Introduction: Acne is the most common skin disease among adolescents and has significant psychological distress. Our objective is to assess acne severity, functional disability, and its psychological distress among acne patients. Methods: A cross-sectional study was conducted from November 2021 to May 2022 among 163 acne patients attending Dermatology Clinics in the district of Kuantan, Pahang. The severity of acne was graded using the Comprehensive Acne Severity Scale (CASS). The functional disability index was measured using a Cardiff Acne Disability Index (CADI), while Depression, Anxiety and Stress Scale (DASS-21) questionnaires were used as a screening tool to detect the psychological distress of acne. Data were analysed using a Chi-square test, Fisher’s exact test and multiple logistic regression. Results: The mean age was 23 years, 60.1% were female, 94.5% were Malay, and 68.1% were unemployed. The severity of acne was more prominent in the mild (30.7%) and moderate (28.2%) categories. A total of 20.2%, 11.7%, and 4.9% of the respondents had anxiety, depression, and stress symptoms, respectively. Regarding the respondents’ functional disability, 40.5% had mild impairment, 38.0% had moderate impairment, and 13.5% had severe impairment. Acne severity was found to be significantly associated with the functional disability index (P<0.05). The functional disability index was also found to be significantly associated with depression (p=0.019) and anxiety symptoms (p=0.042). Conclusion: Clinical management of acne patients should include not only pharmacological treatment but also consideration of the disease’s functional disability status and psychological distress.

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: 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: Psoriasis vulgaris is a chronic immune-mediated inflammatory multi-system disease characterised by keratinocyte hyperproliferation. Data regarding patients’ disease severity, knowledge and quality of life (QOL) is important to optimize treatment strategies for psoriasis. This study aims to evaluate and investigate the relationship between disease severity, knowledge and QOL of patients with psoriasis. Methods: A cross-sectional multicentre study utilizing a socio-demographic data collection form, Psoriasis Knowledge Assessment Questionnaire (PKAQ), Dermatology Life Quality Index (DLQI) and Psoriasis Area and Severity Index (PASI was conducted. Correlations between PKAQ, DLQI and PASI were analysed using Spearman’s test. Results: A total of 114 subjects participated in this study. Majority of them had mild psoriasis (n=73, 64%) based on PASI. The mean score of PKAQ was fourteen out of a total possible score of twenty-five, whereas the DLQI had a non-parametric distribution with a median (interquartile range) of 7 (10). Most subjects (32.5%) stated that psoriasis had a ‘moderate effect’ on their QOL, while only 3.5% said that it had an ‘extremely large effect’ on their QOL. There was a statistically significant correlation between PASI and DLQI (rs = 0.264, p = 0.004), with higher PASI scores corresponding to higher DLQI scores. No statistically significant correlation was found between DLQI and PKAQ (rs = -0.048, p= 0.612), and between PASI and PKAQ (rs = 0.058, p= 0.542). Conclusion Impairment of QOL was positively associated with severity of psoriasis. However, there was no significant relationship between knowledge and quality of life, as well as between knowledge and psoriasis severity.
Psoriasis--diagnosis ; Patient Acuity ; Quality of Life--psychology ; Patient Health Questionnaire

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

Summary Pemphigus refers to a group of life-threatening, autoimmune blistering disease that presents as blisters and erosions involving the skin and mucosa. Systemic corticosteroids and rituximab have been recommended as mainstay therapy for pemphigus vulgaris and pemphigus foliaceus. Herein, we report three cases of pemphigus vulgaris and a case of pemphigus foliaceus treated with rituximab as first-line therapy.
Rituximab ; Pemphigus

Summary Phaeohyphomycosis refers to a heterogenous group of mycotic infections caused by dematiaceous fungi where unintentional traumatic inoculation accounts for majority of the cases. Herein, we are reporting a rare case of iatrogenic subcutaneous phaeohyphomycosis which is secondary to intravenous cannula placement.
Phaeohyphomycosis ; Iatrogenic Disease

Summary We describe nine cases of anti-tuberculosis DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome, a potentially serious complication of treatment that led to interruption of treatment, systemic corticosteroid usage and the resumption of treatment with different regimens. All patients had skin rash, six out of nine patients with hepatitis, two out of nine patients had acute kidney injury, five out of nine patients died. All-cause mortality is high in our cohort.
Drug Hypersensitivity Syndrome

Dapsone is part of the multi-drug therapy used in the treatment of leprosy. It can cause life-threateninghypersensitivity syndromes resulting in significant morbidity and mortality, especially amongsusceptible individuals such as those who are carriers of HLA-B*13:01 allele. Avoidance of dapsonein these susceptible individuals reduces the risk of dapsone-related adverse events. Herein, we reportfour indigenous patients with leprosy who developed dapsone hypersensitivity syndrome.