Introduction: Cryotherapy and salicylic acid ointment are the two most common treatments used for treating plantar warts. The aim of this study is to compare the clearance rate of plantar warts at 12 weeks between liquid nitrogen cryotherapy and 20% salicylic acid ointment. Methods: Patients with plantar warts were randomized into cryotherapy and 20% salicylic acid groups. Patients assigned into cryotherapy group received a maximum of four treatments given two weeks apart. Patients recruited into 20% salicylic acid group were instructed to apply the salicylic acid ointment onto the wart nightly and to cover the treated area with a hypoallergenic plaster. Both groups were also provided with a personal foot file to thin out the surrounding callus daily at home. Digital pictures were taken at first visit and 12 weeks after enrolment to assess the resolution of plantar wart. Results: Eighty patients with plantar warts were included. Thirty-nine patients were randomized into cryotherapy group and forty-one patients were randomized into 20% salicylic acid ointment group. Thirteen (33.3%) patients had a complete clearance of the warts with cryotherapy whereas eleven (26.8%) patients had a complete clearance of the warts with topical 20% salicylic acid ointment (p=0.526). Nine patients were lost to follow-up. With cryotherapy, two patients reported blister formation and one patient developed hyperpigmentation. No side effects were reported with 20% salicylic acid ointment. Conclusion: There is no difference in effectiveness between cryotherapy and 20% salicylic acid ointment in the treatment of plantar wart.

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.

Introduction: Psoriasis is considered an independent cardiovascular risk factor. This study aims to determine and describe the cardiac abnormalities using echocardiography and electrocardiography in patients with plaque psoriasis. Methods: This is a case control study of psoriasis patients with no previous history of cardiac disease. One hundred and thirty-five patients attending the Dermatology Clinic, Hospital Kuala Lumpur were recruited over one year. A full history, physical examination, echocardiogram and electrocardiogram were done. The controls were 135 age and sex matched healthy individuals. Results: The psoriasis group had a significantly higher body mass index and blood pressure. The echocardiogram showed that the mean left ventricular wall diastolic thickness, aortic annulus diameter and isovolumetric relaxation time of the left ventricle was significantly prolonged, and a higher prevalence of tricuspid regurgitation in psoriasis. On the electrocardiogram, more psoriasis patients had left ventricular hypertrophy, ischaemia and right bundle branch block. The QRS interval was significantly shorter in these patients. The tricuspid valve E/A ratio was significantly lower in patients with psoriatic arthropathy. The mitral valve early filling velocity deceleration time, tricuspid valve E/A ratio and QRS interval were significantly higher among systemic therapy naïve patients. The mean mitral and tricuspid valve E/A ratio were significantly lower; and the mean ascending aorta diameter larger, in those with psoriasis for more than ten years. Conclusion: Psoriasis may be associated with an increased risk of cardiac abnormalities suggesting diastolic dysfunction and tricuspid regurgitation. These abnormalities appear to be related to disease duration. Further studies employing newer echocardiographic and cardiac imaging techniques are needed to validate this.

Introduction:The Department of Dermatology, Hospital Kuala Lumpur has been providing cutaneous laser therapyservices for over 20 years. We aim to describe the utilization of cutaneous laser therapy at the Departmentof Dermatology, Hospital Kuala Lumpur and the post treatment complications.Methods:We reviewed all patients who received cutaneous laser therapy at the Department of Dermatology, HospitalKuala Lumpur from January 2012 till December 2016. Complications were defined as dyspigmentation,infection, scarring, blisters, ulcerations, skin textural changes or contact dermatitis secondary to post/ pre-lasertopical therapy.Results:A total of 1190 patients with a male to female ratio of 1:2.21 and a mean age of 35.8 years received single,repeated or combination cutaneous laser therapy from 2012 till 2016 for 48 different skin conditions. Annually,an average of 1314 laser sessions were performed. Indications included seborrhoeic keratosis (249, 20.9%),port wine stain (162, 13.6%), solar lentigines (144, 12.1%), syringoma (105, 8.8%), viral warts (88, 7.4%),and Naevus of Ota (82, 6.9%) among others. Majority underwent Q-switched Nd:YAG laser (36.5%) followedby pulsed dye laser (33.6%), ablative conventional carbon dioxide laser (29.2%) and fractional carbon dioxidelaser (0.7%). Over the past 5 years, 3 patients developed severe complication post laser therapy which wasblisters. Pain was tolerable with application of topical 5% EMLA? (lidocaine 2.5% and prilocaine 2.5%) creampre-laser treatment.Conclusion:Q-switched Nd:YAG laser therapy was the most frequently employed laser in the Department ofDermatology, Hospital Kuala Lumpur. Our centre has a high volume of cases with a low rate of posttreatment complication.

Intoduction:There are multiple treatment modalities for keloids but no single modality has been proven to be thegold standard. This study aims to compare the efficacy of intralesional triamcinolone acetonide (TAC)with silicone gel sheeting (SGS) in treating keloids and their effect on patients’ quality of life(QoL).Methods:This was a two-arm randomized-controlled trial involving 56 subjects in which intralesional TAC 20mg/mL after dilution with 2% lignocaine was administered on keloids monthly for patients in group1 while patients in group 2 applied SGS on keloids daily. Patients were treated for 12 weeks andfollowed-up for 16 weeks. Patient and Observer Scar Assessment Scale (POSAS) and DermatologyLife Quality Index (DLQI) were assessed to monitor treatment efficacy and patients’ QoL respectively.Results:There was 44.2% of improvement in the mean of total score of POSAS in group 1 as compared to11.6% in group 2 (p<0.001). Both groups showed significant improvement in vascularity, pigmentation,thickness and pliability but the improvement was more significant in group 1. Subjects in group 1demonstrated a 67.3% of DLQI score improvement as compared to 13.1% in group 2 (p<0.001). Sideeffects reported were pain during procedure in group 1 and pruritus in group 2.Conclusion:Intralesional TAC was superior than SGS in treating keloids as well as improving patients’ QoL andhence recommended as the first-line treatment. SGS can be considered as an alternative treatment forpatients who are intolerable to pain or as an adjunctive treatment.

Summary Calcinosis cutis is characterized by the accumulation of insoluble calcium salts in the cutaneous and subcutaneous tissue. This condition is classified into four subtypes of calcification: dystrophic, metastatic, idiopathic and iatrogenic. Here, we describe a case of calcinosis cutis in a patient with systemic lupus erythematosus (SLE) who was recently diagnosed with ovarian cancer. Following total hysterectomy with bilateral salphingo-oophorectomy, she developed a painful erythematous plaque over the anterior aspect of the left forearm which turned into single thin yellowish plaque over the following days. Multiple attempts of intravenous cannulation for intravenous fluids occurred at the site. Skin biopsy revealed calcification in the dermis and subcutaneous fat associated with altered dermal collagen. Von Kossa stain demonstrated the presence of calcium deposition. She responded to topical calcineurin inhibitor which resulted in a complete resolution of the skin lesion.
Calcinosis Cutis ; Lupus Erythematosus, Systemic ; Ovarian Neoplasms

Introduction: Atopic eczema (AE) is a common infammatory skin dermatosis that is increasing in prevalence. However, it can present in various clinical presentations, which leads to challenges in the diagnosis and treatment of the condition, especially in a primary care setting. Te Clinical Practice Guidelines on the Management of Atopic Eczema was developed by a multidisciplinary development group and approved by the Ministry of Health Malaysia in 2018. It covers the aspects of diagnosis, severity assessment, treatment, and referral.

Abstract Atopic eczema (AE) is a complex, chronic and recurrent inflammatory pruritic skin condition that impacts the quality of life and exerts an economic toll on patients and their families. One of the factors contributing to AE is the immune dysregulation of the Janus kinase-signal transducers and activators of transcription (JAK-STAT) inflammatory pathway. This has prompted the conduct of various large clinical trial programs to evaluate the efficacy and safety of Janus kinase inhibitors (JAK-i) for AE. The overall and significant benefit of these drugs from clinical studies resulted in regulatory approvals for JAK-i to treat moderate-to-severe atopic eczema. The objective of this position paper was to evaluate the safety, efficacy and role of upadacitinib, baricitinib and abrocitinib in managing AE and update the current recommended treatment algorithm within the 2018 Malaysian Clinical Practice Guidelines for the Management of Atopic Eczema. The Persatuan Dermatologi Malaysia recommends that these JAK-i can be considered as an option for systemic therapy in severe AE.
Dermatitis, Atopic--therapy ; Janus Kinase Inhibitors

The aim of this Biologic Advisory Group (BAG) Malaysia consensus guideline is to provide clinicians managing cutaneous diseases with biologics relevant parameters to consider prior to initiating or stopping or continuing any biologic treatment in the current landscape of the COVID-19 pandemic. Besides reviewing the medical literatures on COVID-19 and evidences related to other human coronavirus or influenza, expert opinions and clinical experiences are shared and debated in formulation of this biologic consensus guideline.