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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

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Prevalence and Types of Mucocutaneous Disorders, Their Correlation to CD4 Count and Their Impact on Quality of Life in Adults with HIV Infection

Yee Ting Lim ; Kwee Eng Tey ; Siew Eng Choon

Malaysian Journal of Dermatology.2021;46(June 2021):11-20.

Background: Data on prevalence and type of mucocutaneous diseases in HIV-positive patients and their impact on quality of life (QoL) are sparse. We aim to determine prevalence and type of mucocutaneous disorders, their correlation to CD4+ counts and impact on QoL for adults with HIV, using the Dermatology Life Quality Index (DLQI). Methods: A cross-sectional study of HIV-infected adults seen in HIV and Dermatology Clinic. Results: The majority (90%) of 174 participants recruited was male. Median age at diagnosis of HIV infection was 29 years (IQR 10). Mucocutaneous disorders were present in 90.2%, out of which 58.6% had two or more mucocutaneous disorders. Mean CD4+ count was significantly lower in patients with, compared to those without mucocutaneous disorders (363 vs 548 cells/µL; p=0.030). Infections accounted for 67.2% of all mucocutaneous disorders seen, followed by inflammatory dermatoses (51.7%), cutaneous adverse drug reactions (17.8%) and neoplasm (2.3%). The five most frequent manifestations were eczema (22.4%), anogenital warts (21.2%), candidiasis (16.7%), dermatophytosis (15.5%) and secondary syphilis (12.0%). Oral candidiasis, pruritic papular eruption, drug-induced maculopapular eruption and drug rash with eosinophilia and systemic symptoms were significantly more prevalent in patients with CD4+ counts <200 cells/µL but anogenital warts were more prevalent in patients with CD4+ counts ≥200 cells/µL. The mean DLQI score was 8.39 (SD ± 6.83). QoL was severely impaired (DLQI >10) in 34.4%. Conclusion Mucocutaneous disorders were common in HIV patients causing significant impairment in quality of life. Prevalence co-related with low CD4+ counts. Adequate management of HIV may reduce the prevalence of mucocutaneous disorders and improve QoL.
HIV Infections ; Mucocutaneous Lymph Node Syndrome

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Prevalence of Atopic Dermatitis Among Primary School Children and Its Impact on Quality of Life in Kuching, Sarawak

Sut Enn Lee ; Sze Ying Foo ; Nur Shairah Fatin Binti Badaruddin ; Mohamad Adam Bujang ; Pubalan Muniandy

Malaysian Journal of Dermatology.2021;46(June 2021):21-30.

Background: Atopic dermatitis (AD) is a common chronic inflammatory skin disorder that significantly burdens both children and caregivers’ quality of life. This study aimed to investigate the prevalence and sociodemography of AD and determine its impact on the quality of life among AD children and their families in Sarawak. Methods: This was a cross-sectional, observational population-based epidemiological study of primary school children in Kuching. The U.K. Working Party’s Diagnostic (UKWPD) criteria was utilized to diagnose atopic dermatitis. Disease impact on quality of life was assessed via standardized questionnaires. Skin examination was performed. Results: A total of 968 children aged 7 to 12 years were recruited. The prevalence of AD was 7.0%. Malays were the commonest affected ethnic group. Most of the AD children had other associated atopies. Majority of children with AD had mild to moderate severity based on IGA with mean EASI score (standard deviation) of 1.50 (2.0). The mean Children’s Dermatology Quality Life Index (CDQLI) and Dermatitis Family Impact (DFI) were 7.26 (5.53) and 7.74 (6.12), respectively. “Symptoms of itch, sore or pain” was the most affected domain in children, whereas “Treatment impact” most affected in families. There was significant association between disease severity and children’s quality of life. Conclusion Atopic Dermatitis is common in Kuching school children. Children with AD and their families had a significant impact on quality of life, although most were mild diseases.
Dermatitis, Atopic ; Sarawak (Malaysia)

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The Association of Skin and Nasal Colonisations of Staphylococcus aureus in Children with Atopic Dermatitis with Disease Severity and Its Impact on Quality of Life

Jin Huang Lim ; Anis Roziana Mohamad ; Kwee Eng Tey

Malaysian Journal of Dermatology.2021;46(June 2021):31-37.

Background: Atopic dermatitis (AD) is a chronic, recurrent, pruritic inflammatory skin disease that causes significant burden to affected children. Staphylococcus aureus plays a vital role in AD, and its resistance to current topical antibiotics is worrying. This study aims to determine the frequency of Staphylococcus aureus colonisation and its resistance pattern. It further assesses the association between Staphylococcus aureus colonisation and disease severity; as well as its impact on quality of life. Methods: A cross-sectional study was conducted among 153 children with AD. Skin and nasal swabs were collected. Antibiotic sensitivity to penicillin, cefoxitin, erythromycin, methicillin, clindamycin, gentamicin, trimethoprim/sulfamethoxazole, tetracycline, rifampicin, fusidic acid and linezolid were tested. Clinical evaluation was performed using the SCORing Atopic Dermatitis index (SCORAD). Quality of life was assessed with the Dermatological Life Quality Index (DLQI). Results: Twenty-nine patients had positive skin swab results. One patient had methicillin-resistant Staphylococcus aureus isolated from nasal swab. Skin colonisation with Staphylococcus aureus (p=0.03) and DLQI (p<0.01) were significantly associated with disease severity. The resistant rate is highest in penicillin, followed by fusidic acid, tetracycline, and erythromycin. Conclusion Skin colonisation with Staphylococcus aureus is an indicator of disease severity in children with AD. Patients with severe disease have lower quality of life. Clinicians need to be aware of high resistance rates towards penicillin and fusidic acid and be prudent in the choice of antibiotics. Antiseptic wash can be considered in patients with Staphylococcus aureus colonisation.
Staphylococcus aureus ; Dermatitis, Atopic ; Child Health

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A 5-years Retrospective Study on Narrowband Ultraviolet B (NBUVB) Phototherapy Utilisation Experience in A Tertiary Hospital in East Malaysia

Teo Hock Gin ; Kiing Jiu Wen ; Pubalan Muniandy

Malaysian Journal of Dermatology.2021;46(June 2021):38-42.

Background: Phototherapy had been a less favourable treatment in recent years. Our study aims to audit the usage of NB-UVB phototherapy service in a tertiary hospital in East Malaysia. Methods: This is a retrospective study. Phototherapy file of patients who underwent NB-UVB phototherapy between year 2016 and 8 March 2021 were reviewed. Demographic data, treatment history, and acute side effects were analysed. Results: Forty eight subjects were recruited in this study. The majority (33.3%) of the subjects were in 20-29 age group. There was an equal number of male and female subjects. About 66.7% of the subjects had psoriasis and 18.8% of them had vitiligo. Nearly 36.6% of the subjects had 26-50% body surface area involved at initial phototherapy. Almost 54.2% of the subjects had <50 sessions of NB-UVB phototherapy. About 52.1% of the subjects had a cumulative dose of NB-UVB <25 J/cm2 while 26.7% of subjects had a cumulative dose >200 J/cm2. Acute side effects including burning (17.8%), pruritus (4.4%) and flare of psoriasis (2.2%). Discussion: Low utilization rate of NB-UVB phototherapy was likely due to logistical and transportation factors. Psoriasis was the commonest indication for NB-UVB in our study followed by vitiligo. Annual skin malignancy surveillance should be done especially on patients received NB-UVB >350 sessions even after the discontinuation of treatment. Most patients tolerate NB-UVB phototherapy well with no major side effects. Conclusion In conclusion, NB-UVB phototherapy is a relatively safe yet underutilised treatment in our centre.
Phototherapy ; Tertiary Care Centers ; Malaysia

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Dermoscopy of Dilated Pore of Winer

Shashikumar Basavapura Madegowda ; Savitha Somiiah Allaranda

Malaysian Journal of Dermatology.2021;46(June 2021):43-45.

Summary Dilated pore of Winer is a benign adnexal tumour of follicular differentiation. It has typical clinical feature of asymptomatic, solitary enlarged pore with a keratin plug. Dermoscopy offers further assistance in diagnosis. In this case on dermoscopy, well defined lamellated central blackish area arranged in concentric circles, surrounded by a bluish grey halo was seen with a rim of hyperpigmentation.
Dermoscopy

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Calcinosis Cutis Secondary to Trauma in a Patient with Systemic Lupus Erythematosus and Ovarian Cancer

Mazliha Mashor ; Noor Zalmy Azizan ; Bang Rom Lee

Malaysian Journal of Dermatology.2021;46(June 2021):46-48.

Summary Calcinosis cutis is characterized by the accumulation of insoluble calcium salts in the cutaneous and subcutaneous tissue. This condition is classified into four subtypes of calcification: dystrophic, metastatic, idiopathic and iatrogenic. Here, we describe a case of calcinosis cutis in a patient with systemic lupus erythematosus (SLE) who was recently diagnosed with ovarian cancer. Following total hysterectomy with bilateral salphingo-oophorectomy, she developed a painful erythematous plaque over the anterior aspect of the left forearm which turned into single thin yellowish plaque over the following days. Multiple attempts of intravenous cannulation for intravenous fluids occurred at the site. Skin biopsy revealed calcification in the dermis and subcutaneous fat associated with altered dermal collagen. Von Kossa stain demonstrated the presence of calcium deposition. She responded to topical calcineurin inhibitor which resulted in a complete resolution of the skin lesion.
Calcinosis Cutis ; Lupus Erythematosus, Systemic ; Ovarian Neoplasms

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Quinacrine: An Effective Addition to the Treatment of Refractory Cutaneous Lupus Erythematosus

Hui Jen Ding ; Swee Gaik Ong

Malaysian Journal of Dermatology.2021;46(June 2021):49-51.

Summary Treatment of refractory cutaneous lupus is challenging. When conventional therapy, including hydroxychloroquine (HCQ), corticosteroids and immunosuppressants, has failed, the addition of quinacrine may be a promising option. We describe a case of refractory chronic cutaneous lupus erythematosus (CCLE) who responded well to quinacrine.
Quinacrine ; Lupus Erythematosus, Cutaneous

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Cutaneous Serratia Marcescens Infection - A Rare Case Report

Kwang Meng Yew ; Stephanie Sue San Ong ; Mazita Ismail ; Jyh Jong Tang

Malaysian Journal of Dermatology.2021;46(June 2021):52-54.

Summary Cutaneous serratia marcescens (S. marcescens) infection is very rare and most cases had history of skin trauma or cutaneous procedure done before. It presents in various forms like non-healing ulcers, abscess formation, nodules with an intermittent course or as granulomatous lesions, thus mimicking non-infective lesions. Antibiotic choice is challenging due to multiple antibiotic resistant strains. We are reporting a case of cutaneous S. marcescens in a 70-year old lady with diabetes mellitus presented with non-healing ulcers over the dorsum of left hand for 6 months.
Serratia marcescens ; Dermatomycoses

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Symmetrical Flexural and Intertriginous Exanthema: A Rare Manifestation Associated with COVID-19 Infection

Jin Yi Goh ; Huang Hin Chin ; Pek Woon Chin ; Masliza Zaid

Malaysian Journal of Dermatology.2021;46(June 2021):55-57.

Summary Cutaneous manifestations of Coronavirus disease (COVID-19) are variable. We present a case of non-drug related symmetrical flexural and intertriginous exanthema in a patient with COVID-19 infection. A 58-year-old Chinese male who was diagnosed to have COVID-19 infection, developed maculopapular erythematous rashes at bilateral axillary and inguinal folds on the fourth day of illness. He was treated symptomatically with anti-histamine and topical corticosteroid. The skin condition improved and he was discharged well on tenth day of illness. Although symmetrical flexural intertriginous exanthema isclassically caused by drug reaction, this case demonstrated the possibility of the rash being directly associated with COVID-19 infection. More cohorts should be evaluated to fully describe the full spectrum of dermatological manifestation in COVID-19.
Exanthema ; COVID-19 ; Skin Manifestations

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