in Sarawak utilizing the dermatology life quality index (DLQI). Results The mean DLQI score was 4.1. Patients with family income < RM 3000 had higher mean DLQI scores (4.8 vs. 3.2, p = 0.02). There was also a tendency for indigenous groups to have higher DLQI scores compared to Chinese although it was not statistically significant (4.5 vs. 3.5, p = 0.15). Females were significantly more impaired in the domains of symptoms and feelings (2.1 vs. 1.5, p = 0.02); and work and school (0.3 vs. 0.2, p = 0.04). DLQI was weakly correlated with acne severity in patients with mild acne (Pearson coefficient = 0.27, p = 0.01) but become insignificant for patients with moderate and severe acne. No correlation was seen between DLQI and age of patients. Conclusion Acne vulgaris has a quality of life impact similar to that of psoriasis in Sarawak and must be addressed. Health care providers and administrators should view acne as a psychologically disabling disease requiring optimal management and resource allocation. Education of junior doctors and medical student on this issue is also important.

Primary cutaneous anaplastic large cell lymphoma (c-ALCL) is an uncommon type of cutaneous T cell lymphoma currently classified as one of the CD30+ lymphoproliferative disorders of the skin under the WHO-EORTC classification1. We describe a series of three patients with c-ALCL from 2005-2009 in the Department of Dermatology, Hospital Kuala Lumpur.

Backround Gonorrhoea is the third most common sexually transmitted infection (STI) in the Genitourinary Medicine Clinic. Despite high cure rates achieved with the use of intramuscular ceftriaxone, all patients with gonorrhoea are followed up with one test of cure (gonococcal culture) after treatment. This is essential to ensure success of cure hence preventing complications, to screen for and treat concomitant STIs, and to reduce the possibility of re-infection through repeated patient education. A defaulter is defined as a patient who fails to attend follow-up and undergo test of cure within a period of 2 weeks after completion of treatment. Previous studies showed high defaulter rates of 41.1% and 43.8% in 1996 and 1997 respectively. This study aims to determine the defaulter rate of follow-up of patients with gonorrhoea, and to formulate remedial measures to reduce defaulter rate and thereby improve the management of gonorrhoea specifically and all sexually transmitted infections in general. Materials and Methods An audit of defaulter rate of patients diagnosed as gonorrhoea was performed from January 1998 to December 2005 in the Genitourinary Medicine Clinic, Department of Dermatology, Kuala Lumpur Hospital. All patients who failed to attend follow-up visit within 2 weeks after treatment were recorded as defaulters. An analysis was performed on all defaulters from January to December 2005. Results Defaulter rates for patients with gonorrhoea were generally high throughout the years studied, ranging from 35.0% to 48.2%, the highest being in year 2001. Despite continuous and relentless efforts in patient education and counseling, there has been no decreasing trend. In the year 2005, all defaulters were males. Majority (72.1%) of the defaulters were young adults aged between 21 and 40 years. 67.4% of the defaulters were Malay, followed by Indian 14.0%, Chinese 7.0% and other ethnic groups 11.6%. Among the defaulters, 30.2% had repeated gonococcal infection and 38.5% had concomitant STIs. Conclusions More effort is necessary in educating patients to attend follow-up visit after treatment of gonorrhoea. Emphasis has to be made on the importance of confirming cure and thereby preventing complications and transmission to sexual partners. Counseling should also be given to all patients regarding practice of safe sex to prevent gonococcal re-infection and other STIs.

Introduction: Cumulative Sum (CUSUM) technique is an objective statistical method used in assessing and monitoring doctor’s performance. It has been incorporated into quality improvement strategies in clinical services by the Ministry of Health, Malaysia. A pilot study was aimed at evaluating its usefulness in monitoring the performance of specialists in conducting skin biopsy. Methods: All skin biopsies performed by specialists in the Department of Dermatology, Kuala Lumpur Hospital from September 2009 to April 2011 were included in the prospective observational study. Outcomes monitored were wound complications within 14 days post-biopsy, and tissue sample being adequate and representative for histopathological interpretation. CUSUM scores of each consecutive biopsy performed by individual specialist were calculated and charted with the eCUSUM web application (https://app.acrm.org.my/eCUSUM). Results: A total of 870 skin biopsies were performed by 15 clinical specialists and three consultant dermatologists during the study period. Wound infection or dehiscence were reported in 13 (4.1%) of the 318 biopsy wounds evaluated. Tissue samples were inadequate in 10 (1.2%) and non-representative in 11 (1.3%) of the 817 histopathological reports evaluated. No learning curve was observed in all CUSUM charts indicating that all specialists had been adequately trained for the procedure. However, out-of-control signals indicating unacceptable wound complication rates and either inadequate or non-representative tissue samples were detected in three clinical specialists. Feedback and counseling were given while monitoring was continued. Conclusions: The CUSUM method is a useful performance monitoring tool which is able to promptly detect unacceptable outcomes in skin biopsy. It is invaluable in the supervision of junior doctors and trainees as well as self-monitoring for the trained specialists.

Arthroscopy ; adverse effects ; instrumentation ; methods ; Diagnostic Equipment ; adverse effects ; microbiology ; Disinfection ; methods ; Equipment Failure ; Humans ; Materials Testing ; methods ; Orthopedic Equipment ; adverse effects ; microbiology ; Postoperative Complications ; etiology ; prevention & control