Genital Herpes Simplex Virus (HSV) is a major global public health issue where the number of patientsincreases every year. It has a variety of clinical presentations, and a tendency to recur when the immunesystem is compromised. Patients with human immunodeficiency virus (HIV) have a higher chance ofbeing infected with HSV possibly due to their high risk attributes. We reported a case of a 19-yearoldhomosexual male who was recently diagnosed with HIV and presented with perianal lesions for aduration of three months. This case is presented with the aim to highlight the differential diagnosis ofrash in immunocompromised patients and how to approach them.

Background: People living with Human Immunodeficiency Virus (PLHIV) are living longer with the advent of highly active antiviral therapy (HAART). Aside from extending the life span, quality of life is vital in PLHIV management. However, there is a paucity of data on the cutaneous manifestations in PLHIV on HAART. The objective of this study is to ascertain the prevalence of cutaneous manifestations, effect on daily lives, and relation to CD4 levels. Methods: This is a prospective cross-sectional study comparing 2 groups of PLHIV patients on HAART and not on HAART therapy done from March 2020 to November 2020. Results: A total of 259 patients were recruited in this study with a mean age of 40 years. There were 216 (83.4%) male and 43 (16.6 %) female. Men having sex with men accounts for 49%. The most common cutaneous disorder was post-inflammatory pigmentation (20.4%). Infective dermatoses were 43 (6.7%), and cutaneous malignancy 3 (0.6%). Mean DLQI in PLHIV on HAART were 2, as compared to PLHIV not on HAART which scored 3. Bidayuh ethnicity accounts for 30% of adverse drug reactions with Bactrim being the most common drug. Conclusion There is a high prevalence of dermatoses in PLHIV. HAART increases the CD4 count of patients thereby reducing the risk of opportunistic infection and related disorders. However, it did not reduce the cutaneous manifestations in PLHIV, as HAART itself may increase the risk of adverse cutaneous drug reactions. DLQI is not the best tool to assess quality of life.
HIV ; Dermatomycoses--pathology

Background: Phototherapy had been a less favourable treatment in recent years. Our study aims to audit the usage of NB-UVB phototherapy service in a tertiary hospital in East Malaysia. Methods: This is a retrospective study. Phototherapy file of patients who underwent NB-UVB phototherapy between year 2016 and 8 March 2021 were reviewed. Demographic data, treatment history, and acute side effects were analysed. Results: Forty eight subjects were recruited in this study. The majority (33.3%) of the subjects were in 20-29 age group. There was an equal number of male and female subjects. About 66.7% of the subjects had psoriasis and 18.8% of them had vitiligo. Nearly 36.6% of the subjects had 26-50% body surface area involved at initial phototherapy. Almost 54.2% of the subjects had <50 sessions of NB-UVB phototherapy. About 52.1% of the subjects had a cumulative dose of NB-UVB <25 J/cm2 while 26.7% of subjects had a cumulative dose >200 J/cm2. Acute side effects including burning (17.8%), pruritus (4.4%) and flare of psoriasis (2.2%). Discussion: Low utilization rate of NB-UVB phototherapy was likely due to logistical and transportation factors. Psoriasis was the commonest indication for NB-UVB in our study followed by vitiligo. Annual skin malignancy surveillance should be done especially on patients received NB-UVB >350 sessions even after the discontinuation of treatment. Most patients tolerate NB-UVB phototherapy well with no major side effects. Conclusion In conclusion, NB-UVB phototherapy is a relatively safe yet underutilised treatment in our centre.
Phototherapy ; Tertiary Care Centers ; Malaysia

Background: Atopic dermatitis (AD) is a common chronic inflammatory skin disorder that significantly burdens both children and caregivers’ quality of life. This study aimed to investigate the prevalence and sociodemography of AD and determine its impact on the quality of life among AD children and their families in Sarawak. Methods: This was a cross-sectional, observational population-based epidemiological study of primary school children in Kuching. The U.K. Working Party’s Diagnostic (UKWPD) criteria was utilized to diagnose atopic dermatitis. Disease impact on quality of life was assessed via standardized questionnaires. Skin examination was performed. Results: A total of 968 children aged 7 to 12 years were recruited. The prevalence of AD was 7.0%. Malays were the commonest affected ethnic group. Most of the AD children had other associated atopies. Majority of children with AD had mild to moderate severity based on IGA with mean EASI score (standard deviation) of 1.50 (2.0). The mean Children’s Dermatology Quality Life Index (CDQLI) and Dermatitis Family Impact (DFI) were 7.26 (5.53) and 7.74 (6.12), respectively. “Symptoms of itch, sore or pain” was the most affected domain in children, whereas “Treatment impact” most affected in families. There was significant association between disease severity and children’s quality of life. Conclusion Atopic Dermatitis is common in Kuching school children. Children with AD and their families had a significant impact on quality of life, although most were mild diseases.
Dermatitis, Atopic ; Sarawak (Malaysia)

Background: Sexually transmitted infections (STIs) are common worldwide. This study aims to determine the patterns of STIs among attendees in the Genito-Urinary Medicine (GUM) clinic of Sarawak General Hospital (SGH). Methods: This is a retrospective study. Medical records of new cases referred to GUM clinic, SGH between the year 2018 and 2020 were reviewed. Demography data, diagnosis, and clinical characteristics of STIs were reviewed and analysed using SPSS software. Results: There was a total of 225 patients with newly diagnosed STIs. Their mean age was 30.9 years old. There were 124 (55.1%) males and 101 (44.9%) females. Nearly half (46.7%) of the patients were Malay, followed by Sarawak indigenous groups (33.3%), and Chinese (18.7%). Most patients (n=119, 52.9%) were single at the time of diagnosis. Three quarters (73.3%) of the patients were heterosexual, while 47 (20.9%) patients were homosexual or bisexual, and missing data in the remaining 5.8%. Anogenital wart was the commonest STI (49.8%), followed by syphilis (n=91, 40.4%), genital herpes (n=24,10.7%) and gonorrhoea (n= 15, 6.7%). The commonest symptoms were genital growth (n= 107, 47.6%), followed by pelvic discharge (n=22, 9.8%). Conclusion The most common STIs in our study are anogenital warts, syphilis, genital herpes and gonorrhea. Effective national sexuality education in Malaysia is paramount in reducing premarital sex and STIs. Human Papillomavirus (HPV) vaccines are effective to reduce genital warts and HPV related malignancies.
Sexually Transmitted Diseases ; Papillomavirus Vaccines ; Genito-Urinary Medicine Clinic, Sarawak General Hospital (Malaysia)

Objectives: High rates of syphilis have been reported worldwide among men who have sex with men (MSM). This study aims to describe the clinical pattern and treatment response of syphilis among human immunodeficiency virus (HIV)-infected MSM in Malaysia. Methods: This is a retrospective study on all HIV-infected MSM with syphilis between 2011 and 2015. Data was collected from case notes in five centres namely Hospital Kuala Lumpur, Hospital Sultanah Bahiyah, Hospital Umum Sarawak, University of Malaya Medical Centre and Hospital Sungai Buloh. Results: A total of 294 HIV seropositive MSM with the median age of 29 years (range 16-66) were confirmed to have syphilis. Nearly half (47.6%) were in the age group of 20-29 years. About a quarter (24.1%) was previously infected with syphilis. Eighty-three patients (28.2%) had other concomitant sexually transmitted infection with genital warts being the most frequently reported (17%). The number of patients with early and late syphilis in our cohort were almost equal. The median pre-treatment non-treponemal antibody titre (VDRL or RPR) for early syphilis (1:64) was significantly higher than for late syphilis (1:8) (p<0.0001). The median CD4 count and the number of patients with CD4 <200/μl in early syphilis were comparable to late syphilis. Nearly four-fifth (78.9%) received benzathine-penicillin only, 5.8% doxycycline, 1.4% Cpenicillin, 1% procaine penicillin, and 12.4% a combination of the above medications. About 44% received treatment and were lost to follow-up. Among those who completed 1 -year follow-up after treatment, 72.3% responded to treatment (serological non-reactive – 18.2%, four-fold drop in titre – 10.9%; serofast – 43.6%), 8.5% failed treatment and 17% had re-infection. Excluding those who were re-infected, lost to follow-up and died, the rates of treatment failure were 12.1% and 8.8% for early and late syphilis respectively (p=0.582) Conclusion: The most common stage of syphilis among MSM with HIV was latent syphilis. Overall, about 8.5% failed treatment at 1-year follow-up.

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.