ABSTRACT
Introduction: Our country is fast becoming a developed country with improved life expectancy. The healthcare system should be prepared to manage medical conditions which are prevalent in the older age group. Skin diseases are commonly observed in the geriatric population. We seek to characterize the dermatological conditions affecting patients at the extremes of age. Methods: To determine the types of dermatological diseases affecting patients over 80 years of age, and to determine their clinical characteristics and comorbidities. Objectives: Subjects with photodamage were older, and had lower education and employment rates compared to subjects without photodamage. There was no significant difference in knowledge on the harmful effects of sun exposure and on sun protection or in sun avoidance behaviour (other than use of protective sunglasses) between the two groups, though more patients with photodamage felt that they take adequate sun protection measures. Of note, only a low percentage of subjects in both groups (24.5% of subjects with photodamage and 23.1% of subjects without photodamage) practise regular use of sunscreen. Methods: This was a retrospective study conducted at the Dermatology Unit, University Kebangsaan Malaysia Medical Center (UKMMC). All patients aged ≥80 years who attended the Dermatology Clinic UKMMC in 2015 were identified from the clinic database. Their clinical notes were reviewed. Demography, clinical characteristics and dermatological diagnosis were recorded and analyzed using SPSS Version 22. Results: One hundred and three octogenarians were included in the study. Fifty one (49.5%) were females, and 52 (50.5%) were males. The age ranged from 80 to 89 years. The majority were Chinese, 76 (73.8%), 16 (15.5%) were Malays, 6 (5.8%) were Indians and remaining 5 (4.9%) were of other ethnicities. The most commonly seen diseases were endogenous eczema 46 (44.7%), cutaneous malignancy 10 (9.7%), psoriasis 8 (7.8%), bullous pemphigoid 7 (6.8%) and fungal infection 6 (5.8%). More than half of patients [25 (24.3%)] with endogenous eczema had unclassified eczema. Other conditions were seborrheic keratosis 5 (4.9%), adverse drug eruption 5 (4.9%), viral infections 4 (3.9%) and lichen amyloidosis 3 (2.9%). Comorbidities of the patients were 48 (46.6%) hypertension, 29 (28.2%) diabetes, 25 (24.3%) atherosclerosis related disease, 22 (21.4%) dyslipidemia, 9 (8.7%) chronic lung disease and 9 (8.7%) non-skin malignancy.Conclusions: Eczema is very common in elderly patients. In the majority of patients the clinical features of eczema are often not typical of endogenous eczema subtypes. We propose the term senectus eczema as a diagnosis, however its clinical characteristics has yet to be clearly delineated. Skin cancers, psoriasis, bullous pemphigoid, fungal infections, drug eruption and viral infection are other conditions which should not be missed in assessing these patients.
ABSTRACT
Background: The association between chronic hepatitis C infection with lichen planus (LP) remains controversial. Geographical and immunogenetic factors may play a role in this association. Objectives: We sought to compare the prevalence of hepatitis C in patients with LP with healthy blood donors at our centre. Materials & Methods: We conducted a retrospective study in Hospital Kuala Lumpur, Malaysia. All patients with biopsy- proven LP who had undergone hepatitis C serology screening from January 2007 to June 2012 were recruited. The prevalence of Hepatitis C seropositivity among healthy blood donors in Malaysia was used as comparison. Results: Thirty five patients with LP were included in the study. Majority of the patients were Indians (71.4%) followed by Malays (14.3%), Chinese (8.6%) and other ethnicity (5.7%). 82.6% of patients had classical cutaneous LP out of which 17% had oral involvement. Anti-HCV was reactive in 2.9% patients. Among the healthy blood donors, anti-HCV was positive in 1.5% of patients. There was no significant difference between the prevalence of hepatitis C seropositivity between the two groups (p=0.431). Conclusion: There is no significant association between chronic hepatitis C infection and LP among our patients. We recommend screening for hepatitis C in LP patients should be limited to those with risk factors.
ABSTRACT
Background Leprosy is often complicated by deformities, disabilities and intermittent hypersensitivity reactions. In the course of management, the physical impact of this disease is often assessed thoroughly but its psychological impact and quality of life is often left unaddressed. Objective To assess the effect of leprosy on the quality of life (QOL) among our patients. Methods This cross sectional study was conducted on patients diagnosed with leprosy in Kuala Lumpur Hospital. The patients were interviewed using World Health Organization Quality of Life Assessment - abbreviated version (WHOQOL-BREF) questionnaire which consists of 26 questions exploring four domains: physical, psychological, social relationships and environmental. Patient’s perception towards diagnosis was also assessed. Results Out of the 26 respondents, 19 (73.1%) were males and 7 females with the mean age of 41 years. 84.6% were of Malay descent and 14 (53.8%) patients were foreigners. Twenty three patients (88.5%) were diagnosed multibacillary and 3 (11.5%) had paucibacillary leprosy. Mean QOL scores by domains were: physical 13.0, psychological 12.5, social relationships 13.4 and environmental 14.2. The mean total QOL score among males were 52.9 and 54 for females but the difference was not statistically significant. Fear was the commonest reaction to initial diagnosis. Conclusion Quality of life is reduced among our patients with leprosy. Early detection and treatment can prevent deformities and disabilities but the importance of incorporating counselling and patient education in overall management cannot be overemphasized.