1.An Epidemiological Study of Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) overlap in University Malaya Medical Centre
Leng Leng Tan ; Sze Ting Ooi ; Su Ming Wong ; Chin Chwen Ch’ng ; Zhenli Kwan ; Adrian Sze Wai Yong
Malaysian Journal of Dermatology 2017;38(June):52-56
Introduction:
Steven-Johnson syndrome and Toxic Epidermal Necrolysis are rare but life threatening severe
cutaneous adverse reactions to drugs. To determine the epidemiology of SJS, TEN and SJS/TEN
overlap in University Malaya Medical Centre (UMMC).
Methods:
All patients admitted to UMMC from year 2013-2015 for SJS, SJS/TEN, TEN were recruited. The
classification of SJS, SJS/TEN overlap and TEN was made based on the criteria laid down by Bastuji
et al.2
Results:
A total of 32 patients were recorded to have SJS, SJS/TEN overlap and TEN from 2013 to 2015. Drugs
(n=32, 86.49%) remained the most common aetiology of SJS and TEN. The top three commonest
drugs are allopurinol (n=6), followed by carbamazepine (n=5) and bactrim (n=3).
Conclusion:
This study demonstrates that drugs were the most common cause of SJS/TEN. Antibiotics were the
most common drug group that caused SJS/TEN. Awareness of the common etiology such as drug
is important and high index of suspicion of SJS and TEN is needed if patients were on the above
medications.
2.MOHS Micrographic Surgery: The Malaysian Experience and a Review of the Evidence
Adrian Sze Wai Yong ; Zhenli Kwan ; Leng Leng Tan ; Chin Chwen Ch’ng ; Jayalakshmi Pailoor
Malaysian Journal of Dermatology 2017;38(June):2-12
MOHs micrographic surgery is a technique of microscopic margin control in the surgical management
of skin cancers particularly at cosmetically sensitive sites. This review article is aimed at sharing our
initial experience of performing MOHs surgery for skin cancers in Malaysia since 2015.
3.Causes of mortality in patients with psoriasis in Malaysia –Evidence from the Malaysian Psoriasis Registry
Zhenli Kwan ; Chin Aun Yeoh ; Azura Mohd Affandi ; Fatimah Afifah Alias ; Muneer Hamid ; Nurakmal Baharum ; Adrian Sze Wai Yong ; Roshidah Baba
The Medical Journal of Malaysia 2015;70(5):273-277
Background: Patients with severe psoriasis, namely those
requiring phototherapy or systemic treatment, have an
increased risk of death. The aim of this study was to
determine the prevalence, aetiology and risk factors for
mortality among adult patients aged 18 years and above with
psoriasis in Malaysia.
Methods: This was a retrospective study involving adult
patients notified by dermatologists to the Malaysian
Psoriasis Registry between July 2007 and December 2013.
Data were cross-checked against the National Death
Registry. Patients certified dead were identified and the
cause of death was analysed. Multivariate analysis using
multiple logistic regression were conducted on potential
factors associated with higher risk of mortality.
Results: A total of 419 deaths were identified among the
9775 patients notified. There were four significant risk
factors for higher mortality: age>40 years (age 41-60 years
old, Odds Ratio (OR) 2.70, 95%CI 1.75, 4.18; age>60 years
OR 7.46, 95%CI 4.62, 12.02), male gender (OR 1.72, 95%CI
1.33,2.22), severe psoriasis with body surface area (BSA)
>10% (OR 1.52, 95%CI 1.19, 1.96) and presence of at least
one cardiovascular co-morbidity (OR 1.67, 95% CI 1.30,
2.14). Among the 301 patients with verifiable causes of
death, the leading causes were infection (33.9%),
cardiovascular disease (33.6%) and malignancy (15.9%).
Conclusion: Infection was the leading cause of death among
psoriasis patients in Malaysia. Although cardiovascular
diseases are well-known to cause significant morbidity and
mortality among psoriasis patients, the role of infections
and malignancy should not be overlooked.
Psoriasis