Background: Psoriasis is a common dermatological condition affecting both adults and children. It causes significant physical and psychological burden on patients and adversely affect their quality of life. Aim: To evaluate the clinical characteristics of paediatric patients with psoriasis in Malaysia. Materials & Methods: Data were obtained from the Malaysian Psoriasis Registry (MPR). All paediatric patients aged <18 years notified to the registry from July 2007 to December 2012 were included in this study. Results: A total of 677 patients were notified from 18 participating centres. There was a slight female preponderance (ratio 1.3:1). Malay accounted for 70.6%, followed by Chinese (8.9%), Indian (12.3%) and others (8.1%). Mean age of onset was 9.8 ± 4.4 years. Positive family history was noted in 19.1%. Plaque psoriasis was the commonest type of psoriasis (79.6%), followed by guttate psoriasis (7.4%), pustular psoriasis (1.6%), erythrodermic (1.2%) and flexural psoriasis (1.2%). Psoriatic arthropathy was reported in only 2.2% of patients. Nail involvement is common, affecting 38.1%. Pitting was the commonest (89.9%). Topical treatment remains the most popular choice of treatment and was given in 95.1% of our patients. Topical steroid was the commonest prescribed (81.4%), followed by tar preparations (78.7%) and emollients (51.6%). Only 1.2% of our patients received phototherapy. Of the patients who had phototherapy, narrowband UVB (NBUVB) was the commonest used (87.5%). Systemic therapy was given in 5.3% of paediatric patients. The most frequently used systemic therapy was methotrexate (50%) and acitretin (27.8%). The mean CDLQI score for paediatric patients with psoriasis was 7.7 ± 5.5. Conclusion: Data from the Malaysian Psoriasis Registry highlights the clinical features of paediatric patients with psoriasis in Malaysia. We hope to get more participation from other centres in the future, especially from private sectors, so that our results can represent the Malaysian data more accurately.

Background Antibiotic therapy directed against Propionibacterium acnes (P. acnes) has been a mainstay of treatment in acne vulgaris for more than 40 years. Prolonged antibiotic usage has been associated with emergence of antibiotic-resistant P. acnes and is linked to treatment failure. Little work has been done in Malaysia on drug resistance in P. acnes and there is no surveillance data on this aspect to guide the clinical decision. Objective This study aims to evaluate antibiotic sensitivity of P. acnes isolated from patients with acne vulgaris in Kuala Lumpur Hospital, Malaysia. Methods This is a non interventional, single centered, cross-sectional hospital-based survey of antibiotic sensitivity of P. acnes isolated from patients with acne vulgaris in Kuala Lumpur Hospital from January 2010 to June 2010. Results A total of 100 patients were recruited in our study. P. acnes was isolated in 53% of patients and 11% had gram negative organism. Antibiotic resistant P. acnes was found in 15.1% of positive isolates. Clindamycin resistance was the highest (15.1%) followed by erythromycin (7.5%), doxycycline (5.7%), tetracycline (1.9%) and minocycline (0%). Isolates of antibiotic resistant P. acnes was significantly higher in patients treated with antibiotics within the last 6 months (29%) as compared with non antibiotic treated patients (0%) (p<0.05).The mean duration of prior antibiotic treatment was significantly longer in the group of antibiotic resistant P. acnes as compared with antibiotic sensitive P. acnes (17.13 weeks vs 5.74 weeks, p<0.05). Conclusion Antibiotic resistant P. acnes is present locally with clindamycin and erythromycin accounting for the highest resistance. Longer duration of antibiotic treatment predisposes to antibiotic resistant P. acnes and may also induce emergence of gram negative organisms. Strategies to reduce antibiotic resistance should be emphasized when prescribing antibiotic for acne vulgaris in order to achieve optimal therapeutic results while reducing the potential for antibiotic resistance.

Background: Individuals with AD have an increased susceptibility to colonization with Staphylococcus aureus (S. aureus), contributing to the exacerbation of the disease. Sodium hypochlorite (bleach) has both in vitro and in vivo antimicrobial activity against S.aureus. Objectives: To evaluate the efficacy and safety of diluted sodium hypochlorite (bleach) baths in patients with moderate to severe atopic dermatitis in our Malaysian population. Methods: This was a prospective randomized, investigator-blinded, placebo-controlled study. Patients were randomly assigned through computer generated simple randomized numbers to treatment (bleach baths) or placebo (distilled water baths). Patients were instructed to soak in the baths neck down for 10 minutes, twice a week for 2 months. The efficacy outcome measures were the Eczema Area and Severity Index (EASI) score, percentage body surface area involved, quantitative S. aureus counts and patient’s assessment of overall response (including itch scores). Safety outcomes were also assessed. Results: A total of 36 patients completed the study. EASI scores and body surface area showed significant improvement between treatment and placebo groups at 2 months (p=0.02, p=0.02). At baseline, 88% of patients yielded S. aureus from lesional skin. Although most cultures in the treatment group continued to yield S. aureus, there was a reduction in the density over time, although not statistically significant. Five patients reported burning/stinging and dry skin in the treatment arm which did not differ significantly compared to placebo. Conclusion: Diluted sodium hypochlorite baths as an adjunctive treatment decreased the clinical severity of patients with moderate to severe atopic dermatitis and may reduce S. aureus density. This treatment was well tolerated with minimal adverse effects.

Background Antibiotic therapy directed against Propionibacterium acnes has been a mainstay of treatment in acne vulgaris for more than 40 years. Prolonged antibiotic usage has been associated with emergence of antibiotic-resistant P. acnes and is linked to treatment failure. Little work has been done in Malaysia on drug resistance in P. acnes and there is no surveillance data on this aspect to guide the clinical decision. Objective This study aims to evaluate antibiotic sensitivity of P. acnes isolated from patients with acne vulgaris in Kuala Lumpur Hospital, Malaysia. Methods This is a non interventional, single centered, cross-sectional hospital-based survey of antibiotic sensitivity of P. acnes isolated from patients with acne vulgaris in Kuala Lumpur Hospital from January 2010 to June 2010. Results A total of 100 patients were recruited in our study. P. acnes was isolated in 53% of patients and 11% had gram negative organism. Antibiotic resistant P. acnes was found in 15.1% of positive isolates. Clindamycin resistance was most common (15.1%) followed by erythromycin (7.5%), doxycycline (5.7%), tetracycline (1.9%) and minocycline (0%). Isolates of antibiotic resistant P. acnes was significantly higher in patients treated with antibiotics within the last 6 months (29%) as compared with non antibiotic treated patients (0%) (p<0.05). The mean duration of prior antibiotic treatment was significantly longer in the group of antibiotic resistant P. acnes as compared with antibiotic sensitive P. acnes (17.13 weeks vs 5.74 weeks, p<0.05). Conclusion Antibiotic resistant P. acnes is present locally with clindamycin and erythromycin conferring the highest resistance. Longer duration of antibiotic treatment predisposes to antibiotic resistant P. acnes and may also induce emergence of gram negative organisms. Strategies to reduce antibiotic resistance should be emphasized when prescribing antibiotic for acne vulgaris in order to achieve optimal therapeutic results while reducing the potential for antibiotic resistance.

Background: Lipid lowering drugs (LLDs) are widely used. However, reports on its adverse cutaneous drug reactions (ACDRs) are scarce. Objectives: The study objective was to review the patterns of LLD induced ACDRs. Methods: We reviewed all LLDs induced ACDRs reported to MADRAC (Malaysian Adverse Drug Reaction Advisory Committee) from January 2005 till December 2009. Results: LLD induced ACDRs (124 patients) comprised of 2.07% of all ACDRs reported during the study period. Statins were responsible for most cases (81.5%), followed by fibrates (15.8%), selective cholesterol-absorption inhibitors (1.4%) and combination therapies (statin/selective cholesterol-absorption inhibitors and selective prostaglandin-2 receptor inhibitor/ niacin) in 1.4%. Majority were due to lovastatin (42.5%), simvastatin (28.1%) and gemfibrozil (8.9%). The three commonest ACDRs reported with statins usage were non-specific dermatitis (45.0%), pruritus/stinging (25.0%) and urticaria/angioedema (10.0%) while fibrates caused non-specific dermatitis (52.2%), urticaria/angioedema (13.0%) and photodermatitis (9.7%). There was no reported case of photodermatitis associated with statin usage. Interestingly, statins were the offending drugs resulting in all the five cases of vesiculobullous eruptions, two cases of Stevens-Johnson syndrome and one case of dermatomyositis. No mortalities were reported to be associated with LLD induced ACDRs. Conclusions: LLD induced ACDRs were not uncommon. Statins were the main putative drugs implicated in those reactions. Spectrum of ACDRs differed between statin and fibrate although non-specific dermatitis remained the main ACDRs in both classes. The unavailability of guided and classified ACDRs reporting accounted for the large number of non-specific dermatitis. Although most LLD induced ACDRs were mild, statins were reported to cause severe ACDRs.

Introduction: Cumulative Sum (CUSUM) technique is an objective statistical method used in assessing and monitoring doctor’s performance. It has been incorporated into quality improvement strategies in clinical services by the Ministry of Health, Malaysia. A pilot study was aimed at evaluating its usefulness in monitoring the performance of specialists in conducting skin biopsy. Methods: All skin biopsies performed by specialists in the Department of Dermatology, Kuala Lumpur Hospital from September 2009 to April 2011 were included in the prospective observational study. Outcomes monitored were wound complications within 14 days post-biopsy, and tissue sample being adequate and representative for histopathological interpretation. CUSUM scores of each consecutive biopsy performed by individual specialist were calculated and charted with the eCUSUM web application (https://app.acrm.org.my/eCUSUM). Results: A total of 870 skin biopsies were performed by 15 clinical specialists and three consultant dermatologists during the study period. Wound infection or dehiscence were reported in 13 (4.1%) of the 318 biopsy wounds evaluated. Tissue samples were inadequate in 10 (1.2%) and non-representative in 11 (1.3%) of the 817 histopathological reports evaluated. No learning curve was observed in all CUSUM charts indicating that all specialists had been adequately trained for the procedure. However, out-of-control signals indicating unacceptable wound complication rates and either inadequate or non-representative tissue samples were detected in three clinical specialists. Feedback and counseling were given while monitoring was continued. Conclusions: The CUSUM method is a useful performance monitoring tool which is able to promptly detect unacceptable outcomes in skin biopsy. It is invaluable in the supervision of junior doctors and trainees as well as self-monitoring for the trained specialists.

Background There is lack of data on the impact of acne vulgaris on the quality of life in Malaysia. Thus, this study was done to determine the impact of acne vulgaris on the quality of life in Sarawak, Malaysia and to examine its relationship with the severity of acne. Methods A cross-sectional study of 173 patients in 3 dermatology clinics in Sarawak utilizing the dermatology life quality index (DLQI). Results The mean DLQI score was 4.1. Patients with family income < RM 3000 had higher mean DLQI scores (4.8 vs. 3.2, p = 0.02). There was also a tendency for indigenous groups to have higher DLQI scores compared to Chinese although it was not statistically significant (4.5 vs. 3.5, p = 0.15). Females were significantly more impaired in the domains of symptoms and feelings (2.1 vs. 1.5, p = 0.02); and work and school (0.3 vs. 0.2, p = 0.04). DLQI was weakly correlated with acne severity in patients with mild acne (Pearson coefficient = 0.27, p = 0.01) but become insignificant for patients with moderate and severe acne. No correlation was seen between DLQI and age of patients. Conclusion Acne vulgaris has a quality of life impact similar to that of psoriasis in Sarawak and must be addressed. Health care providers and administrators should view acne as a psychologically disabling disease requiring optimal management and resource allocation. Education of junior doctors and medical student on this issue is also important.

Syphilis is an ancient sex u a l ly transmitted infection, described since centuries ago, caused by the bacterium Treponema pallidum. Syphilis or luetic disease is known as the great imitator as it can have myriads of clinical presentations, often making it a diagnostic challenge to clinicians. We report a patient with secondary syphilis, wh o presented with scaly plaques on his trunk and face, sparing the palms and soles.

Primary cutaneous anaplastic large cell lymphoma (c-ALCL) is an uncommon type of cutaneous T cell lymphoma currently classified as one of the CD30+ lymphoproliferative disorders of the skin under the WHO-EORTC classification1. We describe a series of three patients with c-ALCL from 2005-2009 in the Department of Dermatology, Hospital Kuala Lumpur.

Introduction: Skin is the second most commonly affected organ in SLE. Lupus-specific cutaneous LE(CLE) is classified according to Gilliam Classification into acute CLE (ACLE), subacute CLE(SCLE), chronic CLE(CCLE). CLASI (CLE Disease Activity and Severity Index) is an outcome measures to asses cutaneous activity Objectives: To study the correlation between cutaneous disease severity and severity of systemic disease using SLEDAI (SLE Disease Severity Index) and SLICC / ACR (Systemic Lupus International Collaborating Clinics) outcome measures. Methods: Study design: Cross-sectional A total of 71 patients were recruited from Dermatology and Rheumatology Clinic from Kuala Lumpur Hospital, Selayang Hospital and Pusat Perubatan UKM. Study period was from December 2009 to August 2010. Study data were obtained from clinical history, examination, investigations and medical record review. Results: The mean CLASI activity/damage scores in patients with ACLE, SCLE and CCLE were 11.8 / 8.1, 22.6 / 17.2 and 21.1 / 22.1 respectively. The mean SLEDAI/SLICC scores in similar group of patients were 12.3 / 2.1, 6.8 / 1.6, 13.2 / 1.7 respectively. The cutaneous disease activity in patients with SCLE was found to be inversely correlated to systemic disease activity. The cutaneous damage in patients with CCLE was positively correlated with systemic disease damage Conclusions: Patients with SCLE, despite having high cutaneous disease activity, had mild systemic disease. Patients with CCLE whom had high cutaneous damage scores were more likely to have higher systemic damage, hence more thorough investigations to seek other organs damage, should be offered.