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The Utilization of Cutaneous Laser Therapy at the Department of Dermatology, Hospital Kuala Lumpur: A 5-year review

Suganthy ROBINSON ; Min Moon TANG ; Noor Zalmy AZIZAN

Malaysian Journal of Dermatology.2017;39(Dec):37-45.

Introduction:The Department of Dermatology, Hospital Kuala Lumpur has been providing cutaneous laser therapyservices for over 20 years. We aim to describe the utilization of cutaneous laser therapy at the Departmentof Dermatology, Hospital Kuala Lumpur and the post treatment complications.Methods:We reviewed all patients who received cutaneous laser therapy at the Department of Dermatology, HospitalKuala Lumpur from January 2012 till December 2016. Complications were defined as dyspigmentation,infection, scarring, blisters, ulcerations, skin textural changes or contact dermatitis secondary to post/ pre-lasertopical therapy.Results:A total of 1190 patients with a male to female ratio of 1:2.21 and a mean age of 35.8 years received single,repeated or combination cutaneous laser therapy from 2012 till 2016 for 48 different skin conditions. Annually,an average of 1314 laser sessions were performed. Indications included seborrhoeic keratosis (249, 20.9%),port wine stain (162, 13.6%), solar lentigines (144, 12.1%), syringoma (105, 8.8%), viral warts (88, 7.4%),and Naevus of Ota (82, 6.9%) among others. Majority underwent Q-switched Nd:YAG laser (36.5%) followedby pulsed dye laser (33.6%), ablative conventional carbon dioxide laser (29.2%) and fractional carbon dioxidelaser (0.7%). Over the past 5 years, 3 patients developed severe complication post laser therapy which wasblisters. Pain was tolerable with application of topical 5% EMLA? (lidocaine 2.5% and prilocaine 2.5%) creampre-laser treatment.Conclusion:Q-switched Nd:YAG laser therapy was the most frequently employed laser in the Department ofDermatology, Hospital Kuala Lumpur. Our centre has a high volume of cases with a low rate of posttreatment complication.

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Generalized Pustular Psoriasis

Siew Eng CHOON

Malaysian Journal of Dermatology.2017;39(Dec):2-9.

Generalized Pustular Psoriasis (GPP) is a dermatological emergency that often requires hospitalizationbecause of possible life-threatening complications, including heart failure, renal failure and sepsis. Itis a chronic recalcitrant disease in which acute pustular flares frequently recur on exposure to classictriggers. This review article is aimed to update the new insights into the genetic basis of GPP andhighlighted the central role IL1 and IL36 in the pathogenesis of GPP.

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Contact Allergic Dermatitis to Cosmetics and Topical Anti-ageing Products

Rohna RIDZWAN ; Badrul Hisyam ZAINUDIN

Malaysian Journal of Dermatology.2017;39(Dec):10-21.

The main objective of this review article is to provide an update of the literature concerning delayedtypereactions or contact allergic dermatitis caused by cosmetic and anti-ageing ingredients. We scanfor tips on how to recognize these reactions from the history and clinical signs. The common allergensreported include fragrances and preservatives. Be aware of the new allergens. There is a need to patchtest with some of the heavy metals because of their presence in cosmetics but besides nickel, cobaltand occasional mercury, heavy metals do not frequently cause allergic contact dermatitis. They aredangerous because of their systemic toxicity on other internal organs. It is important to recognizethe source of the contact allergens that have been documented in various continents. Reports fromAsian countries (India, China, Korea, Singapore, Malaysia and Japan) have been included to increasethe awareness of cosmetic induced contact allergic dermatitis in this region. This knowledge uponreflections may assist us in our own daily practice.

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Vascular Anomalies: A 3-Year Review in the Paediatric Institute Hospital Kuala Lumpur Between 2013 And 2015

Fei Yin NG ; Min Moon TANG ; Sabeera BEGUM ; Kin Fon LEONG

Malaysian Journal of Dermatology.2017;39(Dec):22-30.

Introduction:Vascular anomalies, regardless of tumour or malformation, may result in significant morbidity. Thediagnosis of vascular anomalies in the paediatric group is always challenging. We aim to describe thepattern of vascular anomalies referred to the Paediatric Institute Kuala Lumpur Hospital (PIKLH).Methods:This is a 3-year retrospective review on vascular anomalies among children referred to PIKLH between2013 and 2015.Results:There were 289 children; male to female ratio of 1:2.1; aged from birth to 14 years with median age of5 months recruited. The referring diagnoses included haemangioma (71.3%), capillary malformation(13.8%), lymphatic malformation (1.7%), kaposiform hemangioendothelioma (1.0%) and others. Ahundred and sixty-one (55.7%) had lesions located at the head and neck region, followed by trunk(14.2%), lower limbs (9.3%), upper limbs (7.6%), perineum (3.8%) and multiple sites (6.9%). In 197patients (68.2%), there were no further investigations performed, 13.5% had ultrasonography, 7.3%had MRI, 4.8% had both ultrasonography and MRI; 4.1% had skin biopsy, 0.3% had angiogram.The final diagnoses were haemangioma (72.3%) of which 10 were ulcerated; capillary malformations(17.6%), combined vascular malformations (2.4%), kaposiform hemangioendothelioma (2.8%),lymphatic malformations (2.1%); venous malformations (1.4%); tufted angioma (1.0%) andarteriovenous malformations (0.3%). One hundred and nine patients (37.7%) received beta-blockers;71(24.6%) underwent laser, 16(5.5%) received sirolimus, 9(3.1%) received systemic corticosteroidswith vincristine, 4(1.4%) had systemic corticosteroids, 3(1.0%) had excision and 2(0.7%) hadsclerotherapy. The remaining patients were put under observation.Conclusion:Three-quarters of the vascular anomalies referred were hemangioma followed by vascularmalformations. Vascular anomalies have a large variation in clinical presentation. Expertise inthe diagnosis and management modalities are essential to achieve optimum outcomes. Thereforevascular anomalies are best managed in a multidisciplinary setting.

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Prevalence of Co-infection with Gonorrhoea and Non-Gonococcal Urethritis in Males with Urethral Discharge Genitourinary Clinic, Hospital Kuala Lumpur: A 5-year study between 2011 – 2015

Vijayaletchumi KRISHNASAMY ; Asmah JOHAR

Malaysian Journal of Dermatology.2017;39(Dec):31-36.

Introduction:Dual infection with Neisseria gonorrhoeae and Chlamydia sp has been reported in several studies worldwidein men presenting with urethral discharge. The rate of co-infection has been reported to be between 1.5 to 51%.This study aims to determine the demographic characteristics and sexual behaviour of men diagnosed to haveurethritis.Methods:This is a retrospective study on all men who presented with urethral discharge and diagnosed to havegonococcal (GU) and non-gonococcal urethritis (NGU) for the year 2011 to 2015 in Genito-UrinaryMedicine Clinic (GUM), Hospital Kuala Lumpur. The case notes were retrieved and reviewed.Results:There were a total of 307 men who attended the GUM clinic with urethral discharge. The mean ageof patients was 26.4 years (range 16-57 years). Majority (64.5%) were in the age group between 20-29 years. Around 95% were Malaysians and of these about 80% were Malays. Thirty-seven patients(12%) completed their tertiary education. There were 24 patients (8%) documented to have substanceabuse. Majority (78%) were heterosexual. About 36% of patients had 2 or more partners (range 2-10)6 months before the symptoms developed. The most common cause of urethritis was gonococcalurethritis (66.4%), followed by NGU (24.4%). Among the NGU, nine were detected to have Chlamydiasp infection (12%). Co-infection with Neisseria gonorrhoea and Chlamydia sp were detected in 28men (9.1%). Seven (2.3%) were HIV seropositive.Conclusion:Majority of males diagnosed with gonorrhoea were heterosexuals acquired mainly via casual partners.About 10% had co-infection with Neisseria gonorrhoeae and Chlamydia sp.

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Gardner – Diamond Syndrome

Ellie CHOI ; Sam YANG ; See Ket NG

Malaysian Journal of Dermatology.2017;39(Dec):46-48.

Gardner–Diamond syndrome (GDS), or autoerythrocyte sensitisation, is a rare cause of recurrentpainful bruising with a typical anamnesis and prodrome. We describe a patient with GDS and discussthe literature surrounding this unique condition.

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Dialysis-associated Pseudoporphyria: An Often Overlooked Cause

Rajalingam RAMALINGAM

Malaysian Journal of Dermatology.2017;39(Dec):49-52.

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.

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Angiosarcoma Mimicking Rhinophymatous Rosacea

Raja Siti Aishah Bt Raja Mohd Radzi ; Kwee Eng TEY ; Siew Eng CHOON ; Meng Yen LEE

Malaysian Journal of Dermatology.2017;39(Dec):53-55.

Cutaneous angiosarcoma is a rare, highly malignant vascular tumor. More than 50% of them arelocalized to the skin of the head and neck regions.It usually present as nodules with ulceration, plaques,or bruise-like lesions. However, the clinical features may vary. We reported this case due to its atypicalclinical presentation, which presented with rhinophyma-like features, making it a diagnostic challengeto the clinicians.

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Atypical Presentation of Cutaneous Larva Migrans: A Case Report & Literature Review

Kean Pan ONG ; Wooi Chiang TAN ; Yew Thong CHONG ; Yek Huan KHOR ; Lee Chin CHAN

Malaysian Journal of Dermatology.2017;39(Dec):56-58.

Cutaneous larva migrans, also known as “migrant linear epidermitis”, “beach worm”, “migranthelminthiasis”, “dermatitis serpiginosus” or “creeping eruption”. It is a zoonosis which caused byaccidental percutaneous inoculation of helminth larvae, usually parasites of the small intestines of catsand dogs. It typically presents as an itchy, erythematous, serpiginous, cutaneous eruption. We describea case of disseminated and extensive infection of cutaneous larva migrans in a 21-year-old traveler,leading a delay in diagnosis and treatment.

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The Immunocompromised Patient with Perianal Lesions

Angelina Siing Ngi Tang ; Kar Keong NEOH ; Joshua Mohanraj DANIEL ; Pubalan MUNIANDY

Malaysian Journal of Dermatology.2017;39(Dec):59-64.

Genital Herpes Simplex Virus (HSV) is a major global public health issue where the number of patientsincreases every year. It has a variety of clinical presentations, and a tendency to recur when the immunesystem is compromised. Patients with human immunodeficiency virus (HIV) have a higher chance ofbeing infected with HSV possibly due to their high risk attributes. We reported a case of a 19-yearoldhomosexual male who was recently diagnosed with HIV and presented with perianal lesions for aduration of three months. This case is presented with the aim to highlight the differential diagnosis ofrash in immunocompromised patients and how to approach them.

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