Introduction: Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) , and drug reaction with eosinophilia and systemic symptoms (DRESS) are severe cutaneous adverse drug reactions (SCARs) related to a variety of medications. Objectives: We aim to document the epidemiological features, the causative drugs and clinical outcomes of patients with SCARs treated in Hospital Tengku Ampuan Rahimah (HTAR) between January 2009 and December 2013. Materials & Methods: A retrospective review of the data of all patients with SJS, TEN and DRESS treated from January 2009 to December 2013 was retrieved and analyzed. Results: A total of 33 SCARs patients were seen, which included SJS (25), TEN (3) and DRESS (5). The mean age was 42.8 years. The male-to-female ratio was 1.36:1. Allopurinol (33.3%) was the commonest offending drug, followed by antibiotics (30.3%), anticonvulsants (12.1%), non-steroidal anti-inflammatory drugs (12.1%) and traditional medications (6.1%). Eighty percent of SJS and all TEN and DRESS patients were given systemic corticosteroids. One patient with TEN (33.3%) was concurrently given intravenous immunoglobulin. All SJS patients survived. Two patients with TEN (66.7%) and one patient with DRESS (20%) succumbed due to sepsis. Conclusion: The commonest drugs implicated for SCARs in our study were allopurinol and antibiotics. Inappropriate use of these drugs leads to increased risk of SCARs. Early recognition and prompt treatment of patients with SCARs may improve their outcome.

Background: Individuals with AD have an increased susceptibility to colonization with Staphylococcus aureus (S. aureus), contributing to the exacerbation of the disease. Sodium hypochlorite (bleach) has both in vitro and in vivo antimicrobial activity against S.aureus. Objectives: To evaluate the efficacy and safety of diluted sodium hypochlorite (bleach) baths in patients with moderate to severe atopic dermatitis in our Malaysian population. Methods: This was a prospective randomized, investigator-blinded, placebo-controlled study. Patients were randomly assigned through computer generated simple randomized numbers to treatment (bleach baths) or placebo (distilled water baths). Patients were instructed to soak in the baths neck down for 10 minutes, twice a week for 2 months. The efficacy outcome measures were the Eczema Area and Severity Index (EASI) score, percentage body surface area involved, quantitative S. aureus counts and patient’s assessment of overall response (including itch scores). Safety outcomes were also assessed. Results: A total of 36 patients completed the study. EASI scores and body surface area showed significant improvement between treatment and placebo groups at 2 months (p=0.02, p=0.02). At baseline, 88% of patients yielded S. aureus from lesional skin. Although most cultures in the treatment group continued to yield S. aureus, there was a reduction in the density over time, although not statistically significant. Five patients reported burning/stinging and dry skin in the treatment arm which did not differ significantly compared to placebo. Conclusion: Diluted sodium hypochlorite baths as an adjunctive treatment decreased the clinical severity of patients with moderate to severe atopic dermatitis and may reduce S. aureus density. This treatment was well tolerated with minimal adverse effects.

Wegener’s granulomatosis is a rare multisystem necrotizing granulomatous vasculitis aff e c t i n g small - and medium-sized vessels. Its clinical manifestations can be nonspecific during the initial stages and indistinguishable from a variety of neoplastic, infectious, and inflammatory diseases. The disease may run a course from indolence to one of rapid progression leading to life-threatening multiorgan failure. We report a rare case of rapidly progressing Wegener’s granulomatosis.

Objectives To evaluate the efficacy and safety of tacrolimus ointment 0.1% in adult and 0.03% in pediatric patients with moderate to severe atopic dermatitis in Malaysia. Methods This is an open-labeled and single arm multi-center study. 36 adult and 37 pediatric patients were enrolled. Tacrolimus ointment is applied twice daily for four weeks. The primary efficacy outcome is based on the Physician’s Global Evaluation of Clinical Response (PG) at Week 4. The secondary efficacy outcomes are Eczema Area and Severity Index (EASI) score, changes from baseline in individual scores of signs and symptoms and body surface area affected and Patients Assessment of Treatment Effects. Results Overall success rate were 97.1% and 91.2% in the adult and pediatric groups respectively. The decline in EASI, percentage of total BSA affected and patient’s assessment of pruritus were significant (P<0.001). Of adults and pediatric patients, 97.2% and 75.7% respectively reported adverse effect. The most common adverse effect reported was skin burning sensation in 91.7% adult patients and pruritus in 67.6% pediatric patients. Conclusion Tacrolimus ointment 0.1% in adult and 0.03% in pediatric patients is effective for the treatment of moderate to severe atopic dermatitis in Malaysia.