3.Case Series of Acrodermatitis Enteropathica in Langkawi Hospital
Shen Wei LEE ; Shin Yi OOI ; Wooi Chiang TAN
Malaysian Journal of Dermatology 2017;39(Dec):69-71
Acrodermatitis enteropathica (AE) is a rare genetic autosomal recessive disorder characterised byperiorificial inflammatory rash, diarrhoea and hair loss. Hereby, we report 3 cases of acrodermatitisenteropathica.
4.Leprosy in Pregnancy: A Case Series in 4 Dermatology Clinics in Malaysia
Ken Chen LOH ; Min Moon TANG ; Wooi Chiang TAN ; Lee Chin CHAN ; Sook Yee Michelle Voo ; Suganthi THEVARAJAH
Malaysian Journal of Dermatology 2018;40(June):41-48
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.
5.A 10-years retrospective study on Severe Cutaneous Adverse Reactions (SCARs) in a tertiary hospital in Penang, Malaysia
Chai Har LOO ; Wooi Chiang TAN ; Yek Huan KHOR ; Lee Chin CHAN
The Medical Journal of Malaysia 2018;73(2):73-77
Introduction: Severe cutaneous adverse drug reactions(SCARs) are not uncommon and potentially lifethreatening.Our objective is to study the patientcharacteristics, the pattern of implicated drugs andtreatment outcome among patients with SCARs.Methods: A 10-year retrospective analysis of SCARscases in Penang General Hospital was carried out fromJanuary 2006 to December 2015. Data collection is basedon the Malaysian Adverse Drug Reactions AdvisoryCommittee registry and dermatology clinic records.Results: A total of 189 cases of SCARs were encountered(F:M ratio; 1.2:1.0; mean age of 45 year). The commonestmanifestation was Stevens-Johnson Syndrome [SJS](55.0%), followed by toxic epidermal necrolysis [TEN](23.8%), drug rash with eosinophilia and systemicsymptoms [DRESS] (12.7%), acute generalisedexanthematous pustulosis [AGEP] (4.8%), SJS/TENoverlap syndrome (2.6%) and generalised bullous fixeddrug eruptions [GBFDE] (1.1%). Mean time to onset forTEN/SJS/Overlap syndrome was 10.5±13 days; AGEP,three days; GBFDE, 2.5±0.7 days, and DRESS, 29.4±5.7days. The most common drugs implicated wereantibiotics (33.3%), followed by allopurinol (18.9%) andanticonvulsant (18.4%). Out of 154 cases ofSJS/TEN/overlap syndrome, allopurinol was thecommonest causative agents (20.1%). In DRESS,allopurinol accounts for 45.8% of the cases. The mortalityrate in SJS, TEN and DRESS were 1.9%, 13.3% and 12.5%respectively. No mortality was observed in AGEP andGBFDE.Conclusion: The commonest manifestations of SCARs inour setting were SJS, TEN and DRESS. Allopurinol wasthe most common culprit. Thus, judicious allopurinol useis advocated and pre-emptive genetic screening for HLAB*5801 should be consider
6.Atypical Presentation of Cutaneous Larva Migrans: A Case Report & Literature Review
Kean Pan ONG ; Wooi Chiang TAN ; Yew Thong CHONG ; Yek Huan KHOR ; Lee Chin CHAN
Malaysian Journal of Dermatology 2017;39(Dec):56-58
Cutaneous larva migrans, also known as “migrant linear epidermitis”, “beach worm”, “migranthelminthiasis”, “dermatitis serpiginosus” or “creeping eruption”. It is a zoonosis which caused byaccidental percutaneous inoculation of helminth larvae, usually parasites of the small intestines of catsand dogs. It typically presents as an itchy, erythematous, serpiginous, cutaneous eruption. We describea case of disseminated and extensive infection of cutaneous larva migrans in a 21-year-old traveler,leading a delay in diagnosis and treatment.
7.Prevalence and risk factors of genitourinary Chlamydia trachomatis infection among patients attending sexually transmitted disease clinics in northern Malaysia
Chin Aun Yeoh ; Lee Chin Chan ; Chin Chin Ch&rsquo ; ng ; Wooi Chiang Tan
The Medical Journal of Malaysia 2020;75(2):103-109
Chlamydia trachomatis; sexually transmitted disease; prevalence;infection
Introduction: Chlamydia trachomatis is one of the most
common sexually transmitted diseases (STDs) globally.
However, data on its prevalence and risk factors in Malaysia
is still scarce.
Objective: We aimed to identify the prevalence and risk
factors of genitourinary C.trachomatis infection among
patients attending STD clinics in northern Peninsular
Malaysia.
Methods: A hospital-based cross-sectional study was
conducted in STD clinics of Hospital Pulau Pinang and
Hospital Sultanah Bahiyah, Kedah from January to
November 2014. Participants were individually interviewed
using a structured data collection form followed by a
physical examination and laboratory tests. Nucleic Acid
Amplification Test (NAAT) was used to detect C.trachomatis
infection. Analysis was carried out using SPSS Version 15.
Results: Eighty-three sexually active patients were enrolled,
consisting of 51 males and 32 females. The median age was
28.0 years. In general, 32.5% patients were asymptomatic,
the remaining presented with genital discharge (41.0%),
genital warty lesion (25.3%), genital ulcer (13.3%), dysuria
(13.3%), dyspareunia (2.4%), urine hesistancy (1.2%) and
genital swelling (1.2%). The prevalence of genitourinary
C.trachomatis infection was 21.7% in the study population;
17.6% in males and 28.1% in females. Among the infected
females, 44.4% were pregnant. Of those infected 56.6% did
not show any symptoms of genital infection, and 77.8% were
aged between 18 and 30 years, of which most were females.
Among newly diagnosed HIV patients, the prevalence was
14.3%. From multivariable logistic regression analysis, age
under 28 years, being married and engagement in oral sex
had significantly increased odds of C.trachomatis infection.
Conclusions: C.trachomatis infection was common among
patients attending STD clinics in northern Penisular
Malaysia especially in the younger age groups. Majority of
the infected patients were asymptomatic.
8.Management of Atopic Eczema in primary care
Ainol Haniza Kherul Anuwar ; Azura Mohd Affandi ; Ch&rsquo ; ng Chin Chwen ; Dawn Ambrose ; Heah Sheau Szu ; Khor Yek Huan ; Lalitha Pillay a/p B. Gopinathan ; Leow Wooi Leong ; Mohd. Aminuddin Mohd. Yusof ; Noor Zalmy Azizan ; Sabeera Begum ; Siti Shafatun Mohsin ; Tan Wooi Chiang ; Tarita Taib ; Wong Ping Foo ; Zaridah Zainuri ; Siti Mariam Tukimin
Malaysian Family Physician 2020;15(1):39-43
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.
9.Psoriasis Patients with Human Immunodeficiency Virus Infection: Data from the Malaysian Psoriasis Registry
Yeon Chiat Teh ; Suganthy Robinson ; Wooi Chiang Tan ; Zhenli Kwan ; Min Moon Tang
Malaysian Journal of Dermatology 2021;46(June 2021):2-10
Background:
Psoriasis can be a presenting feature of human immunodeficiency virus (HIV) infection. Our objective
was to determine the frequency of HIV infection among patients with psoriasis and to describe the
clinical features, treatment and quality of life in this population.
Methods:
This is a multi-centre retrospective cross-sectional study of psoriasis patients who were registered to
the Malaysian Psoriasis Registry (MPR) from January 2007 to December 2018.
Results:
Of a total of 21,735 patients registered, 105 (0.5%) had HIV infection. Among these patients, 90
(85.0%) were male, mean age was 40.90 ± 10.85 years, and plaque psoriasis was the most frequently
encountered presentation (85.7%). Significantly more patients with HIV had severe psoriasis (61.3%
vs 49.9%, p=0.043), face and neck (62.7% vs 51.4%, p=0.022) involvement, and nail disease (69.9% vs
56.2%, p=0.005) compared to those without HIV. Only n patients (8.7%) had psoriatic arthropathy, and
only 9 (8.8%) received systemic therapy, namely acitretin and methotrexate. None received a biologic,
and only one patient was treated with narrowband ultraviolet-B therapy. The mean Dermatology Life
Quality Index (DLQI) score at enrolment was 10.98 ± 7.07 for the HIV cohort compared to 8.68 ±
6.60 for the non-HIV cohort (t=2.190, p=0.029). More patients with HIV reported a DLQI score >10
compared to those without HIV (51.5% vs 40.2%, p=0.021).
Conclusion
The frequency of HIV infection among patients with psoriasis in the MPR was 0.5%. Patients with
HIV had more severe disease, more nail, face and neck involvement, and greater impairment of quality
of life. Treatment of HIV patients with psoriasis remains conservative in Malaysia.
HIV Infections
;
Psoriasis
10.Bringing the Treatment of Atopic Eczema Into a New Era with Janus Kinase Inhibitors: A Position Statement By the Persatuan Dermatologi Malaysia
Noor Zalmy Azizan ; Adawiyah Jamil ; Chang Choong Chor ; Dawn Ambrose ; Henry Foong Boon Bee ; How Kang Nien ; Rajalingam Ramalingam ; Sabeera Begum Bt Kader Ibrahim ; Sharifah Rosniza Binti Syed Nong Chek ; Tan Wooi Chiang ; Wong Hoi Ling
Malaysian Journal of Dermatology 2022;49(Dec 2022):2-11
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