Abstract Introduction: Due to the emergence of antibiotic resistance worldwide, the bacterial pathogens and susceptibility patterns causing skin infections should be monitored periodically to alert early intervention. This study aimed to analyse the bacterial profile and their antibiotic susceptibility patterns among the patients with cutaneous infections at Department of Dermatology, Hospital Kuala Lumpur (HKL). Methods: This retrospective analysis analysed the bacterial profile and the antibiotic susceptibility patterns of 1221 positive cultures obtained from skin swabs and biopsy specimens sent from the Department of Dermatology Hospital Kuala Lumpur (HKL) from 2013-2015. Results: Staphylococcus aureus (2/3 methicillin-sensitive, 1/3 methicillin-resistant) was the most frequent isolate (44%), followed by Pseudomonas aeruginosa (17.4%); Acinetobacter sp. (6.7%); Proteus sp. (6.1%); Klebsiella sp. (5.7%), Enterobacter sp. (3.0%), Escherichia coli (2.8%) and others. About 45% and 10% of MRSA was resistant to fucidic acid and mupirocin respectively. About 15% of Pseudomonas aeruginosa was resistant to ciprofloxacin. Majority of Acinetobacter sp. were resistant to most of the common antibiotics used. Conclusion: Staphylococcus aureus remained the main microorganisms isolated from patients with cutaneous bacterial infections. Empirical use of antibiotics prior to availability of culture sensitivity should be avoided for prevention of multi-resistant micro-organisms. We advocate judicious use of antibiotics based on results of the culture sensitivity and strict adherence to infection control measures to prevent development of antibiotic resistance.

Behcet’s disease (BD) is a variant of systemic vasculitides characterized by recurrent oral aphthous ulcers, recurrent genital ulcers with eyes, cutaneous, gastrointestinal, joints, neurological and others organ involvement. Here we aim to describe the demography, clinical patterns and the treatment of 5 cases of BD presented to the Department of Dermatology Hospital Kuala Lumpur between 2002 and 2016. All the patients had a delay in their diagnosis. The clinical characteristics and the choices of treatment in our patients did not differ greatly compared to the reports from other countries. BD could be under-diagnosed in Malaysia as the presenting symptoms are non-specific. Therefore, a high index of suspicion is needed.

No abstract available.

Angiosarcoma is a rare but aggressive malignant tumor of vascular endothelial cells accounting for1-2% of soft tissue sarcoma. Due to its rarity and heterogeneity in clinical presentation, delay indiagnosis and treatment is not uncommon. Hence, prognosis is usually guarded. Here we report acase of primary cutaneous angiosarcoma arising from the right cheek which progressed rapidly andresulted in perforation of buccal mucosa despite combination therapy of paclitaxel and propranolol.

IntroductionManagement of leprosy in pregnancy is challenging. Here we aim to describe the clinical characteristicsand the management of leprosy in pregnancy.MethodsThis is a retrospective study on pregnant women with leprosy managed in the Department ofDermatology in Hospital Kuala Lumpur, Hospital Pulau Pinang, Hospital Sultanah Bahiyah andHospital Queen Elizabeth between 1994 and 2015.ResultsThere were ten patients with 12 pregnancies with a median age of 27.5 years (range: 16-33). Fivewere foreigners. There were four cases of lepromatous leprosy, two cases of borderline lepromatous,two cases borderline tuberculoid leprosy and one case each for tuberculoid and mid borderline leprosy.Seven pregnancies (58%) were documented to have reactions. Four reversal reactions (33%), threeerythema nodusom leprosum (25%) and two Lucio’s phenomenon (17%) were documented. Bothpatients with Lucio’s phenomenon had undiagnosed leprosy and presented with preterm labour,anemia, oligohydramnios and intrauterine growth restriction. Mortality was recorded in one patientdue to dapsone induced hypersensitivity syndrome complicated with septicaemia. All patients wereprescribed multidrug therapy but in three pregnancies, the patients chose to defer the treatment. Therewas a spontaneous miscarriage at second trimester and a case of early neonatal death. The neonatalcomplications recorded for the 10 live deliveries were low birth weight, jaundice and clofazimineinducedhyperpigmentation.ConclusionThe majority of our patients with leprosy had complications throughout the pregnancies. Earlydetection and prompt treatment can prevent unfavorable fetal outcome & threatened maternal health.

Background: Although Dermatology is primarily a non-acute, outpatient-centered clinical specialty, some of them require in-patient care for intensive skin management. We aim to describe the demographic data, clinical characteristics, and outcomes of Dermatology inpatients in Hospital Kuala Lumpur (HKL). Methods: This is a retrospective study on all dermatology inpatients in HKL between 2016 and 2020. Data was obtained from admission records and further analyzed. Results: A total of 1567 patients were admitted to the Dermatology ward between 2016 and 2020 accounted for 2292 admissions. The mean age was 45 years (range 8-93). The male to female ratio was 1.16:1. The majority were Malaysian (99.2%). Most Malaysian were Malays (60%) followed by Chinese (19.3%) and Indian (17.1%). About 91% of the admissions were arranged from the dermatology clinic. The mean length of stay was 5.06 days (range 0-63). About 20% of the patients required multiple admissions. The main dermatological diagnosis requiring inpatient care were non-infective dermatoses (60.4%) which included eczematous dermatoses, autoimmune dermatoses, psoriasis, cutaneous adverse drug reactions, inflammatory and non-inflammatory dermatoses. This was followed by cutaneous infections (24.5%) and drug allergy testing & drug provocation tests (7.9%). About 3% of patients were transferred to other departments for further intensive management, and the rest were discharged home well. No mortality occurred in the Dermatology ward. Conclusion The Dermatology ward HKL managed 2292 admissions between 2016 and 2020. The three main dermatological diagnoses requiring intensive skin management were eczematous conditions, cutaneous infections, and autoimmune dermatoses.
Dermatology ; Inpatients ; Hospital Kuala Lumpur (Malaysia)

Background: Adolescents, who aged between 10 and 19 years old, comprise about 20% of the world’s population. They are vulnerable to acquisition of sexually transmitted infections (STIs). Here, we aim to determine the demography and pattern of STIs among adolescents attending Genito-Urinary Medicine (GUM) Clinic, Hospital Kuala Lumpur (HKL). Methods: This is a retrospective study on all adolescents attending GUM clinic between 2014 and 2018. Data was obtained from case notes and further analysed. Results: A total of 111 adolescents attended GUM clinic between 2014 and 2018. The mean age was 18 years (range 12-19). The male to female ratio was 2.26:1. All patients were Malaysian. Only 2 were foreign nationals. The majority were Malays (85.3%) followed by Indians (11%) and Chinese (3.7%). About 46.8% were still schooling, 28.8% were employed and 23.4% were unemployed. About 8.3% had a history of substance abuse. The majority (67.6%) were heterosexual, about 17.1% were homosexual and 3.6% were bisexual. Nearly 95% engaged in unprotected sex. Majority (46%) had casual sex. The most frequent presenting symptoms for male and female adolescents were discharge (43.2%) followed by swelling/growth (23.4%). About 83% had confirmed STIs. The most common STIs among the male were gonorrhoea (44.1%), genital warts (23.4%) and non-gonococcal urethritis (14.7%). The most common STIs among the female were herpes genitalis (50%), genital warts (33.3%) and syphilis (8.3%). Six patients were infected with the human immunodeficiency virus (HIV). Conclusion The most common STI among adolescents between 2014 and 2018 was gonorrhoea for male and herpes genitalis for female.
Sexually Transmitted Diseases ; Adolescent ; Genitourinary Medicine Clinic Hospital Kuala Lumpur (Malaysia)

Patients with human immunodeficiency virus (HIV) may have significant cutaneous morbidities which can potentially affect their quality of life or be life-threatening. This study aimed to describe the demographic data and the pattern of cutaneous manifestations of patients infected with HIV.

Background: Anogenital human papillomavirus (HPV) is the most frequent reported sexually transmitted infection in the world. We aim to describe the local demographic data and the clinical characteristics of anogenital warts (AGWs). Methods: This is a retrospective study on all patients with AGWs who attended the GUM clinic between 2015 and 2020. Data was obtained from case notes and further analysed. Results: A total of 935 patients with AGWs attended the GUM clinic between 2015 and 2020. The mean age was 30.4 years (range 12-84). The male to female ratio was 2.35:1. Majority were Malaysian (97%). Majority of the Malaysian were Malays (61.5%) followed by Chinese (27.7%) and Indian (8.9%). About 5.6% had a history of substance abuse. While the majority (57.9%) were heterosexual, 34.8% were homosexual and 6.4% were bisexual. About 59.8% had more than one sexual partner. A quarter (25.6%) was infected with the human immunodeficiency virus. The most frequent site of AGWs in males was the perianal area (52.6%), followed by the penis (45.7%), and with a fifth of them having lesions at multiple sites. For female patients, the most frequent site of AGWs was the posterior fourchette (45.2%) followed by the labia minora (33%) with 46.6% had involvement at multiple sites. Approximately 17.6% had other concomitant sexually transmitted infections. Local treatment application used included cryotherapy (86.4%), podophyllin (35.3%), tri-chloroacetic acid (26.8%) and imiquimod (2.6%). About 41.5% required combination of these modalities. Nearly 6.2% experienced recurrence. About 2% required surgical intervention. Conclusions AGWs was more commonly observed in male. The most frequent site of involvement was perianal for male (52.6%) and posterior fourchette in female (45.2%).
Papillomavirus Infections ; Sexually Transmitted Diseases

Adult onset Still’s disease (AOSD) is a sporadic complex autoinflammatory syndrome first described in 1971.1 It is characterised by high spiking fever, polyarthritis, sore throat, lymphadenopathy, hepatosplenomegaly, serositis, and evanescent skin eruptions.1,2 It is associated with life-threatening complications too. Diagnosis of AOSD is laborious as it requires extensive investigations to exclude infections, autoimmune diseases and malignancy. Here we illustrate a young female who exhibited a turbulent presentation of ASOD.