1.Efficacy and safety of sodium hypochlorite (bleach) baths in patients with moderate to severe atopic dermatitis
Wong Su-ming ; Ng TG ; Roshidah B
Malaysian Journal of Dermatology 2011;27(-):17-17
Background:
Individuals with AD have an increased susceptibility to colonization with Staphylococcus aureus (S. aureus), contributing to the exacerbation of the disease. Sodium hypochlorite (bleach) has both in vitro and in vivo antimicrobial activity against S.aureus.
Objectives:
To evaluate the efficacy and safety of diluted sodium hypochlorite (bleach) baths in patients with moderate to severe atopic dermatitis in our Malaysian population.
Methods:
This was a prospective randomized, investigator-blinded, placebo-controlled study. Patients were randomly assigned
through computer generated simple randomized numbers to treatment (bleach baths) or placebo (distilled water baths). Patients were instructed to soak in the baths neck down for 10 minutes, twice a week for 2 months. The efficacy outcome measures were the Eczema Area and Severity Index (EASI) score, percentage body surface area involved, quantitative S. aureus counts and patient’s assessment of overall response (including itch scores). Safety outcomes were also assessed.
Results:
A total of 36 patients completed the study. EASI scores and body surface area showed significant improvement between treatment and placebo groups at 2 months (p=0.02, p=0.02). At baseline, 88% of patients yielded S. aureus from lesional skin. Although most cultures in the treatment group continued to yield S. aureus, there was a reduction in the density over time, although not statistically significant. Five patients reported burning/stinging and dry skin in the treatment arm which
did not differ significantly compared to placebo.
Conclusion:
Diluted sodium hypochlorite baths as an adjunctive treatment decreased the clinical severity of patients with moderate to severe atopic dermatitis and may reduce S. aureus density. This treatment was well tolerated with minimal adverse effects.
2.Lipid lowering drugs induced adverse cutaneous drug reactions
Lee Chew Kek ; Lee YY ; Roshidah B
Malaysian Journal of Dermatology 2011;27(-):22-22
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.
3.Correlations study between cutaneous disease severity and systemic disease severity in SLE (Systematic Lupus Erythematosus) patients
Tarita Taib ; Thevarajah S ; Roshidah B
Malaysian Journal of Dermatology 2011;27(-):4-4
Introduction: Skin is the second most commonly affected organ in SLE. Lupus-specific cutaneous LE(CLE) is classified according to Gilliam Classification into acute CLE (ACLE), subacute CLE(SCLE), chronic CLE(CCLE). CLASI (CLE Disease Activity and Severity Index) is an outcome measures to asses cutaneous activity
Objectives: To study the correlation between cutaneous disease severity and severity of systemic disease using SLEDAI (SLE Disease Severity Index) and SLICC / ACR (Systemic Lupus International Collaborating Clinics) outcome measures.
Methods: Study design: Cross-sectional
A total of 71 patients were recruited from Dermatology and Rheumatology Clinic from Kuala Lumpur Hospital, Selayang
Hospital and Pusat Perubatan UKM. Study period was from December 2009 to August 2010. Study data were obtained
from clinical history, examination, investigations and medical record review.
Results: The mean CLASI activity/damage scores in patients with ACLE, SCLE and CCLE were 11.8 / 8.1, 22.6 / 17.2 and 21.1 / 22.1 respectively. The mean SLEDAI/SLICC scores in similar group of patients were 12.3 / 2.1, 6.8 / 1.6, 13.2 / 1.7 respectively. The cutaneous disease activity in patients with SCLE was found to be inversely correlated to systemic disease activity. The cutaneous damage in patients with CCLE was positively correlated with systemic disease damage
Conclusions: Patients with SCLE, despite having high cutaneous disease activity, had mild systemic disease. Patients with CCLE whom had high cutaneous damage scores were more likely to have higher systemic damage, hence more thorough investigations to seek other organs damage, should be offered.
4.Epidemiology And Clinical Features Of Paediatric Patients With Psoriasis In Malaysia: Evidence From The Malaysian Psoriasis Registry (2007-2012)
Azura MA ; Fatimah AA ; Asmah J ; Roshidah B
Malaysian Journal of Dermatology 2015;34(-):2-9
Background: Psoriasis is a common dermatological condition affecting both adults and children. It
causes significant physical and psychological burden on patients and adversely affect their quality of
life.
Aim: To evaluate the clinical characteristics of paediatric patients with psoriasis in Malaysia.
Materials & Methods: Data were obtained from the Malaysian Psoriasis Registry (MPR). All paediatric
patients aged <18 years notified to the registry from July 2007 to December 2012 were included in
this study.
Results: A total of 677 patients were notified from 18 participating centres. There was a slight female
preponderance (ratio 1.3:1). Malay accounted for 70.6%, followed by Chinese (8.9%), Indian (12.3%)
and others (8.1%). Mean age of onset was 9.8 ± 4.4 years. Positive family history was noted in 19.1%.
Plaque psoriasis was the commonest type of psoriasis (79.6%), followed by guttate psoriasis (7.4%),
pustular psoriasis (1.6%), erythrodermic (1.2%) and flexural psoriasis (1.2%). Psoriatic arthropathy
was reported in only 2.2% of patients. Nail involvement is common, affecting 38.1%. Pitting was the
commonest (89.9%). Topical treatment remains the most popular choice of treatment and was given
in 95.1% of our patients. Topical steroid was the commonest prescribed (81.4%), followed by tar
preparations (78.7%) and emollients (51.6%). Only 1.2% of our patients received phototherapy. Of
the patients who had phototherapy, narrowband UVB (NBUVB) was the commonest used (87.5%).
Systemic therapy was given in 5.3% of paediatric patients. The most frequently used systemic therapy
was methotrexate (50%) and acitretin (27.8%). The mean CDLQI score for paediatric patients with
psoriasis was 7.7 ± 5.5.
Conclusion: Data from the Malaysian Psoriasis Registry highlights the clinical features of paediatric
patients with psoriasis in Malaysia. We hope to get more participation from other centres in the future,
especially from private sectors, so that our results can represent the Malaysian data more accurately.
5.Antibiotic sensitivity of Propionibacterium acnes isolated from patients with acne vulgaris in Kuala Lumpur Hospital,Malaysia
Dr Tang Jyh Jong ; Agnes H ; Chan LC ; Roshidah B
Malaysian Journal of Dermatology 2011;27(-):18-18
Background
Antibiotic therapy directed against Propionibacterium acnes has been a mainstay of treatment in acne vulgaris for more
than 40 years. Prolonged antibiotic usage has been associated with emergence of antibiotic-resistant P. acnes and is linked
to treatment failure. Little work has been done in Malaysia on drug resistance in P. acnes and there is no surveillance data
on this aspect to guide the clinical decision.
Objective
This study aims to evaluate antibiotic sensitivity of P. acnes isolated from patients with acne vulgaris in Kuala Lumpur
Hospital, Malaysia.
Methods
This is a non interventional, single centered, cross-sectional hospital-based survey of antibiotic sensitivity of P. acnes
isolated from patients with acne vulgaris in Kuala Lumpur Hospital from January 2010 to June 2010.
Results
A total of 100 patients were recruited in our study. P. acnes was isolated in 53% of patients and 11% had gram negative
organism. Antibiotic resistant P. acnes was found in 15.1% of positive isolates. Clindamycin resistance was most common
(15.1%) followed by erythromycin (7.5%), doxycycline (5.7%), tetracycline (1.9%) and minocycline (0%). Isolates of
antibiotic resistant P. acnes was significantly higher in patients treated with antibiotics within the last 6 months (29%)
as compared with non antibiotic treated patients (0%) (p<0.05). The mean duration of prior antibiotic treatment was
significantly longer in the group of antibiotic resistant P. acnes as compared with antibiotic sensitive P. acnes (17.13 weeks
vs 5.74 weeks, p<0.05).
Conclusion
Antibiotic resistant P. acnes is present locally with clindamycin and erythromycin conferring the highest resistance. Longer
duration of antibiotic treatment predisposes to antibiotic resistant P. acnes and may also induce emergence of gram
negative organisms. Strategies to reduce antibiotic resistance should be emphasized when prescribing antibiotic for acne
vulgaris in order to achieve optimal therapeutic results while reducing the potential for antibiotic resistance.
6.The impact of acne vulgaris on the quality of life in Sarawak,Malaysia
Felix Yap Boon Bin ; Pubalan M ; Chang CC ; Roshidah B
Malaysian Journal of Dermatology 2011;27(-):27-27
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.
7.Syphilis - The great mimicker
Wong Su-ming ; Moonyza AAK ; Dawn A ; Roshidah B
Malaysian Journal of Dermatology 2011;26(-):18-20
Syphilis is an ancient sex u a l ly transmitted
infection, described since centuries ago, caused by
the bacterium Treponema pallidum. Syphilis or
luetic disease is known as the great imitator as it can
have myriads of clinical presentations, often
making it a diagnostic challenge to clinicians. We
report a patient with secondary syphilis, wh o
presented with scaly plaques on his trunk and face,
sparing the palms and soles.
8.Primary Cutaneous Anaplastic Large Cell Lymphoma: Report of 3 cases from Hospital Kuala Lumpur
Tang MM ; Chang CC ; Affandi AM ; Roshidah B
Malaysian Journal of Dermatology 2011;26(-):21-24
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.
9.Wegener’s Granulomatosis: A case report and literature review
Tang JJ ; Tang MM ; Lee BR ; Ng TG ; Roshidah B
Malaysian Journal of Dermatology 2010;25(-):31-35
Wegener’s granulomatosis is a rare multisystem
necrotizing granulomatous vasculitis aff e c t i n g
small - and medium-sized vessels. Its clinical
manifestations can be nonspecific during the initial
stages and indistinguishable from a variety of
neoplastic, infectious, and inflammatory diseases.
The disease may run a course from indolence to one
of rapid progression leading to life-threatening
multiorgan failure. We report a rare case of rapidly
progressing Wegener’s granulomatosis.
10.Antibiotic sensitivity of propionibacterium acnes isolated from patients with acne vulgaris in Hospital Kuala Lumpur, Malaysia
Tang JJ ; Heng A ; Chan LC ; Tang MM ; Roshidah B
Malaysian Journal of Dermatology 2012;28(-):1-8
Background Antibiotic therapy directed against Propionibacterium acnes (P. acnes) has been a
mainstay of treatment in acne vulgaris for more than 40 years. Prolonged antibiotic usage has been
associated with emergence of antibiotic-resistant P. acnes and is linked to treatment failure. Little
work has been done in Malaysia on drug resistance in P. acnes and there is no surveillance data on
this aspect to guide the clinical decision.
Objective This study aims to evaluate antibiotic sensitivity of P. acnes isolated from patients with
acne vulgaris in Kuala Lumpur Hospital, Malaysia.
Methods This is a non interventional, single centered, cross-sectional hospital-based survey of
antibiotic sensitivity of P. acnes isolated from patients with acne vulgaris in Kuala Lumpur Hospital
from January 2010 to June 2010.
Results A total of 100 patients were recruited in our study. P. acnes was isolated in 53% of patients
and 11% had gram negative organism. Antibiotic resistant P. acnes was found in 15.1% of positive
isolates. Clindamycin resistance was the highest (15.1%) followed by erythromycin (7.5%),
doxycycline (5.7%), tetracycline (1.9%) and minocycline (0%). Isolates of antibiotic resistant
P. acnes was significantly higher in patients treated with antibiotics within the last 6 months (29%)
as compared with non antibiotic treated patients (0%) (p<0.05).The mean duration of prior antibiotic
treatment was significantly longer in the group of antibiotic resistant P. acnes as compared with
antibiotic sensitive P. acnes (17.13 weeks vs 5.74 weeks, p<0.05).
Conclusion Antibiotic resistant P. acnes is present locally with clindamycin and erythromycin
accounting for the highest resistance. Longer duration of antibiotic treatment predisposes to
antibiotic resistant P. acnes and may also induce emergence of gram negative organisms. Strategies
to reduce antibiotic resistance should be emphasized when prescribing antibiotic for acne vulgaris
in order to achieve optimal therapeutic results while reducing the potential for antibiotic resistance.