Background: Lipid lowering drugs (LLDs) are widely used. However, reports on its adverse cutaneous drug reactions (ACDRs) are scarce. Objectives: The study objective was to review the patterns of LLD induced ACDRs. Methods: We reviewed all LLDs induced ACDRs reported to MADRAC (Malaysian Adverse Drug Reaction Advisory Committee) from January 2005 till December 2009. Results: LLD induced ACDRs (124 patients) comprised of 2.07% of all ACDRs reported during the study period. Statins were responsible for most cases (81.5%), followed by fibrates (15.8%), selective cholesterol-absorption inhibitors (1.4%) and combination therapies (statin/selective cholesterol-absorption inhibitors and selective prostaglandin-2 receptor inhibitor/ niacin) in 1.4%. Majority were due to lovastatin (42.5%), simvastatin (28.1%) and gemfibrozil (8.9%). The three commonest ACDRs reported with statins usage were non-specific dermatitis (45.0%), pruritus/stinging (25.0%) and urticaria/angioedema (10.0%) while fibrates caused non-specific dermatitis (52.2%), urticaria/angioedema (13.0%) and photodermatitis (9.7%). There was no reported case of photodermatitis associated with statin usage. Interestingly, statins were the offending drugs resulting in all the five cases of vesiculobullous eruptions, two cases of Stevens-Johnson syndrome and one case of dermatomyositis. No mortalities were reported to be associated with LLD induced ACDRs. Conclusions: LLD induced ACDRs were not uncommon. Statins were the main putative drugs implicated in those reactions. Spectrum of ACDRs differed between statin and fibrate although non-specific dermatitis remained the main ACDRs in both classes. The unavailability of guided and classified ACDRs reporting accounted for the large number of non-specific dermatitis. Although most LLD induced ACDRs were mild, statins were reported to cause severe ACDRs.

Pemphigus foliaceous (PF) is an autoimmune blistering disease resulting from acquired immunoglobulin G autoantibodies against desmoglein 1 of the skin, which is one of the adhesion molecules of keratinocytes. Clinically patients with PF develop crusted and scaly erosions mainly over the seborrhoeic distribution i.e. the face, scalp and upper trunk. Mild cases of PF may be localized but in some cases it may progress to erythrodermic exfoliative dermatitis. There is however no mucosal involvement in PF in contrast to pemphigus vulgaris and paraneoplastic pemphigus. Light microscopy of lesional biopsy shows subcorneal acantholysis. Direct immunofluorescence study of perilesional skin reveals presence of intraepithelial intercellular deposit of IgG and C3. We describe 2 cases of PF in the presence of thymoma, a relatively rare association, which could further support the fact of thymoma associated autoimmune disease.

Sweet’s syndrome was first described by Dr. Robert Douglas Sweet in 19641. It was originally described as an ‘acute febrile neutrophilic dermatosis’1. There are primarily three subtypes of Sweet’s syndrome, ie. classical Sweet’s syndrome, malignancy-associated Sweet’s syndrome and drug-induced Sweet’s syndrome.We are reporting a case of classical Sweet’s syndrome in a 47-year-old man.

Background Hori’s naevus is an acquired bilateral naevus of Ota-like macules (ABNOM). It was first reported by Hori et al in 1984. It is common among Asians and has a female preponderance. Hori’s naevus is characterised by blue-brown macules typically on the malar region of the face. Objectives To evaluate the clinical characteristics of patients with Hori’s naevus seen at Hospital Kuala Lumpur and the efficacy of Qswitched neodynium-yttrium-aluminium-garnet (Nd:YAG) laser in the treatment of this condition. Method A retrospective analysis of 16 patients diagnosed clinically with Hori’s naevus and treated with Q-switched Nd:YAG laser was carried out. Patient’s demographic data and clinical characteristics, response to Q-switched Nd:YAG laser, complications and recurrence were reviewed. Results A total of 16 patients diagnosed clinically with Hori’s naevus and treated with Q-switched Nd:YAG laser were reviewed. Fifteen of the patients were female with one male. Their ages ranged from 33-61 years old (mean age = 47). Nine of these patients were Chinese with seven Malays. All had Fitzpatrick skin phototype IV. The age of onset ranged from 15-45 years old. The most common clinical presentation was bilateral brown macules on the malar region of the face. Eleven patients received treatment with Q-switched 1064nm Nd:YAG and five combination treatment with Q-switched 532nm Nd:YAG followed by 1064nm laser. Two patients were lost to follow up after a single treatment. After a single treatment, 13 patients graded their clinical response as ‘poor’ (0-25% improvement) and 1 as ‘fair’ (26-50% improvement). Six patients received a total of two treatments of whom 4 graded their response as ‘fair’ (26-50% improvement) and 2 as ‘good’ (51-75% improvement). Two patients who received a total of four treatments graded their responses as ‘good’ and ‘excellent’ (76-100% improvement) respectively. 10 patients had significant hyperpigmentation post laser treatment. However, none reported any recurrences. Conclusion There is no difference in pigment clearance between concurrent use of Q-switched 532nm Nd:YAG laser followed by 1064nm laser and Q-switched 1064nm Nd:YAG laser for Hori’s naevus. However, there is only minimal improvement after a single treatment, and multiple sessions are required to achieve satisfactory improvement. Post inflammatory hyperpigmentation was the main complication seen.

Cutaneous tuberculosis is an old and rare infectious disease. Laennec reported the first case of cutaneous tuberculosis in 1826 and M.tuberculosis was discovered by Koch in 18821. Since then, many cases of cutaneous tuberculosis have been described and classified. The different forms of diseases correlate with the immunologic status of the host, host’s prior sensitization, route of disease transmission, layer of skin primarily involved and rate of disease progression. Nevertheless, the most widely accepted classification is based on the mechanism of disease propagation which can be via direct inoculation, through contiguous infection or via hematogenous route2. Bacterial load has also been used to categorize this disease into multibacillary and paucibacillary forms. Diseases under the multibacillary forms include primary inoculation tuberculosis (tuberculous chancre), scrofuloderma, tuberculous perioficialis, acute miliary tuberculosis and tuberculous gumma. Paucibacillary forms include lupus vulgaris, tuberculosis verrucosa cutis and tuberculids. Strains of M. Tuberculosis complex that can be isolated include M.tuberculosis, M. africanum, M. canetti and M. bovis, M. microti and M.bovis BCG.

Introduction Skin cancer is ranked the ninth commonest cancer among males and tenth among females in Malaysia. Objectives To review the pattern of skin cancers at University Malaya Medical Centre (UMMC). Methods This is a retrospective review of all histo-pathological confirmed skin cancers at UMMC from 2004 till 2010. Results Among the 155 patients reviewed, basal cell carcinoma (BCC) was the commonest skin cancer (44.5%), followed by squamous cell carcinoma (SCC) (27.1%) and malignant melanoma (MM) (11.6%). The nodulo-ulcerative subtype made up 46% of all BCC while 50% of MM was of acral lentiginous subtype. Patients with BCC were significantly older (>60 years old), (p=0.003). A majority of skin cancers were found on the head and neck. Conclusion BCC was the commonest skin cancer, with significantly older patients and located mainly on head and neck. MM was the least common skin cancer but associated with the highest mortality.

Background: Skin cancer is ranked the ninth commonest cancer among male and tenth among female in Malaysia. Objective: To determine the pattern of skin cancers and demography of skin cancer sufferers in University Malaya Medical Centre (UMMC). Methods: This is a retrospective review of all histo-pathologically confirmed skin cancers in UMMC from 2004 to 2010. Patients with incomplete or missing data were excluded. Results: A total of 155 patient records were reviewed. The commonest skin cancer was basal cell carcinoma (BCC) (44.5%), followed by squamous cell carcinoma (SCC) (27.1%) and malignant melanoma (MM) (11.6%). The other skin cancers included dermatofibrosarcoma protuberans and cutaneous lymphoma (5.2% each), extramammary Paget’s disease 3.2% and Kaposi sarcoma 2.6%. A majority (78%) of BCC was of nodulo-ulcerative subtype while 50% of MM was of acral lentiginous melanoma subtype. BCC had a significantly higher number of patients from the older age group (>60 years old) compared to other skin cancers (p=0.003). SCC had significantly more male patients than other skin cancers (p=0.006). With the exception of MM, a majority of skin cancers were found on the head and neck. Conclusions: BCC was the commonest skin cancer followed by SCC and MM. Patients with BCC were older with a female preponderance and mainly located on the head and neck. MM was the least common of the three major skin cancers, but has the highest risk of metastasis and mortality.

Introduction: The increasing prevalence of overweight and obesity among children has become a major public health problem in Malaysia. Parents play an important role in child feeding especially among younger children. Methods: A study was conducted to evaluate the beliefs, attitudes and practices in child feeding among parents of normal weight, as well as overweight and obese primary school children in Kelantan using the Child Feeding Questionnaire (CFQ). This cross-sectional study was carried out on 175 Malay children from three schools in Kota Bharu district in Kelantan. Results: This study showed that 13.1% of the children were overweight and obese. Scores for perceived parent weight (p<0.05) and perceived child weight (p<0.001) were significantly higher among parents of overweight and obese children compared to parents of children with normal body weight. However, the score for pressure to eat among parents of overweight and obese children was significantly lower (p<0.05) than parents of normal weight children. The perceived child weight (r=0.468, p<0.01), perceived parental weight (r=0.190, p<0.05) and food restriction (r=0.179, p<0.05) factors were found to be positively correlated with children’s body mass index (BMI), whereas pressure to eat factor (r=-0.355, p<0.01) was negatively correlated with children’s body mass index (BMI). Conclusion: The findings showed that parental feeding practices were linked to children’s weight status and childhood obesity. Therefore parents should be given education and guidance on appropriate child feeding practices to maintain their child’s nutritional status on a healthy weight range.

Introduction: The objective of this cross-sectional study was to determine the body somatotypes, anthropometric characteristics and physical activity levels of young adults. Methods: Using a systematic sampling approach, a total of 180 students were recruited from three institutions of higher learning in the state of Kelantan. Body weight, height and other anthropometric dimensions including skinfold, bone breadth and limb girth were measured to determine their body mass index (BMI) and body somatotypes. Physical activity level was determined using the Short Form - International Physical Activity Questionnaire (IPAQ). Results: Almost half (49.4%) of the respondents were with a mean age of 21.5 (1.5), and mean BMI of 22.1 (4.5) kg/m2. The proportion of overweight and obese respondents based on the World Health Organisation (WHO) classification was 17.2% and 6.7%, respectively. In terms of body somatotype, 57.2% and 18.3% of them were classified as endomorphic and mesomorphic somatotype groups respectively, while another 24.4% were ectomorphic. The IPAQ scoring protocol indicated that 35.0% of them achieved high physical activity levels, while 19.3% reported low physical activity levels. There were significantly more endomorphic females, whereas the males significantly dominated the mesomorphic somatotype group. Conclusion: Respondents with mesomorphic body somatotype (relative muscularity) were categorised as obese under the BMI classification although their body weight could be due to higher skeletal/muscle mass. The somatotyping method can be used as an additional tool to the conventional BMI indicators for assessing adiposity.

Background: Psoriasis has been shown to be associated with a higher risk of metabolic syndrome and cardiovascular disease. Objective: To investigate the prevalence of metabolic syndrome among patients with psoriasis and study the association between psoriasis and cardiovascular risk factors. Methods: This was a hospital based case-control study conducted at the Dermatology Clinic, University Malaya Medical Centre (UMMC) from May 2010 to March 2011. A total of 131 adult patients with psoriasis and 129 age-, gender- and race-matched controls were recruited. All subjects answered a standardised cardiovascular risks questionnaire and had anthropometric measurements recorded. Laboratory investigations included fasting glucose / lipid profile, erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), urine microalbumin:creatinine ratio and an electrocardiogram. The diagnosis of metabolic syndrome was made using the harmonised criteria for metabolic syndrome in South East Asians. Statistical analysis was performed using statistical processing software (SPSS-17). Results: Metabolic syndrome was significantly higher among patients with psoriasis (64.9% versus 51.9%) (p = 0.034). The presence of metabolic syndrome was associated with low high density lipoprotein (HDL) (p=0.002) and high triglyceride (TG) levels (p = 0.014). The prevalence of diabetes mellitus was also significantly higher among patients with psoriasis (46.6% versus 27.1%) (p = 0.001). Hypertension, ischaemic heart disease, low density lipoprotein (LDL) levels, smoking and obesity were not significantly higher among patients with psoriasis. Conclusion: Our results demonstrate an association between psoriasis and metabolic syndrome which was primarily due to diabetes mellitus and dyslipidaemia.