1.Sarcocystis nesbitti related autoimmune diffuse alopecia
Chin Chwen Ch’ng ; Su-Ming Wong ; Chong Tin Tan
Neurology Asia 2016;21(3):261-264
Background & Objective: Symptomatic sarcocystosis has been said to be rare until recent years, when
there were reports of outbreaks of febrile myositis for travellers returning from the Malaysian island
resorts. In 2012, an outbreak of Sarcocystis nesbitti infection involving 92 college students and staff
occurred after returning from Pangkor Island, Malaysia. A few months after recovering from the
febrile illness, some patients complained of hair loss. This study aimed to determine the prevalence,
clinical features and outcome of this disorder. Methods: All patients who became sick in the outbreak
were asked whether they had the hair loss. For those who had, they were interviewed with standard
questionnaires, examined and investigated. Patients were followed-up via an online survey 2 years
later. Results: Out of 89 patients who were ill, 19 patients (21.4%) complained of alopecia. The mean
peak onset was 4 months after the initial illness. Eleven patients (57.9%) reported the hair fall of more
than 100 per day. The other symptoms were itch 10 (52.6%), scaling 10 (52.6%), erythema 4 (21.1%),
none had scarring. Eleven patients (57.8%) had positive antinuclear factor with high titre (speckled or
nucleolar pattern). Two years after the event, 10 had complete or near complete spontaneous recovery,
1 had partial response and 1 had no improvement.
Conclusions: A delayed transient diffuse alopecia is seen in close to half of patients with Sarcocystis
nesbittiinfection. This high frequency of positive ANF suggested an immune-mediated mechanism.
Sarcocystosis
2.MOHS Micrographic Surgery: The Malaysian Experience and a Review of the Evidence
Adrian Sze Wai Yong ; Zhenli Kwan ; Leng Leng Tan ; Chin Chwen Ch’ng ; Jayalakshmi Pailoor
Malaysian Journal of Dermatology 2017;38(June):2-12
MOHs micrographic surgery is a technique of microscopic margin control in the surgical management
of skin cancers particularly at cosmetically sensitive sites. This review article is aimed at sharing our
initial experience of performing MOHs surgery for skin cancers in Malaysia since 2015.
3.The Association Between Bullous Pemphigoid and Neurological Disorders in A Selected Malaysian Population
Zhenli Kwan ; Yit Nian Lai ; Chin Chwen Ch’ng ; Ai Huey Tan ; Leng Leng
The Medical Journal of Malaysia 2015;70(2):81-85
Background: An association of bullous pemphigoid with
neurological disorders has been reported. The objectives of
this study were to review the clinical characteristics of
patients with bullous pemphigoid and compare the
association between bullous pemphigoid and various
neurological disorders and comorbidities.
Methods: This was a retrospective case-control study
involving 43 patients with bullous pemphigoid and 43 age-,
sex- and ethnicity-matched controls.
Results: There was a statistically significant association
between bullous pemphigoid and neurological disorders
[Odds Ratio (OR) = 3.5, 95% Confidence Interval (CI) 1.3 to
9.2, p=0.011 and adjusted OR=3.5, 95% CI 1.2-10.3, p=0.026],
in particular for dementia (p=0.002). Although stroke was
more common among patients with bullous pemphigoid,
this association was not statistically significant with OR of
1.9 (95% CI 0.7 to 5.2) and adjusted OR of 2.1 (95% CI 0.6 to
7.2). Similarly both ischaemic stroke (OR 1.5, 95% CI 0.5 to
4.2) and haemorrhagic stroke (OR 1.5, 95% CI 0.2 to 9.7) were
more common. Other neurological disorders more common
among patients with bullous pemphigoid were Parkinson’s
disease and epilepsy. Dyslipidaemia was significantly less
common among patients with bullous pemphigoid (OR 0.4,
95% CI 0.1 to 0.9, p=0.033).
Conclusion: A combination of an inflammatory process,
prothrombotic state and endothelial activation leads to an
increased frequency of neurological disorders among
patients with bullous pemphigoid. Thus, a holistic approach
to patient care, including screening for dementia and control
of comorbidities, should be practised as bullous
pemphigoid affects more than just the skin.
Pemphigoid, Bullous
4.An Epidemiological Study of Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) overlap in University Malaya Medical Centre
Leng Leng Tan ; Sze Ting Ooi ; Su Ming Wong ; Chin Chwen Ch’ng ; Zhenli Kwan ; Adrian Sze Wai Yong
Malaysian Journal of Dermatology 2017;38(June):52-56
Introduction:
Steven-Johnson syndrome and Toxic Epidermal Necrolysis are rare but life threatening severe
cutaneous adverse reactions to drugs. To determine the epidemiology of SJS, TEN and SJS/TEN
overlap in University Malaya Medical Centre (UMMC).
Methods:
All patients admitted to UMMC from year 2013-2015 for SJS, SJS/TEN, TEN were recruited. The
classification of SJS, SJS/TEN overlap and TEN was made based on the criteria laid down by Bastuji
et al.2
Results:
A total of 32 patients were recorded to have SJS, SJS/TEN overlap and TEN from 2013 to 2015. Drugs
(n=32, 86.49%) remained the most common aetiology of SJS and TEN. The top three commonest
drugs are allopurinol (n=6), followed by carbamazepine (n=5) and bactrim (n=3).
Conclusion:
This study demonstrates that drugs were the most common cause of SJS/TEN. Antibiotics were the
most common drug group that caused SJS/TEN. Awareness of the common etiology such as drug
is important and high index of suspicion of SJS and TEN is needed if patients were on the above
medications.