Onychomycosis is a common nail disease with numerous etiological pathogens. In order to determine and trend the local mycological pattern of culture-positive diseased nail samples sent from the Department of Dermatology, Hospital Kuala Lumpur, a five-year retrospective audit was carried out, which revealed that non-dermatophyte molds were the predominant fungi isolated, followed by yeasts and dermatophytes. This is similar to two previous studies in Malaysia, but varies greatly from other studies around the world which showed a dermatophyte-predominant prevalence. This could be due to the nature of the environment our patients encountered.

Pseudoporphyria is a condition clinically and histologically similar to porphyria cutanea tarda (PCT)but without abnormalities in porphyrin metabolism. Pseudoporphyria has also been described inpatients with chronic renal failure, with or without accompanying dialysis. Herein we report a caseof dialysis-associated pseudoporphyria in the hopes that increased awareness of this condition mayultimately lead to improved outcomes with the institution of specific treatment measures.

Leptospirosis has a wide spectrum of nonspecific clinical manifestations ranging from mild diseaseto multiorgan failure with variable cutaneous manifestations. Disseminated herpes simplex virusinfection usually occurs in the setting of immunosuppression. Both these infections are rare infectivecauses of fulminant hepatitis. Herein, we report a case of fatal leptospirosis and disseminated herpessimplex virus coinfection, in the hopes that this report will increase awareness among health careproviders for relevant investigation and prompt management.

Dapsone is part of the multi-drug therapy used in the treatment of leprosy. It can cause life-threateninghypersensitivity syndromes resulting in significant morbidity and mortality, especially amongsusceptible individuals such as those who are carriers of HLA-B*13:01 allele. Avoidance of dapsonein these susceptible individuals reduces the risk of dapsone-related adverse events. Herein, we reportfour indigenous patients with leprosy who developed dapsone hypersensitivity syndrome.

Summary Pemphigus refers to a group of life-threatening, autoimmune blistering disease that presents as blisters and erosions involving the skin and mucosa. Systemic corticosteroids and rituximab have been recommended as mainstay therapy for pemphigus vulgaris and pemphigus foliaceus. Herein, we report three cases of pemphigus vulgaris and a case of pemphigus foliaceus treated with rituximab as first-line therapy.
Rituximab ; Pemphigus

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: 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.

Summary Phaeohyphomycosis refers to a heterogenous group of mycotic infections caused by dematiaceous fungi where unintentional traumatic inoculation accounts for majority of the cases. Herein, we are reporting a rare case of iatrogenic subcutaneous phaeohyphomycosis which is secondary to intravenous cannula placement.
Phaeohyphomycosis ; Iatrogenic Disease

Summary We describe nine cases of anti-tuberculosis DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome, a potentially serious complication of treatment that led to interruption of treatment, systemic corticosteroid usage and the resumption of treatment with different regimens. All patients had skin rash, six out of nine patients with hepatitis, two out of nine patients had acute kidney injury, five out of nine patients died. All-cause mortality is high in our cohort.
Drug Hypersensitivity Syndrome