1.MOHS Micrographic Surgery: The Malaysian Experience and a Review of the Evidence
Adrian Sze Wai Yong ; Zhenli Kwan ; Leng Leng Tan ; Chin Chwen Ch’ng ; Jayalakshmi Pailoor
Malaysian Journal of Dermatology 2017;38(June):2-12
MOHs micrographic surgery is a technique of microscopic margin control in the surgical management
of skin cancers particularly at cosmetically sensitive sites. This review article is aimed at sharing our
initial experience of performing MOHs surgery for skin cancers in Malaysia since 2015.
2.The Association Between Bullous Pemphigoid and Neurological Disorders in A Selected Malaysian Population
Zhenli Kwan ; Yit Nian Lai ; Chin Chwen Ch’ng ; Ai Huey Tan ; Leng Leng
The Medical Journal of Malaysia 2015;70(2):81-85
Background: An association of bullous pemphigoid with
neurological disorders has been reported. The objectives of
this study were to review the clinical characteristics of
patients with bullous pemphigoid and compare the
association between bullous pemphigoid and various
neurological disorders and comorbidities.
Methods: This was a retrospective case-control study
involving 43 patients with bullous pemphigoid and 43 age-,
sex- and ethnicity-matched controls.
Results: There was a statistically significant association
between bullous pemphigoid and neurological disorders
[Odds Ratio (OR) = 3.5, 95% Confidence Interval (CI) 1.3 to
9.2, p=0.011 and adjusted OR=3.5, 95% CI 1.2-10.3, p=0.026],
in particular for dementia (p=0.002). Although stroke was
more common among patients with bullous pemphigoid,
this association was not statistically significant with OR of
1.9 (95% CI 0.7 to 5.2) and adjusted OR of 2.1 (95% CI 0.6 to
7.2). Similarly both ischaemic stroke (OR 1.5, 95% CI 0.5 to
4.2) and haemorrhagic stroke (OR 1.5, 95% CI 0.2 to 9.7) were
more common. Other neurological disorders more common
among patients with bullous pemphigoid were Parkinson’s
disease and epilepsy. Dyslipidaemia was significantly less
common among patients with bullous pemphigoid (OR 0.4,
95% CI 0.1 to 0.9, p=0.033).
Conclusion: A combination of an inflammatory process,
prothrombotic state and endothelial activation leads to an
increased frequency of neurological disorders among
patients with bullous pemphigoid. Thus, a holistic approach
to patient care, including screening for dementia and control
of comorbidities, should be practised as bullous
pemphigoid affects more than just the skin.
Pemphigoid, Bullous
3.An Epidemiological Study of Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) overlap in University Malaya Medical Centre
Leng Leng Tan ; Sze Ting Ooi ; Su Ming Wong ; Chin Chwen Ch’ng ; Zhenli Kwan ; Adrian Sze Wai Yong
Malaysian Journal of Dermatology 2017;38(June):52-56
Introduction:
Steven-Johnson syndrome and Toxic Epidermal Necrolysis are rare but life threatening severe
cutaneous adverse reactions to drugs. To determine the epidemiology of SJS, TEN and SJS/TEN
overlap in University Malaya Medical Centre (UMMC).
Methods:
All patients admitted to UMMC from year 2013-2015 for SJS, SJS/TEN, TEN were recruited. The
classification of SJS, SJS/TEN overlap and TEN was made based on the criteria laid down by Bastuji
et al.2
Results:
A total of 32 patients were recorded to have SJS, SJS/TEN overlap and TEN from 2013 to 2015. Drugs
(n=32, 86.49%) remained the most common aetiology of SJS and TEN. The top three commonest
drugs are allopurinol (n=6), followed by carbamazepine (n=5) and bactrim (n=3).
Conclusion:
This study demonstrates that drugs were the most common cause of SJS/TEN. Antibiotics were the
most common drug group that caused SJS/TEN. Awareness of the common etiology such as drug
is important and high index of suspicion of SJS and TEN is needed if patients were on the above
medications.
5.Causes of mortality in patients with psoriasis in Malaysia –Evidence from the Malaysian Psoriasis Registry
Zhenli Kwan ; Chin Aun Yeoh ; Azura Mohd Affandi ; Fatimah Afifah Alias ; Muneer Hamid ; Nurakmal Baharum ; Adrian Sze Wai Yong ; Roshidah Baba
The Medical Journal of Malaysia 2015;70(5):273-277
Background: Patients with severe psoriasis, namely those
requiring phototherapy or systemic treatment, have an
increased risk of death. The aim of this study was to
determine the prevalence, aetiology and risk factors for
mortality among adult patients aged 18 years and above with
psoriasis in Malaysia.
Methods: This was a retrospective study involving adult
patients notified by dermatologists to the Malaysian
Psoriasis Registry between July 2007 and December 2013.
Data were cross-checked against the National Death
Registry. Patients certified dead were identified and the
cause of death was analysed. Multivariate analysis using
multiple logistic regression were conducted on potential
factors associated with higher risk of mortality.
Results: A total of 419 deaths were identified among the
9775 patients notified. There were four significant risk
factors for higher mortality: age>40 years (age 41-60 years
old, Odds Ratio (OR) 2.70, 95%CI 1.75, 4.18; age>60 years
OR 7.46, 95%CI 4.62, 12.02), male gender (OR 1.72, 95%CI
1.33,2.22), severe psoriasis with body surface area (BSA)
>10% (OR 1.52, 95%CI 1.19, 1.96) and presence of at least
one cardiovascular co-morbidity (OR 1.67, 95% CI 1.30,
2.14). Among the 301 patients with verifiable causes of
death, the leading causes were infection (33.9%),
cardiovascular disease (33.6%) and malignancy (15.9%).
Conclusion: Infection was the leading cause of death among
psoriasis patients in Malaysia. Although cardiovascular
diseases are well-known to cause significant morbidity and
mortality among psoriasis patients, the role of infections
and malignancy should not be overlooked.
Psoriasis
6.Psoriasis Patients with Human Immunodeficiency Virus Infection: Data from the Malaysian Psoriasis Registry
Yeon Chiat Teh ; Suganthy Robinson ; Wooi Chiang Tan ; Zhenli Kwan ; Min Moon Tang
Malaysian Journal of Dermatology 2021;46(June 2021):2-10
Background:
Psoriasis can be a presenting feature of human immunodeficiency virus (HIV) infection. Our objective
was to determine the frequency of HIV infection among patients with psoriasis and to describe the
clinical features, treatment and quality of life in this population.
Methods:
This is a multi-centre retrospective cross-sectional study of psoriasis patients who were registered to
the Malaysian Psoriasis Registry (MPR) from January 2007 to December 2018.
Results:
Of a total of 21,735 patients registered, 105 (0.5%) had HIV infection. Among these patients, 90
(85.0%) were male, mean age was 40.90 ± 10.85 years, and plaque psoriasis was the most frequently
encountered presentation (85.7%). Significantly more patients with HIV had severe psoriasis (61.3%
vs 49.9%, p=0.043), face and neck (62.7% vs 51.4%, p=0.022) involvement, and nail disease (69.9% vs
56.2%, p=0.005) compared to those without HIV. Only n patients (8.7%) had psoriatic arthropathy, and
only 9 (8.8%) received systemic therapy, namely acitretin and methotrexate. None received a biologic,
and only one patient was treated with narrowband ultraviolet-B therapy. The mean Dermatology Life
Quality Index (DLQI) score at enrolment was 10.98 ± 7.07 for the HIV cohort compared to 8.68 ±
6.60 for the non-HIV cohort (t=2.190, p=0.029). More patients with HIV reported a DLQI score >10
compared to those without HIV (51.5% vs 40.2%, p=0.021).
Conclusion
The frequency of HIV infection among patients with psoriasis in the MPR was 0.5%. Patients with
HIV had more severe disease, more nail, face and neck involvement, and greater impairment of quality
of life. Treatment of HIV patients with psoriasis remains conservative in Malaysia.
HIV Infections
;
Psoriasis
7.Human Immunodeficiency Virus-infected men who have sex with men with syphilis: A 5-year multicentre study in Malaysia
Siaw Yen Ong ; Min Moon Tang ; Izzaty Dalawi ; Wooi Chiang Tan ; Chin Aun Yeoh ; Wee Meng Kho ; Pubalan Muniandy ; Pui Li Wong ; Rukumani Devi Velayuthan ; Zhenli Kwan ; Chin Chwen Ch&rsquo ; ng ; Norli Marwyne Mohd Noor ; Vijayaletchumi Krishnasamy ; Asmah Johar
The Medical Journal of Malaysia 2020;75(4):349-355
Objectives: High rates of syphilis have been reported
worldwide among men who have sex with men (MSM). This
study aims to describe the clinical pattern and treatment
response of syphilis among human immunodeficiency virus
(HIV)-infected MSM in Malaysia.
Methods: This is a retrospective study on all HIV-infected
MSM with syphilis between 2011 and 2015. Data was collected
from case notes in five centres namely Hospital Kuala Lumpur,
Hospital Sultanah Bahiyah, Hospital Umum Sarawak,
University of Malaya Medical Centre and Hospital Sungai
Buloh.
Results: A total of 294 HIV seropositive MSM with the median
age of 29 years (range 16-66) were confirmed to have syphilis.
Nearly half (47.6%) were in the age group of 20-29 years.
About a quarter (24.1%) was previously infected with syphilis.
Eighty-three patients (28.2%) had other concomitant sexually
transmitted infection with genital warts being the most
frequently reported (17%). The number of patients with early
and late syphilis in our cohort were almost equal. The median
pre-treatment non-treponemal antibody titre (VDRL or RPR)
for early syphilis (1:64) was significantly higher than for late
syphilis (1:8) (p<0.0001). The median CD4 count and the
number of patients with CD4 <200/μl in early syphilis were
comparable to late syphilis. Nearly four-fifth (78.9%) received
benzathine-penicillin only, 5.8% doxycycline, 1.4% Cpenicillin, 1% procaine penicillin, and 12.4% a combination of
the above medications. About 44% received treatment and
were lost to follow-up. Among those who completed 1 -year
follow-up after treatment, 72.3% responded to treatment
(serological non-reactive – 18.2%, four-fold drop in titre –
10.9%; serofast – 43.6%), 8.5% failed treatment and 17% had
re-infection. Excluding those who were re-infected, lost to
follow-up and died, the rates of treatment failure were 12.1%
and 8.8% for early and late syphilis respectively (p=0.582) Conclusion: The most common stage of syphilis among MSM
with HIV was latent syphilis. Overall, about 8.5% failed
treatment at 1-year follow-up.