ABSTRACT
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.
ABSTRACT
Objective The purpose of this study is to determine the outcome of patients with acne vulgaris treated with oral isotretinoin from January 2003 till January 2008. Methodology This is a 5-year retrospective study of patients with acne vulgaris who were started on oral isotretinoin from January 2003 to January 2008. Only patients who have completed at least 4 months of treatment were included. Case notes were retrieved and analyzed with regards to demographic data, total cumulative dose of oral isotretinoin, duration of treatment, average daily dose of isotretinoin, response, relapse and subsequent treatment. Patients who defaulted follow-up were contacted via phone to ascertain if they had any relapse. Laboratory data that were analyzed included serial liver enzymes, total cholesterol, triglyceride and LDL levels. Results A total of 110 case notes were reviewed but only 83 patients fulfilled the inclusion and exclusion criteria. Average daily dose of isotretinoin was 0.24 mg /kg/day and mean duration of treatment was 9.56 months. Mean total accumulated dose of isotretinoin was 61.96 ± 34.15 mg/kg (range from 11.18 mg/kg to 151.79mg/kg). There were only 6 (7.2%) patients who achieved total accumulated dose of more than 120mg/kg/day. All of our patients responded to treatment with 24 (28.9%) of them were in complete clearance. However, a high percentage (71.2%) of patients developed mucocutaneous side-effects out of which 27.7% required dose reduction. Relapse rate among those who completed treatment and follow up or contactable for at least 6 months post treatment was 24.2% (8 out of 33 patients). There were only 3 (3.6%) patients who developed raised transaminases during treatment but all were less than twice the upper normal limit. Mean total cholesterol, triglyceride and LDL level were significantly raised at 4 months of treatment when compared to the baseline (p<0.05). Conclusion Low dose Isotretinoin (<0.5mg/kg) is an effective treatment for moderate to severe acne vulgaris in our population. All of our patients showed good response to isotretinoin even though some of them relapsed subsequently. Intolerability as a result of mucocutaneous side-effects seems to be a challenging issue when starting isotretinoin in our population.
ABSTRACT
Cutaneous B-cell pseudolymphoma (CBPL) is a reactive B-cell hyperplasia that clinically and histologically mimics cutaneous B-cell lymphoma (CBCL). Many different terms have been used to describe this condition such as lymphocytoma cutis and cutaneous lymphoid hyperplasia. This condition typically present as a solitary nodule or papule over face (cheek, nose and ear lobe), chest and upper extremities, but multiple lesions may also be present. A variety of stimuli are known to induce this condition but most cases have an unknown cause. We report 2 cases of CBPL, the causes of which could not be ascertained.
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Herpes simplex virus (HSV) infection is one of the common opportunistic viral infections that may occur in human immunodeficiency virus (HIV) - infected patients. The natural history of HSV infection is often altered in this group of patients. Characteristically, genital herpes presents with multiple painful vesicles and erosions in immunocompetent patients. However, clinical presentations in immunocompromised patients are frequently severe and atypical which may lead to a delay in diagnosis and treatment. Genital herpes enhances transmission of HIV infection and hence early detection of this condition is important to reduce transmission of HIV and HSV.
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Background Atopic eczema is a common dermatological condition seen in our practice in which the mainstay of treatment is topical medications. One of the main reasons for poor clinical response to therapy in atopic eczema is the lack of understanding of topical preparation usage and thus poor adherence to treatment. Objectives The aim of this study is to determine the effect of explanation and demonstration of topical medication on the clinical response of atopic eczema. Methodology Twenty newly diagnosed patients with atopic eczema who fulfilled the study criteria were recruited and randomized consecutively into 2 groups - A & B. All patients were assessed on the severity of the eczema using the six area, six sign atopic dermatitis severity score (SASSAD) and patients’ assessment of itch, sleep disturbance and irritability were recorded on 10-cm visual analogue scales. They were also assessed on their level of understanding on the proper usage of topical medications using a questionnaire. Group A then received explanation and demonstration on how to apply the topical medications while Group B was not educated on these. They were followed up 2 weeks after treatment and were re-evaluated on their understanding and the severity of their skin condition. This was followed by education by a dermatology nurse on the proper usage of topical medications for both groups. A third evaluation was done 2 weeks later. Results At baseline, 70% of the patients did not understand the potency of topical corticosteroid and between 20-30% of them did not know the correct sites, frequency, time and duration of each topical application prescribed. About two thirds of the patients claimed that they did not receive any explanation or demonstration from either their doctors or the pharmacy dispensers. After education on the proper usage of topical medications, the level of understanding improved to 100% for group A at visit 2 and group B at visit 3. A clinical improvement as measured by SASSAD score reduction was seen in both groups. In group A, a significant SASSAD score reduction of 49.5% (P=0.003) was seen after 2 weeks and it was sustainable, as evidenced by a further reduction to 67% (p=0.001) by week 4. In group B, a significant SASSAD score reduction (64.8%; p=0.002) was seen only at week 4 after patient education and demonstration. The magnitude of improvement in patients’ symptoms which included itch, sleep disturbance and irritability, measured by the patient using visual analog score, were only significant for group A after 4 weeks. Conclusions This study reinforces the importance of explanation and demonstration on the proper usage of topical medications in achieving better clinical response. Failure to explain on the use of topical medications may lead to patient dissatisfaction, poor compliance and lack of treatment efficacy.
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Background Autoimmune bullous diseases (ABD) represent a group of chronic blistering dermatoses in which management is often challenging. Epidemiologic data on these diseases in Malaysia has been limited. Objectives Our purpose was to study the spectrum of the various ABD presented to the Department of Dermatology, Ipoh Hospital, and to determine the clinico-epidemiological pattern of the 2 main ABD, namely pemphigus and bullous pemphigoid. Methodology We performed a retrospective review of records for all patients who were diagnosed with ABD confirmed by histopathology and direct immunofluorescence test in this centre between 2001 and 2005. The data were analyzed with regard to age, sex, ethnicity, subtypes of ABD, treatment provided and outcome. Results There were a total of 79 cases of ABD presented to us during this period. Bullous pemphigoid was observed to be the commonest (60.8%) followed by the pemphigus group (36.7%) with the mean incidence of 0.45/100,000/year and 0.28/100,000/year respectively.44% of patients were of ethnic Chinese origin. There was an overall female preponderance. The mean age of presentation was 65.5 years for bullous pemphigoid and 55 years for pemphigus group. The mean duration of disease before presentation was 1.6 months for bullous pemphigoid and 6.3 months for pemphigus. Various combinations of immunosuppressive agents were used to treat the patients. 48% of bullous pemphigoid cases were controlled with prednisolone alone while 67.9% of pemphigus group required at least 2 immunosuppressive agents to achieve disease control. Conclusion In our study population, bullous pemphigoid was more frequently seen than pemphigus.