1.Cost of Medications in the Treatment of Moderate to Severe Acne in Sarawak, Malaysia
Malaysian Journal of Dermatology 2014;33(-):18-22
Introduction: Acne is a common problem causing impairment in quality of life requiring topical and
oral treatment. The objective of this study is to determine the cost of medications for the treatment
of an episode of moderate to severe acne vulgaris in patients attending the dermatology clinics in
Sarawak.
Materials & Methods: This cross sectional study was conducted between June 2008 and January 2009
in all the 3 dermatology clinics in Sarawak. Data were collected from 165 patients with moderate to
severe acne and analysed using SPSS ver 15. Statistical significance was set at p < 0.05.
Results: The mean cost of medications to treat 1 episode of acne was RM 1170.48 per patient. The
government and patients spent an average of RM 519.41 and RM 651.07 respectively. The cost to
treat 1 episode of severe acne (mean RM1861.75) was significantly higher than to treat moderate acne
(mean RM 470.79, p < 0.001). Working patients paid more for their acne medications (mean RM
1624) compared to students (mean RM 732.21, p = 0.001). In patients with moderate acne, patients
with tertiary education spent more (mean RM 657.54) on their medications compared to those with
primary/secondary education (mean RM 338.50, p = 0.04) There was no association between the cost of
medications and the socio-demographic variables of gender, ethnic group and economic background.
Conclusion: Cost of treating moderate to severe acne in Sarawak is high and comparable to Western
societies. This data might help in formulating and optimizing resource allocations for the treatment
of acne.
2.Pattern of cutaneous malignancies in a tertiary hospital in Sarawak
Malaysian Journal of Dermatology 2009;22(-):7-10
Background Most Asian studies have determined that basal cell carcinoma (BCC) is the commonest
skin cancer followed by squamous cell carcinoma (SCC), malignant melanoma (MM) and others.
The pattern of cutaneous malignancies has never been determined in Sarawak. Thus, this
retrospective study was performed to determine the pattern among patients attending the skin clinic
in Sarawak General Hospital.
Materials and Methods The clinic notes of 87 patients diagnosed to have skin cancer
histopathologically between 2000 and 2008 were retrieved and subjected to descriptive analysis.
Analysis for the pattern of disease and demographics was performed.
Results BCC constituted the main skin cancer with 49.4% (n=43) followed by SCC with 26.4%
(n=23), cutaneous lymphomas (CL) with 9.2% (n=8), MM with 4.6% (n=4) and other cutaneous
malignancies with 10.3% (n=9). The number of cases detected steadily increased over the 8 year
period, with most BCC and SCC diagnosed after 2003. The mean age of presentation was highest in
patients suffering from SCC at 62.7 years followed by BCC 60.9 years, MM 59 years, CL 54.3 years
and other malignancies 40.6 years. Female predominance was noted in all the malignancies except
squamous cell carcinoma. Chinese constituted the majority of cases (50.6%) followed by Malays
(29.9%), Bidayuhs (9.2%), Ibans (8.0%) and other indigenous people of Sarawak (2.3%). This
pattern of distribution corresponds with the racial distribution of the clinic attendance.
Conclusion Cutaneous malignancies in Sarawak differ from regional pattern in that CL is ranked as
the third commonest skin cancer and that female predominance was seen in BCC, CL, MM and other
skin cancers
3.Risk factors for type 1 leprosy reaction in a tertiary skin clinic in Sarawak
Malaysian Journal of Dermatology 2009;22(-):29-32
Introduction Identifying risk factors for leprosy reactions can preempt clinicians to initiate prompt
treatment to prevent associated morbidities. Thus, a retrospective study was done to elucidate the risk
factors among 44 newly diagnosed leprosy patients in Sarawak General Hospital from 1993 to 2007.
Materials and methods Case folders were searched for demographic data, clinical characteristics,
slit skin smear results, and the presence of type 1 leprosy reactions, its treatment and outcome.
Analysis was done to determine the relative risks for development of this reaction. Student t test was
used for comparison of means. The level of significance was set at 0.05.
Results Type 1 reaction was seen in 25% (n=11) of patients. It occurred in 44.4% (n=4) of
borderline lepromatous (BL), 33.3% (n=1) of mid borderline (BB), 37.5% (n=3) of borderline
tuberculoid (BT) and 30% (n=3) of tuberculoid (TT) patients. Borderline spectrum of disease gave
a relative risk of 2 (95% CI 0.3-0.9) and age of 40 gave a relative risk of 1.8 (95% CI 0.3-0.9) for
the development of type 1 reaction. Older mean age (mean 53.7 years cf. 37.0 years, p = 0.01) and
earlier presentation to health care workers (mean 5.8 months cf. 11.9 months, p = 0.02) was also
significant risk factors Extent of disease and gender were not identified as risk factors.
Conclusion Risk factors for type 1 leprosy reaction were borderline leprosy, older patients and
shorter duration of illness on presentation.
4.Primary cutaneous anaplastic large cell lymphoma in a young woman
Malaysian Journal of Dermatology 2008;21(-):117-119
Primary cutaneous anaplastic large cell lymphoma (ALCL) constitutes
around 1% of all cutaneous lymphomas1. It is defined as predominance
(>75%) of large clusters of CD 30+ blast like cells in the skin biopsy
with no clinical evidence of lymphomatoid papulosis, extracutaneous
localization at presentation or previous or concurrent mycosis
fungoides or other cutaneous lymphoma2. It is usually seen in males
with a median age of 40 years3. It classically presents as a solitary
ulcerated tumour on the trunk or extremities. Twenty two percent of
cases are multifocal3. Extracutaneous dissemination occurs in
approximately 10%, mainly to regional lymph nodes3. Skin restricted
disease has an excellent prognosis with 96% 5 year survival4.
Here, we report a case of primary cutaneous anaplastic large cell
lymphoma (ALCL) in a 32-year-old woman.
5.A 4-year retrospective study of Stevens-Johnson syndrome and toxic epidermal necrolysis
Yap FBB ; Wahiduzzaman M ; Pubalan M ;
Malaysian Journal of Dermatology 2008;21(-):35-39
Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare bullous mucocutaneous disease usually caused by drugs. We aim to determine the demographics, causes and outcomes of patients admitted with SJS, TEN and SJS-TEN overlap
in Sarawak General Hospital.
Materials and Methods A retrospective review of cases admitted to Sarawak General Hospital with SJS, TEN and SJS-TEN overlap from January 2004 to December 2007 was undertaken. Data regarding the demographic, causes and outcomes were collected from the case folders
and subjected to descriptive statistical analysis using Microsoft Excel.
Results Twenty four cases were admitted with 54.2% having SJS, 25% having SJS-TEN Overlap and 20.8% having TEN. With the mean ages of more than 40 years, patients with SJS and SJS-TEN overlap were older than patients with TEN, with a mean age of only 25.4 years. Seventy nine percent of cases were drugs induced. Anticonvulsants were the main culprit constituting 29.2% followed by allopurinol with
20.8%. Cases with SJS had the longest incubation period with mean of 21.6 days whereas cases with TEN had the longest mean hospital stay with 12.4 days. A 12.5% mortality rate was recorded with 2 deaths in
the SJS-TEN overlap group and one death in the TEN group. All cases who were given intravenous immunoglobulin (IVIg) survived.
Conclusion SSJS, SJS-TEN Overlap and TEN were mainly drug
induced and have high mortality. IVIg treatment seems promising. Early recognition and optimal care in institution with dermatology service is essential in reducing morbidities and mortalities.
6.Comparison of multiple drug therapy in leprosy
Malaysian Journal of Dermatology 2008;21(-):47-51
Introduction Multiple drug therapy (MDT) was utilized for the treatment of Hansen’s disease in Sarawak since 1989. MDT Sungai Buloh and MDT Sarawak were the 2 major MDT regimens used. Hence, we aim to compare the outcomes of MDT Sungai Buloh and MDT Sarawak.
Materials and Methods A retrospective review of 40 cases receiving MDT Sungai Buloh and MDT Sarawak from 1993 to 2006 was performed. Data regarding demographics and outcomes were collected and analysed. Primary outcome was cure and secondary outcomes were relapse, reactivation, death, leprosy reactions and deformities.
Results There were no statistically significant differences in the primary outcome among patients on MDT Sungai Buloh and MDT Sarawak (p=0.41) after adjustment for surveillance rate. We noted that
significantly more patients on MDT Sarawak (40.9%) were still under surveillance compared to MDT Sungai Buloh (5.6%, p=0.01). We also noted a higher rate of erythema nodosum leprosum (ENL) (16.7%)
and deformities (22.2%) in patients receiving MDT Sungai Buloh compared to 9.1% ENL and 9.1% deformity rate among those on MDT Sarawak. However, this did not reach statistical significance. Other secondary outcomes were not significantly different between the
two regimens. No recurrence was reported with the two treatment regimens. Subanalysis for multibacillary patients did not reveal any significant differences between the two regimens in the primary
outcome of cure after adjustment for surveillance rate (p=0.35). Both ENL and deformity rates of 25% each for MDT Sungai Buloh were higher than the rate of 13.3% each for MDT Sarawak although they did not reach statistical significance. Analysis for paucibacillary
patients did not show superiority of any one regimen.
Conclusion Both the MDT Sungai Buloh and MDT Sarawak were
effective in leprosy treatment. Selection of the best treatment regimens will depend on the cost effectiveness, ease of administration and duration of treatment that patients can tolerate.
7.Predictive values of 10% potassium hydroxide examination for superficial fungal infection of the skin
Yap FBB ; Wahiduzzaman M ; Pubalan M
Malaysian Journal of Dermatology 2008;21(-):63-65
Introduction Ten percent potassium hydroxide examination is one of the most frequently performed tests in dermatology. It is usually supplemented by fungal culture for detection of superficial fungal
infection of the skin and its appendages. We aim to determine the predictive values of 10% potassium hydroxide examination in Sarawak General Hospital.
Materials and Methods A retrospective review of 292 skin scraping results for 10% potassium hydroxide examination and culture was done between October 2003 and December 2004. Data for all the scrapings were analysed for predictive values, specificity, sensitivity and likelihood
ratio with fungal culture as the gold standard investigation. Separate data analysis was done for those with onychomycosis.
Results Positive cultures were noted in 80.8% of skin scrapping cases and 85.4% of onychomycosis cases. For the skin scrapping cases, the positive predictive value of 10% potassium hydroxide examination was 67.4%, negative predictive value of 16.9%, sensitivity of 12.3% and
specificity of 75%. For those with onychomycosis, the positive predictive value was 75%, negative predictive value 13.6%, specificity 85.7% and sensitivity was 7.3%. The positive likelihood ratio for all
cases and onychomycosis cases was 0.5 whereas the negative likelihood ratio was 0.9.
Conclusion Ten percent potassium hydroxide examination has a very low negative predictive value and sensitivity, making it a poor investigative tool in Sarawak General Hospital. Thus, culture of the skin scraping for suspected superficial fungal infection of the skin and
its appendages is of utmost importance. Steps to improve the quality of 10% potassium hydroxide examination are important as it is an easy and inexpensive test.
8.Incontinentia pigmenti: Report of 3 cases from Sarawak
Leong KF ; Pubalan M ; Yap FBB
Malaysian Journal of Dermatology 2008;21(-):113-115
Incontinentia pigmenti, also known as Bloch-Sulzberger syndrome, is a rare X- linked dominant multisystem disease involving ectodermal structures namely cutaneous, ocular, dental, neurological and skeletal
systems1. Mutation of the nuclear factor kappa B essential modulator (NEMO) gene in chromosome Xq28 is determined to cause this rare genodermatosis2. The cutaneous manifestations are the most characteristic features of this disorder3. We would like to report 3 cases
of incontinentia pigmenti seen in the skin clinic, Sarawak General Hospital.