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: 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

Chlamydia trachomatis; sexually transmitted disease; prevalence;infection Introduction: Chlamydia trachomatis is one of the most common sexually transmitted diseases (STDs) globally. However, data on its prevalence and risk factors in Malaysia is still scarce. Objective: We aimed to identify the prevalence and risk factors of genitourinary C.trachomatis infection among patients attending STD clinics in northern Peninsular Malaysia. Methods: A hospital-based cross-sectional study was conducted in STD clinics of Hospital Pulau Pinang and Hospital Sultanah Bahiyah, Kedah from January to November 2014. Participants were individually interviewed using a structured data collection form followed by a physical examination and laboratory tests. Nucleic Acid Amplification Test (NAAT) was used to detect C.trachomatis infection. Analysis was carried out using SPSS Version 15. Results: Eighty-three sexually active patients were enrolled, consisting of 51 males and 32 females. The median age was 28.0 years. In general, 32.5% patients were asymptomatic, the remaining presented with genital discharge (41.0%), genital warty lesion (25.3%), genital ulcer (13.3%), dysuria (13.3%), dyspareunia (2.4%), urine hesistancy (1.2%) and genital swelling (1.2%). The prevalence of genitourinary C.trachomatis infection was 21.7% in the study population; 17.6% in males and 28.1% in females. Among the infected females, 44.4% were pregnant. Of those infected 56.6% did not show any symptoms of genital infection, and 77.8% were aged between 18 and 30 years, of which most were females. Among newly diagnosed HIV patients, the prevalence was 14.3%. From multivariable logistic regression analysis, age under 28 years, being married and engagement in oral sex had significantly increased odds of C.trachomatis infection. Conclusions: C.trachomatis infection was common among patients attending STD clinics in northern Penisular Malaysia especially in the younger age groups. Majority of the infected patients were asymptomatic.

Introduction: Atopic eczema (AE) is a common infammatory skin dermatosis that is increasing in prevalence. However, it can present in various clinical presentations, which leads to challenges in the diagnosis and treatment of the condition, especially in a primary care setting. Te Clinical Practice Guidelines on the Management of Atopic Eczema was developed by a multidisciplinary development group and approved by the Ministry of Health Malaysia in 2018. It covers the aspects of diagnosis, severity assessment, treatment, and referral.

The aim of this Biologic Advisory Group (BAG) Malaysia consensus guideline is to provide clinicians managing cutaneous diseases with biologics relevant parameters to consider prior to initiating or stopping or continuing any biologic treatment in the current landscape of the COVID-19 pandemic. Besides reviewing the medical literatures on COVID-19 and evidences related to other human coronavirus or influenza, expert opinions and clinical experiences are shared and debated in formulation of this biologic consensus guideline.

Objectives: High rates of syphilis have been reported worldwide among men who have sex with men (MSM). This study aims to describe the clinical pattern and treatment response of syphilis among human immunodeficiency virus (HIV)-infected MSM in Malaysia. Methods: This is a retrospective study on all HIV-infected MSM with syphilis between 2011 and 2015. Data was collected from case notes in five centres namely Hospital Kuala Lumpur, Hospital Sultanah Bahiyah, Hospital Umum Sarawak, University of Malaya Medical Centre and Hospital Sungai Buloh. Results: A total of 294 HIV seropositive MSM with the median age of 29 years (range 16-66) were confirmed to have syphilis. Nearly half (47.6%) were in the age group of 20-29 years. About a quarter (24.1%) was previously infected with syphilis. Eighty-three patients (28.2%) had other concomitant sexually transmitted infection with genital warts being the most frequently reported (17%). The number of patients with early and late syphilis in our cohort were almost equal. The median pre-treatment non-treponemal antibody titre (VDRL or RPR) for early syphilis (1:64) was significantly higher than for late syphilis (1:8) (p<0.0001). The median CD4 count and the number of patients with CD4 <200/μl in early syphilis were comparable to late syphilis. Nearly four-fifth (78.9%) received benzathine-penicillin only, 5.8% doxycycline, 1.4% Cpenicillin, 1% procaine penicillin, and 12.4% a combination of the above medications. About 44% received treatment and were lost to follow-up. Among those who completed 1 -year follow-up after treatment, 72.3% responded to treatment (serological non-reactive – 18.2%, four-fold drop in titre – 10.9%; serofast – 43.6%), 8.5% failed treatment and 17% had re-infection. Excluding those who were re-infected, lost to follow-up and died, the rates of treatment failure were 12.1% and 8.8% for early and late syphilis respectively (p=0.582) Conclusion: The most common stage of syphilis among MSM with HIV was latent syphilis. Overall, about 8.5% failed treatment at 1-year follow-up.

IntroductionManagement of leprosy in pregnancy is challenging. Here we aim to describe the clinical characteristicsand the management of leprosy in pregnancy.MethodsThis is a retrospective study on pregnant women with leprosy managed in the Department ofDermatology in Hospital Kuala Lumpur, Hospital Pulau Pinang, Hospital Sultanah Bahiyah andHospital Queen Elizabeth between 1994 and 2015.ResultsThere were ten patients with 12 pregnancies with a median age of 27.5 years (range: 16-33). Fivewere foreigners. There were four cases of lepromatous leprosy, two cases of borderline lepromatous,two cases borderline tuberculoid leprosy and one case each for tuberculoid and mid borderline leprosy.Seven pregnancies (58%) were documented to have reactions. Four reversal reactions (33%), threeerythema nodusom leprosum (25%) and two Lucio’s phenomenon (17%) were documented. Bothpatients with Lucio’s phenomenon had undiagnosed leprosy and presented with preterm labour,anemia, oligohydramnios and intrauterine growth restriction. Mortality was recorded in one patientdue to dapsone induced hypersensitivity syndrome complicated with septicaemia. All patients wereprescribed multidrug therapy but in three pregnancies, the patients chose to defer the treatment. Therewas a spontaneous miscarriage at second trimester and a case of early neonatal death. The neonatalcomplications recorded for the 10 live deliveries were low birth weight, jaundice and clofazimineinducedhyperpigmentation.ConclusionThe majority of our patients with leprosy had complications throughout the pregnancies. Earlydetection and prompt treatment can prevent unfavorable fetal outcome & threatened maternal health.

Introduction: Severe cutaneous adverse drug reactions(SCARs) are not uncommon and potentially lifethreatening.Our objective is to study the patientcharacteristics, the pattern of implicated drugs andtreatment outcome among patients with SCARs.Methods: A 10-year retrospective analysis of SCARscases in Penang General Hospital was carried out fromJanuary 2006 to December 2015. Data collection is basedon the Malaysian Adverse Drug Reactions AdvisoryCommittee registry and dermatology clinic records.Results: A total of 189 cases of SCARs were encountered(F:M ratio; 1.2:1.0; mean age of 45 year). The commonestmanifestation was Stevens-Johnson Syndrome [SJS](55.0%), followed by toxic epidermal necrolysis [TEN](23.8%), drug rash with eosinophilia and systemicsymptoms [DRESS] (12.7%), acute generalisedexanthematous pustulosis [AGEP] (4.8%), SJS/TENoverlap syndrome (2.6%) and generalised bullous fixeddrug eruptions [GBFDE] (1.1%). Mean time to onset forTEN/SJS/Overlap syndrome was 10.5±13 days; AGEP,three days; GBFDE, 2.5±0.7 days, and DRESS, 29.4±5.7days. The most common drugs implicated wereantibiotics (33.3%), followed by allopurinol (18.9%) andanticonvulsant (18.4%). Out of 154 cases ofSJS/TEN/overlap syndrome, allopurinol was thecommonest causative agents (20.1%). In DRESS,allopurinol accounts for 45.8% of the cases. The mortalityrate in SJS, TEN and DRESS were 1.9%, 13.3% and 12.5%respectively. No mortality was observed in AGEP andGBFDE.Conclusion: The commonest manifestations of SCARs inour setting were SJS, TEN and DRESS. Allopurinol wasthe most common culprit. Thus, judicious allopurinol useis advocated and pre-emptive genetic screening for HLAB*5801 should be consider

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.

Acrodermatitis enteropathica (AE) is a rare genetic autosomal recessive disorder characterised byperiorificial inflammatory rash, diarrhoea and hair loss. Hereby, we report 3 cases of acrodermatitisenteropathica.