Cutaneous sporotrichosis is a fungal infection caused by traumatic inoculation of Sporothrix. We aimed to study the clinical characteristics of human sporotrichosis, risk factors for infection, the yield of diagnostic methods and therapeutic response to standard clinical therapy. A cohort study of was performed. A total of 29 patients with clinical features suggestive of sporotrichosis were recruited within a one-year period from all public hospitals in Kedah, Malaysia. Majority were females (86%) who were housewives (69%). The most common comorbidities were diabetes mellitus (38%), hypertension (31%) and dyslipidaemia (21%), none was a significant risk factor for severity of infection. Mean duration of disease was 2±2 months. More than 2/3 of the patients (79%) had pet cats, 14(48%) recalled minor cat-inflicted trauma. Lymphocutaneous sporotrichosis (62%) was more common than fixed cutaneous type, affecting the upper limbs in 94%. Ulcerations and nodules were the main lesion morphology. Histopathology showed granulomatous inflammation in 72%, culture grew Sprorothrix in 55% and polymerase chain reaction (PCR) detected Sporothrix schenkii sensu stricto in 65%. Itraconazole was effective with 93% of patients achieving complete resolution with 4 months of therapy. Sporotrichosis in Malaysia remains endemic. Feline contact is the most important risk factor for infection. Diagnosis is best confirmed with tissue PCR while culture and histopathology are also useful. Sporothrix schenkii sensu stricto was the only species identified and itraconazole is an effective first line therapeutic agent.

SHORT-TERM EFFECT OF A MODERATE-POTENCY TOPICAL CORTICOSTEROID ON EPIDERMAL BIOPHYSICAL PARAMETERS IN PATIENTS WITH MILD-TO-MODERATE ATOPIC DERMATITIS: A RANDOMISED CONTROLLED STUDY Introduction: Skin barrier dysfunction is an important component of atopic dermatitis (AD) pathophysiology. Topical corticosteroids (TCSs) are the mainstay therapy, but steroid phobia is emerging due to potential side effects. We aimed to determine the short-term effect of clobetasone butyrate on patients with AD. Methods: This investigator-blinded, randomised, moisturiser-controlled study evaluated patients with stable mild-to-moderate AD. Clobetasone butyrate ointment plus aqueous cream (Aq) or Aq alone was applied on randomised sites twice daily for 6 weeks. The itch score, modified Eczema Area and Severity Index (M-EASI) and epidermal biophysical parameters were assessed at baseline and 1 h, 3 h, 2 weeks and 6 weeks after application. Results: Sixteen patients, among whom 14 (87.5%) were women and two (12.5%) were men, participated in the study. There were no significant differences in pH, transepidermal water loss (TEWL) and hydration between TCS + Aq and Aq from 1 h to 6 weeks. A non-significant trend of pH increment was observed with TCS + Aq from baseline to 6 weeks. TEWL and hydration improved at 6 weeks for both treatment arms. The difference in TEWL from baseline was significant with Aq (P=0.01). The M-EASI at 6 weeks was comparable between the two arms. TCS + Aq improved itch and erythema better than Aq (P=0.02). No cutaneous adverse effects were observed at both sites. Conclusion: Short-term application of clobetasone butyrate with Aq is safe with no significant changes in epidermal biophysical parameters while controlling the symptoms and signs of eczema faster than Aq alone.

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: Chronic urticaria is a spontaneous or idiopathic mast cell driven disease which affects patients’ well-being and quality of life. This study aimed to determine the prevalence of chronic spontaneous urticaria (CSU) in a public tertiary hospital, to determine patients’ quality of life (QoL) and factors associated with impaired QoL. Methods: A cross-sectional study was conducted at Dermatology Clinic, Hospital Putrajaya. Patients aged more than 18 years diagnosed with CSU were included. Patients with other chronic diseases that may affect QoL were excluded. Data was collected by face to face interview. QoL was assessed using Dermatology Quality of Life (DLQI) questionnaire. Urticaria severity was determined using Urticaria Activity Score (UAS-7). Results: A total of 88 patients aged 40±13.9 years participated with a male to female ratio of 1:3.4. Prevalence of CSU was 0.9%. Mean total DLQI score was 6.3±5.46, 27.3% of patients had no QOL effects, 18.2% had small effect, 36.4% moderate effect and 17% very large effect. Symptoms & feelings subdomain revealed the most severe impairment, followed by leisure and daily activities. Median UAS-7 was 6, 51.1% of patients had well-controlled disease. Higher disease activity was associated with a higher DLQI (p=0.02). Risk factors assessed did not show statistically significant effect on QoL. Conclusion CSU had moderate effect on the QoL of most patients. Symptoms and feelings, leisure and daily activities were predominantly affected. Disease activity was negatively associated with QoL impairment.

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: Cutaneous disorders are common clinical manifestations of the Human Immunodeficiency Virus (HIV). In the era of antiretroviral therapy (ART), the spectrum of cutaneous disorders in HIV-infected patients has changed. We assessed the types of dermatoses, including cutaneous infections in HIVpositive patients and the association between the peripheral CD4 cell count and the severity of skin infection. Methods: All HIV-positive patients referred to the Dermatology Department of Hospital Sungai Buloh from January 2021 – December 2021 were enrolled in a prospective cross-sectional study. Patients were subjected to a complete medical and physical examination and appropriate investigation to confirm the diagnosis. Results: A total of 112 (92.6%) male and 9 (7.4%) female patients with a mean age of 38.76 ± SD years participated. The majority of patients were Malay (56.2%), with MSM (54.5%) being the commonest mode of transmission. 65.2% of patients had CD4≥350 cells/ mm3 and 86.7% of patients were on ART. Infections (56.1%) were the most common group of mucocutaneous manifestations, with 45.6% of these due to viral infections. There was no statistically significant correlation between the CD4 count and the severity of skin involvement in bacterial (p=0.302), viral (p=0.145) and fungal (p=0.533) infections. Conclusion Viral infection were the commonest cutaneous manifestations in HIV- positive patients. The frequency and severity of the cutaneous infections were much more common in patients with more advanced immunosuppression.
HIV Infections ; Dermatomycoses

Summary Lichen striatus (LS) is a rare self-limiting inflammatory dermatosis characterized by Blaschkoid distribution. We report a 34-year-old woman with a 1-year history of asymptomatic unilateral rashes on her left trunk and limbs. Physical examination revealed light to dark brown papules, macules, patches and plaques with some erythematous areas in a Blaschkoid pattern with proven skin biopsy as well. Patient received potent topical corticosteroid therapy which resulted in the resolution of the lesion. This case report highlights two rare aspect of lichen striatus; involvement of multiple sites and late adult-onset. It is also a reminder that lichen striatus should be included in the differentials of acquired linear dermatoses.
Skin Diseases ; Adult

Abstract Atopic eczema (AE) is a complex, chronic and recurrent inflammatory pruritic skin condition that impacts the quality of life and exerts an economic toll on patients and their families. One of the factors contributing to AE is the immune dysregulation of the Janus kinase-signal transducers and activators of transcription (JAK-STAT) inflammatory pathway. This has prompted the conduct of various large clinical trial programs to evaluate the efficacy and safety of Janus kinase inhibitors (JAK-i) for AE. The overall and significant benefit of these drugs from clinical studies resulted in regulatory approvals for JAK-i to treat moderate-to-severe atopic eczema. The objective of this position paper was to evaluate the safety, efficacy and role of upadacitinib, baricitinib and abrocitinib in managing AE and update the current recommended treatment algorithm within the 2018 Malaysian Clinical Practice Guidelines for the Management of Atopic Eczema. The Persatuan Dermatologi Malaysia recommends that these JAK-i can be considered as an option for systemic therapy in severe AE.
Dermatitis, Atopic--therapy ; Janus Kinase Inhibitors

Background: Vitamin B12 is a contributing factor in pruritus and peripheral nerve regeneration. Its role in atopic dermatitis (AD) is still unclear. This study aimed to compare vitamin B12 level between AD patients and healthy controls, determine its correlation with pruritus and AD severity, and evaluate dietary pattern with energy, macro and micronutrient intakes. Methods: This was a case control study involving adult AD patients and age-, gender-, ethnicity- and body mass index-matched healthy controls. All adult patients who fulfilled UK Working Party AD diagnostic criteria were included. Exclusion criteria include patients on systemic agents, diseases known to affect B12 level and vegan diet. AD severity was determined using SCORing Atopic Dermatitis (SCORAD) index. Serum vitamin B12 level were measured. A three-day 24-hour dietary recall was collected and analyzed. Results: A total of 42 AD patients and 42 controls were recruited. Mean SCORAD index was 39.2±16.6, and AD duration was 12.7 ± 8.1 years. Vitamin B12 was lower among AD (215.6 ± 110.2 pmol/L) versus control (295.1± 119.9 pmol/L), p<0.01 despite similar dietary B12 intake in both groups. There were no significant correlations between AD duration and severity with vitamin B12 level. Energy intake (kcal/ day) was significantly lower in AD (p=0.04). There were no significant differences in proportion of main food groups consumed and other macronutrient and micronutrient intakes. Conclusion Serum vitamin B12 level was significantly lower in AD patients despite similar dietary pattern and nutrient intake with healthy controls. There were no correlations with AD severity or disease duration. Dietary pattern of AD patients should be routinely assessed to ensure adequate nutrition.
Dermatitis, Atopic--therapy ; Vitamin B12 ; Diet Therapy ; Adult

Carcinoma cuniculatum is a rare, slow growing tumour which is commonly mistaken for warts or corn especially when it presents on the sole. Although it rarely metastasizes, it may cause local invasion affecting the underlying tissue and bone. Early identification provides good prognosis as it can be managed with localized resection. We present a case of carcinoma cuniculatum which was misdiagnosed and treated as a common wart for two years until the diagnosis was confirmed by histopathology. By the time of diagnosis, the lesion had involved the underlying bone and patient required amputation. Carcinoma cuniculatum is rare and easily confused with common warts in the early stages hence, it is important to create awareness to identify and differentiate these two conditions.