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.

Background: Acne vulgaris is a chronic condition which commonly affects adolescents and exerts a psychological burden on its sufferers. Non-adherence to acne treatment is believed to be a major factor contributing to treatment failure. In this study, we characterize the profile of a non-adherent Asian acne patient, and evaluate the relationship between treatment adherence and acne severity and quality of life. Methods: A total of 53 acne patients were recruited from the Dermatology outpatient clinic of National University Hospital, Singapore, and followed up over a 3 month period in this prospective observational study. The Elaboration d’un outil d’evaluation de l’observance (ECOB) adherence assessment tool was used to assess adherence to acne treatment, and acne severity was evaluated using the US Food and Drug Administration Center 5-point Acne Severity Score (ASS). Results: Of the 53 study participants, 29 (54.7%) were non-adherent to acne treatment. There was no significant difference in gender, educational level or acne severity at time of presentation between adherent and non-adherent patients. Adherent patients had a significantly larger improvement in acne severity scores compared to non-adherent patients (change in ASS: -1.33 ± 0.64 vs -0.76 ± 0.83, p = 0.008), but this did not translate to a significant improvement in quality of life. Conclusion: Adherence to acne treatment was not associated with demographic characteristics or acne severity. Factors contributing to adherence to acne treatment are complex and multi-faceted, and individualized motivation and education of each patient may be the method of choice in encouraging treatment adherence.

Introduction: Steroid phobia has been recognized as a hindrance to successful treatment in patients with atopic eczema. Data on this phenomenon is lacking in Malaysia. This study investigates the prevalence and reasons for topical corticosteroid phobia in patients with atopic eczema and their caregivers. Methods: A questionnaire-based study was conducted in both children and adult patients suffering from atopic eczema in two government dermatology clinics at Hospital Kuala Lumpur and Hospital Kota Bharu between May and July 2011. Results: Of the 77 respondents, 39% were worried about using topical corticosteroids for their eczema with 13% totally avoiding steroids. The most common reason for this fear was concern about skin thinning (27.3%) followed by concern on changes in skin colour (14.3%), scarring (13%) and stretch marks (13%). Steroid phobia was significantly higher in those with tertiary education (p=0.005). Conclusion: Steroid phobia appears to be a significant problem in Malaysia especially in those with higher educational background. Despite these concerns, the patients’ compliance to topical corticosteroids is still reasonably good.

Background: Atopic Dermatitis (AD) is a chronic relapsing, pruritic inflammation of the skin which is often colonized by Staphylococcus aureus. Antibiotic resistance of S. aureus is a constant challenge for clinicians who manages atopic dermatitis. Aim: To determine S. aureus antibiotic resistance pattern among patients with non-infected atopic dermatitis and its association with disease severity. Methods: One hundred and seventy eight participants (89 AD patients and 89 controls) were recruited from Universiti Malaya Medical Centre (UMMC). Participants were subjected to a questionnaire on demographics, personal and family medical conditions as well as antibiotic administration. AD severity were determined using Scoring Atopic Dermatitis (SCORAD). Skin swab was taken from eczematous lesion in patients and from left forearm in controls. Antibiotic susceptibility towards methicillin, vancomycin, rifampicin, fusidic acid, erythromycin, gentamicin, clindamycin, sulphamethoxazole, cefuroxime and penicillin were determined using disk diffusion method. Results for antibiotic resistance were categorized as none, sensitive and resistant. Results: Colonization of S. aureus in AD were significantly higher than control (p<0.001). Highest antibiotic resistance was reported for Penicillin (32/39, 82.1%), followed by Fusidic Acid (7/39, 17.9%) as well as Clindamycin and Erythromycin (3/39, 7.7% respectively). Two AD patient (5.1%) were resistant to Gentamicin. In addition, 1 AD patient (2.6%) was resistant towards Methicillin, Sulfamethoxazole and Cefuroxime respectively. No antibiotic resistance was reported for Vancomycin and Rifampicin among the AD patients. Conclusion: High resistance were found for Penicillin and Fusidic acid. Their usage and prescription should be reduced to preserve its sensitivity.

Introduction: Herpes zoster (HZ) is a common acute, cutaneous viral infection caused by reactivation of latent varicella zoster virus with devastating effects on quality of life. This study aims to describe the demographic and clinical characteristic and complications of HZ. Methodology: This was a retrospective study of 179 HZ patients from the Dermatology department of Penang Hospital between January 2010 and June 2013. Results: The 179 patients had a median age of 53 years. Chinese ethnicity was more affected. Majority of the patients came late to seek treatment with the median of disease duration of 4 days. The commonest presenting complaint was pain (98.9%), followed by itching (25.7%) and fever (9.5%). Single dermatome involvement was seen in 90.5% of the patients, of which the thoracic dermatome (54.9%) being the commonest. The incidence of complications such as secondary bacterial infection, post-herpertic neuralgia, eye complication(s) and scar were 36.3%, 4.5%, 5.6% and 2.8% respectively. The complications were not statistically different between the younger and the older patient. However, it was more common among male patients. Conclusion: Patients with HZ in Penang presented late and tend to have complications. Hence, public education and vaccination should be recommended.