A 10-years retrospective study on Severe Cutaneous Adverse Reactions (SCARs) in a tertiary hospital in Penang, Malaysia

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

From Red Herring to Malignancy

Angiosarcoma is a rare but aggressive malignant tumor of vascular endothelial cells accounting for1-2% of soft tissue sarcoma. Due to its rarity and heterogeneity in clinical presentation, delay indiagnosis and treatment is not uncommon. Hence, prognosis is usually guarded. Here we report acase of primary cutaneous angiosarcoma arising from the right cheek which progressed rapidly andresulted in perforation of buccal mucosa despite combination therapy of paclitaxel and propranolol.

Clinical profile, morbidity and outcome of adult patients with psoriasis at a district hospital in Northern Malaysia

SUMMARY Introduction: Psoriasis is a common, chronic, relapsing, immune-mediated inflammatory disease. Our objective is to review the clinical profile, co-morbidities, and outcome of patients with psoriasis. Methods: This is a cross-sectional study of outpatient psoriasis patients attending the dermatology clinic, Hospital Sultan Abdul Halim (HSAH) between January 2012 and June 2014. Data collection was based on Malaysian Psoriasis Registry. Results: Among 296 patients with psoriasis, Malays were the most common 175 (59.1%), followed by Indians 82 (27.7%), Chinese 37 (12.5%) and others 2 (0.6%). Male to female ratio was 1.2:1. More than half (54.7%) of the patients had early onset disease (age 40 or less). Only 26 patients (8.8%) have positive family history. The most common clinical presentation was chronic plaque psoriasis (89.9%), followed by erythrodermic psoriasis (4.7%), guttate psoriasis (3.0%) and pustular psoriasis (1.7%). Twenty eight percent had nail involvement while arthropathy was seen only in 14.7%. Common triggers were sunlight (46.0%), stress (31.1%), trauma (5.4%), food (4.0%), pregnancy (4.0%), and upper respiratory tract infections (2.7%). Co-morbidities observed include ischaemic heart disease (7.1%), hypertension (26.7%), dyslipidemia (17.6%), and diabetes mellitus (22.0%). All patients were on topical medications. About 6.8% of the patients were treated with phototherapy. One third of patients (35.5%) were given systemic therapy. Out of these, 84 patients (80.0%) were on methotrexate while only 16 (15.2%) on acitretin. None was on cyclosporine or biologic. In term of disease severity, 41.7% of patients had BSA >10% and 31.4% patients had DLQI > 10. Conclusion: Our patients show a similar clinical profile and outcome as our Malaysian psoriasis population. However they tend to have a more severe disease. There is a need for a more effective targeted therapy for a better outcome.