Background: Adverse reactions on the skin due to face masks are well documented following the COVID-19 pandemic. This study aims to investigate Staphylococcus aureus colonization in relation to face mask-associated adverse cutaneous reactions (FMACR) Methods: This was a case-control study involving adult patients attending dermatology clinic, Hospital Tengku Ampuan Afzan, Pahang, Malaysia. FMACR was determined via a structured interview. Subjects and healthy controls were matched for age and gender. Skin swabs from the alar crease and glabella were obtained and cultured. The possible risk factors for FMACR including type of mask, frequency of change, average duration of use, and skin care practices were also attained. Results: A total of 114 adult participants, which consisted of 57 case and 57 control were recruited. Itching was the most frequent (32; 32.4%) FMACR noted, followed by acne (31; 31.4%) and rashes (22; 22.2%). The presence of facial dermatoses and oily skin type increased the risk of FAMCR (adjusted OR=5.96, 95% CI (1.96,18.12), p=0.002 and adjusted OR=1.94, 95% CI (0.28,13.28), p=0.009) respectively. Cosmetic use was associated with lower risk of FMACR, (adjusted OR=0.16, 95% CI (0.05, 0.56), p=0.004). No significant association was noted between S. aureus skin colonization and FMACR (p=0.409). Conclusion Staphylococcus aureus skin colonization was not associated with FMACR. Risk factors for FMACR were the presence of facial dermatoses and oily skin type while cosmetic use appears to have a protective effect.

Background: Chronic urticaria is a spontaneous or idiopathic mast cell driven disease which affects patients’ well-being and quality of life. This study aimed to determine the prevalence of chronic spontaneous urticaria (CSU) in a public tertiary hospital, to determine patients’ quality of life (QoL) and factors associated with impaired QoL. Methods: A cross-sectional study was conducted at Dermatology Clinic, Hospital Putrajaya. Patients aged more than 18 years diagnosed with CSU were included. Patients with other chronic diseases that may affect QoL were excluded. Data was collected by face to face interview. QoL was assessed using Dermatology Quality of Life (DLQI) questionnaire. Urticaria severity was determined using Urticaria Activity Score (UAS-7). Results: A total of 88 patients aged 40±13.9 years participated with a male to female ratio of 1:3.4. Prevalence of CSU was 0.9%. Mean total DLQI score was 6.3±5.46, 27.3% of patients had no QOL effects, 18.2% had small effect, 36.4% moderate effect and 17% very large effect. Symptoms & feelings subdomain revealed the most severe impairment, followed by leisure and daily activities. Median UAS-7 was 6, 51.1% of patients had well-controlled disease. Higher disease activity was associated with a higher DLQI (p=0.02). Risk factors assessed did not show statistically significant effect on QoL. Conclusion CSU had moderate effect on the QoL of most patients. Symptoms and feelings, leisure and daily activities were predominantly affected. Disease activity was negatively associated with QoL impairment.

Background: Adverse reactions on the skin due to face masks are well documented following the COVID-19 pandemic. This study aims to investigate Staphylococcus aureus colonization in relation to face mask-associated adverse cutaneous reactions (FMACR). Methods: This was a case-control study involving adult patients attending dermatology clinic, Hospital Tengku Ampuan Afzan, Pahang, Malaysia. FMACR was determined via a structured interview. Subjects and healthy controls were matched for age and gender. Skin swabs from the alar crease and glabella were obtained and cultured. The possible risk factors for FMACR including type of mask, frequency of change, average duration of use, and skin care practices were also attained. Results: A total of 114 adult participants, which consisted of 57 case and 57 control were recruited. Itching was the most frequent (32; 32.4%) FMACR noted, followed by acne (31; 31.4%) and rashes (22; 22.2%). The presence of facial dermatoses and oily skin type increased the risk of FAMCR (adjusted OR=5.96, 95% CI (1.96,18.12), p=0.002 and adjusted OR=1.94, 95% CI (0.28,13.28), p=0.009) respectively. Cosmetic use was associated with lower risk of FMACR, (adjusted OR=0.16, 95% CI (0.05, 0.56), p=0.004). No significant association was noted between S. aureus skin colonization and FMACR (p=0.409). Conclusion Staphylococcus aureus skin colonization was not associated with FMACR. Risk factors for FMACR were the presence of facial dermatoses and oily skin type while cosmetic use appears to have a protective effect.

Abstract Ingrown nails mainly affect the great toes, much less frequently lesser toes and rarely fingers. There are many speculations as to their etiology and pathogenesis; however, at the end, there is almost always a imbalance between too wide the nail plate and too narrow the (distal) nail bed. Ingrown nails occur at all age periods, from newborns to the over-100s though with different frequency, clinical characteristics, and management options. In recent years, conservative treatment options – taping, packing, gutter, braces, and many more - were developed avoiding the often disfiguring results of inadequate surgery. However, they require consistent and long-term therapy. Surgery is either aimed at narrowing the wide nail plate or reducing the hypertrophic lateral nail folds. The number of operation methods is vast; already 150 ago, more 75 different surgical techniques had been known, and there is virtually a new one published every week. Despite ingrown nails being a matter of concern for medical doctors since antique, new aspects continue to be detected, such as retronychia. Further, it was found that orthopedic foot abnormalities are very frequently seen in association with ingrown nails. Their treatment is often necessary to prevent recurrences.
Nails, Ingrown

Background: Acne vulgaris is a chronic inflammatory condition of the pilosebaceous unit. Isotretinoin is used to treat moderate to severe acne that is resistant to antibiotics and topical agents. However, it may cause alterations in lipids and liver enzymes. Methods: A total of 129 patients with acne vulgaris (moderate to severe facial acne) treated with isotretinoin were recruited between May 2020 and July 2021 from the dermatology clinics at Hospital Serdang and Hospital Kuala Lumpur. Of these, 120 patients with complete data of lipid panel (total cholesterol, low density lipoprotein cholesterol [LDL], triglycerides [TG], and high density lipoprotein cholesterol [HDL]) and hepatic panel (alanine transaminase [ALT] and aspartate transaminase [AST]) levels at baseline, and in three subsequent follow-up visits (i.e., one, three, and six months) were included in the analyses. Abnormalities were graded according to standard laboratory values and their severity according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE)grading system. Results: Of the 120 study participants, 83% were female and 37% were male between the ages of 15 and 36 years. We observed a significant increase in median values at baseline and at the six-month follow-up for total cholesterol (p<0.0001), triglycerides (p<0.0001), LDL (p<0.0001), ALT (p<0.0001), and AST (p<0.0001). We observed a significant correlation between body mass index and the HDL (r2 =- 0.26, p=0.01) and ALT (r2 =0.383, p=7.9x10-06) levels. Based on the CTCAE grading system, almost all study participants with abnormal results had grade 1 abnormalities. Only one patient had a grade 2 abnormality in ALT, which required treatment discontinuation. Conclusion Low dose isotretinoin therapy for acne vulgaris may cause mild and non-progressive elevation of LDL, total cholesterol, and liver transaminases which do not require treatment withdrawal in most cases.
Isotretinoin--therapeutic use ; Acne Vulgaris-therapy

Background: Psoriasis is a chronic immune-mediated, multisystem inflammatory skin disease that can profoundly impact the quality of life (QoL) of both patients and their families. This study aimed to analyse the impact of psoriasis on the QoL of patients’ family members and its association with anxiety and depression. Methods: This was a cross-sectional study which had a total of 240 subjects (80 patients, 80 family members, and 80 healthy controls). The Dermatology Life Quality Index (DLQI) questionnaire was used to evaluate the QoL of patients, and the Family Dermatology Life Quality Index (FDLQI) questionnaire was used to assess the QoL of family members. In addition, the Hospital Anxiety and Depression Scale (HADS) was used to evaluate the state of anxiety or depression of all subjects, including the healthy controls. Results: Up to 82.5% of family members of psoriasis patients had impaired QoL (FDLQI ≥2). The mean DLQI was 8.89±7.58, whereas the mean FDLQI scores was 7.58±6.09, showing the considerable impact of psoriasis on both patients and family members’ quality of life. There was a positive correlation between family members’ QoL with patients’ anxiety (rs =0.348; p=0.002) and depression (rs =0.276; p=0.013) level. However, no association was found between family members’ QoL with patients’ psoriasis severity (rs =0.173; p=0.126) and the DLQI scores (rs =0.137; p=0.224). Based on the HADS, the mean anxiety scores was 5.29±4.07 and the mean depression scores was 4.54±4.20 for family members. An anxiety disorder was suggested in 32.5%, while depression was suggested in 23.8% of family members. Conclusion Psoriasis has a significant impact on both patients and their family members, who experienced impairment of their QoL and higher levels of anxiety and depression.
Psoriasis ; Quality of Life--psychology

Background: Psoriasis vulgaris is a chronic immune-mediated inflammatory multi-system disease characterised by keratinocyte hyperproliferation. Data regarding patients’ disease severity, knowledge and quality of life (QOL) is important to optimize treatment strategies for psoriasis. This study aims to evaluate and investigate the relationship between disease severity, knowledge and QOL of patients with psoriasis. Methods: A cross-sectional multicentre study utilizing a socio-demographic data collection form, Psoriasis Knowledge Assessment Questionnaire (PKAQ), Dermatology Life Quality Index (DLQI) and Psoriasis Area and Severity Index (PASI was conducted. Correlations between PKAQ, DLQI and PASI were analysed using Spearman’s test. Results: A total of 114 subjects participated in this study. Majority of them had mild psoriasis (n=73, 64%) based on PASI. The mean score of PKAQ was fourteen out of a total possible score of twenty-five, whereas the DLQI had a non-parametric distribution with a median (interquartile range) of 7 (10). Most subjects (32.5%) stated that psoriasis had a ‘moderate effect’ on their QOL, while only 3.5% said that it had an ‘extremely large effect’ on their QOL. There was a statistically significant correlation between PASI and DLQI (rs = 0.264, p = 0.004), with higher PASI scores corresponding to higher DLQI scores. No statistically significant correlation was found between DLQI and PKAQ (rs = -0.048, p= 0.612), and between PASI and PKAQ (rs = 0.058, p= 0.542). Conclusion Impairment of QOL was positively associated with severity of psoriasis. However, there was no significant relationship between knowledge and quality of life, as well as between knowledge and psoriasis severity.
Psoriasis--diagnosis ; Patient Acuity ; Quality of Life--psychology ; Patient Health Questionnaire

Background: People living with Human Immunodeficiency Virus (PLHIV) are living longer with the advent of highly active antiviral therapy (HAART). Aside from extending the life span, quality of life is vital in PLHIV management. However, there is a paucity of data on the cutaneous manifestations in PLHIV on HAART. The objective of this study is to ascertain the prevalence of cutaneous manifestations, effect on daily lives, and relation to CD4 levels. Methods: This is a prospective cross-sectional study comparing 2 groups of PLHIV patients on HAART and not on HAART therapy done from March 2020 to November 2020. Results: A total of 259 patients were recruited in this study with a mean age of 40 years. There were 216 (83.4%) male and 43 (16.6 %) female. Men having sex with men accounts for 49%. The most common cutaneous disorder was post-inflammatory pigmentation (20.4%). Infective dermatoses were 43 (6.7%), and cutaneous malignancy 3 (0.6%). Mean DLQI in PLHIV on HAART were 2, as compared to PLHIV not on HAART which scored 3. Bidayuh ethnicity accounts for 30% of adverse drug reactions with Bactrim being the most common drug. Conclusion There is a high prevalence of dermatoses in PLHIV. HAART increases the CD4 count of patients thereby reducing the risk of opportunistic infection and related disorders. However, it did not reduce the cutaneous manifestations in PLHIV, as HAART itself may increase the risk of adverse cutaneous drug reactions. DLQI is not the best tool to assess quality of life.
HIV ; Dermatomycoses--pathology

Background: Cutaneous disorders are common clinical manifestations of the Human Immunodeficiency Virus (HIV). In the era of antiretroviral therapy (ART), the spectrum of cutaneous disorders in HIV-infected patients has changed. We assessed the types of dermatoses, including cutaneous infections in HIVpositive patients and the association between the peripheral CD4 cell count and the severity of skin infection. Methods: All HIV-positive patients referred to the Dermatology Department of Hospital Sungai Buloh from January 2021 – December 2021 were enrolled in a prospective cross-sectional study. Patients were subjected to a complete medical and physical examination and appropriate investigation to confirm the diagnosis. Results: A total of 112 (92.6%) male and 9 (7.4%) female patients with a mean age of 38.76 ± SD years participated. The majority of patients were Malay (56.2%), with MSM (54.5%) being the commonest mode of transmission. 65.2% of patients had CD4≥350 cells/ mm3 and 86.7% of patients were on ART. Infections (56.1%) were the most common group of mucocutaneous manifestations, with 45.6% of these due to viral infections. There was no statistically significant correlation between the CD4 count and the severity of skin involvement in bacterial (p=0.302), viral (p=0.145) and fungal (p=0.533) infections. Conclusion Viral infection were the commonest cutaneous manifestations in HIV- positive patients. The frequency and severity of the cutaneous infections were much more common in patients with more advanced immunosuppression.
HIV Infections ; Dermatomycoses

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