2.Incidence of cutaneous adverse drug reactions among medical inpatients of Sultanah Aminah Hospital Johor Bahru
Latha R Selvarajah ; Siew Eng Choon
The Medical Journal of Malaysia 2017;72(3):151-156
Introduction: Cutaneous adverse drug reactions (cADRs)
are common. There are only few studies on the incidence of
cADRs in Malaysia.
Objective: To determine the incidence, clinical features and
risk factors of cADRs among hospitalized patients.
Methods:A prospective study was conducted among
medical inpatients from July to December 2014.
Results: A total of 43 cADRs were seen among 11 017
inpatients, yielding an incidence rate of 0.4%. cADR
accounted for hospitalization in 26 patients. Previous
history of cADR was present in 14 patients, with 50%
exposed to the same drug taken previously. Potentially lifethreatening
severe cutaneous adverse reactions (SCAR),
namely drug reaction with eosinophilia and systemic
symptoms (DRESS: 14 cases) and Stevens-Johnson
Syndrome/Toxic Epidermal Necrolysis (SJS/TEN: 6 cases)
comprise almost 50% of cADRs. The commonest culprit
drug group was antibiotics (37.2%), followed by
anticonvulsants (18.6%). Cotrimoxazole, phenytoin and
rifampicin were the main causative drugs for DRESS.
Anticonvulsants were most frequently implicated in
SJS/TEN (66.7%). Most cases had “probable” causality
relationship with suspected drug (69.8%). The majority of
cases were of moderate severity (65.1%), while 18.6% had
severe reaction with 1 death recorded. Most cases were not
preventable (76.7%). Older age (> 60 years) and mucosal
involvement were significantly associated with a more
severe reaction.
Conclusion: The incidence of cADRs was 0.4%, with most
cases classified as moderate severity and not preventable.
The commonest reaction pattern was DRESS, while the main
culprit drug group was antibiotics. Older age and mucosal
membrane involvement predicts a severe drug reaction.
4.Extramammary Paget's disease: a report of 2 cases and a review of the literature.
Joon Joon Khoo ; Siew Eng Choon
The Malaysian journal of pathology 2003;25(1):73-8
Extramammary Paget's disease (EMPD) is a rare disorder and may be found in the vulva, scrotum, penile area, perianal region and the groin. Frequently, it is associated with an underlying regional neoplasm or internal malignancy. We report 2 cases of EMPD; one involving the scrotal area and the other the vulva. Both were elderly patients who presented to the dermatologists with chronic eczematous lesions in the perineum that did not respond to topical treatment. Skin biopsies confirmed extramammary Paget's disease. Investigations for internal malignancies were negative. However, one of the patients defaulted treatment before surgery. The other patient had two excision surgeries with skin grafting to try to achieve tumour free margins. A long term follow-up was planned for him to look for recurrences. These cases emphasise that EMPD can mimic exudative dermatitis and present as a chronic non-healing lesion in the perineum for many years. Clinicians should have a high index of suspicion to pick up the disease early by biopsy. Various immunohistochemical markers not only can help differentiate other histological diagnoses but also help predict the presence of underlying malignancies. Management of EMPD included thorough search for occult or underlying malignancy followed by complete excision surgery with intraoperative frozen sections. Even then, recurrences are high for this disease and long term follow-up is advocated.
Extramammary Paget's Disease
;
Malignant Neoplasms
;
seconds
;
Review [Publication Type]
;
Lesion, NOS
6.A Case Report of Acne Agminata
Wei Siong Goh ; Kwee Eng Tey ; Siew Eng Choon ; Yabitha Vasavam
Malaysian Journal of Dermatology 2017;38(June):87-90
Granulomatous facial skin lesions are a rare and challenging clinical problem. Differential diagnoses
include cutaneous tuberculosis, sarcoidosis, granulomatous rosacea and acne agnimata. We reported a
case of acne agminata presented with granulamatous facial papules.
7.Clinico-epidemiological profile, including body mass index of Malaysian children with psoriasis
Siew Eng Choon ; Chin Fang Ngim ; Premaa Supramaniam ; Kwee Eng Tey ; Nalini Nanu Madhavan
The Medical Journal of Malaysia 2016;71(4):171-176
background: Limited information exists regarding paediatric
psoriasis and its association with body mass index (bMI) in
Asia.
Objectives: to determine the clinico-epidemiological profile
and to compare the bMI of children with and without
psoriasis.
Methods: A case-control study of 92 children with psoriasis
versus 59 with atopic eczema and 56 with non-inflammatory
skin conditions.
results: Psoriasis was more common in Malay and Indian
children when compared to Chinese with odds ratios (Or) of
4.30 (95% CI, 1.85-9.99) and 3.00 (95% CI, 1.02-8.81)
respectively. Prevalence of psoriasis was similar between
Malay and Indian children (Or 1.43, 95% CI, 0.63-3.25).
Male:female ratio was 1:1.09. the mean onset age of
psoriasis was 7.9 years. Median onset age was earlier in
males (6.5 years versus 9.0 years in females, p=0.05).
Plaque psoriasis was the most common phenotype (89.1%)
and 94.5% had scalp lesions. Arthritis was seen in 4.3%.
Odds of excess adiposity, defined as bMI ≥85th percentile,
was higher in children with psoriasis versus noninflammatory
controls (Or 2.35, 95% CI 0.99-5.56, p= 0.052).
No increased risk of adiposity was noted between children
with psoriasis and eczema (Or 1.14, 95% CI 0.5-2.62,
p=0.753). More children with psoriasis (17.4%) and eczema
(20.3%) were underweight (bMI <5th percentile) compared to
non-inflammatory controls (10.7%).
Conclusion: Malays and Indians are three to four times more
likely than Chinese to have psoriasis in multi-ethnic
Malaysia. Plaque psoriasis is the most common phenotype.
Odds of excess adiposity is about two times higher in
children with psoriasis compared to non-inflammatory
controls although this observation just missed conventional
statistical significance.
Psoriasis
8.Generalized Pustular Psoriasis
Malaysian Journal of Dermatology 2017;39(Dec):2-9
Generalized Pustular Psoriasis (GPP) is a dermatological emergency that often requires hospitalizationbecause of possible life-threatening complications, including heart failure, renal failure and sepsis. Itis a chronic recalcitrant disease in which acute pustular flares frequently recur on exposure to classictriggers. This review article is aimed to update the new insights into the genetic basis of GPP andhighlighted the central role IL1 and IL36 in the pathogenesis of GPP.
9.Acute onset of proptosis secondary to subcutaneous panniculitis-like T cell lymphoma
Hayati Abdul AZIZ ; Loh Swee SENG ; Choon Siew ENG ; Wan Hazabbah Wan HITAM
International Eye Science 2010;10(7):1257-1259
To report a rare case of acute onset of proptosis secondary to subcutaneous panniculitis-like T cell lymphoma (SPTCL). METHODS: A case report. RESULTS: A 27-year-old Malay man presented with history of acute onset of proptosis in the left eye for 2 weeks. It was associated with history of prolonged high fever. He also developed multiple erythematous swelling on his body and both thighs during this period. On examination, visual acuity in both eyes was 6/6. The left eye was proptosed and chemotic.The extraocular move-ment was limited in all directions.The cornea and the anterior segment were normal. Fundoscopy showed normal optic disc and retina.The examination of the right eye was unremarkable.His body temperature was 40.0℃.There was presence of multiple erythematous subcu-taneous lesions over the body mainly in the left axillary, right hypochondriac, both thighs and the suprapubic area.The inguinal lympnodes were also palpable.MRI of orbit and brain revealed generalized soft tissue swelling in the left extraconal and retro-orbital space suggesting of inflammatory reaction.The cavernous sinus and brain were normal.Skin biopsy from the erythematous lesion revealed as SPTCL.He was referred to the haematologist and was started on chemotherapy-CHOP regime. The patient responded well to the chemotherapy and the proptosis reduced. CONCLUSION: Proptosis secondary to SPTCL is very rare. This is a variant of a peripheral T cell lymphoma characterised by multiple subcutaneous nodules presented with proptosis and fever.
10.Clinical features and prognostic factors of cutaneous vasculitis among dermatology patients in Johor Bahru, Malaysia
Latha R SELVARAJAH ; Siew Eng CHOON ; Kwee Eng TEY ; Yong Nian CHEE
The Medical Journal of Malaysia 2017;72(6):345-349
Background: Cutaneous vasculitis is common, yet the riskfactors for its chronicity have not been established.Objective: To describe the clinical spectrum and identify riskfactors for chronicity of cutaneous vasculitis.Methods: Retrospective data analysis of 275 patientsdiagnosed with cutaneous vasculitis from January 2008 toDecember 2013.Results: The mean age was 33.7 (±17.89) years, with femalepredominance. The majority of patients were Malays (67.3%).Skin biopsy was performed in 110 (40%) patients. Thecommonest sign was palpable purpura (30.6%). Theaetiology remained elusive in 51.3% of patients. Commonidentifiable causes include infection (19.7%) and connectivetissue disease (10.2%). Extracutaneous features were notedin 46.5% of patients. Erythrocyte sedimentation rate andantinuclear antibody were raised in 124 of 170 and 27 of 175patients with documented results respectively. Cutaneousvasculitis was the presenting symptom in seven patientswith newly diagnosed systemic lupus erythematosus. AntiStreptolysin O Titre was positive in 82 of 156 patients withdocumented results. Despite antibiotics, 31.7% of them hadchronic lesions. Prednisolone alone was used in 20% ofpatients while 16.4% needed steroid-sparing agents. Mostpatients who needed systemic therapy (62%) hadunidentifiable aetiology. Among the 155 patients whoremained under follow up, 36.4% had chronic disease, onepatient succumbed due to septicaemia, and the rest fullyrecovered within three months. The presence of ulcerativelesion was significantly associated with developing chronicvasculitis (p=0.003).Conclusion: The clinical spectrum of cutaneous vasculitis inour population was similar to other studies. Ulcerativelesion predicts a chronic outcome