ABSTRACT
Intoduction:There are multiple treatment modalities for keloids but no single modality has been proven to be thegold standard. This study aims to compare the efficacy of intralesional triamcinolone acetonide (TAC)with silicone gel sheeting (SGS) in treating keloids and their effect on patients’ quality of life(QoL).Methods:This was a two-arm randomized-controlled trial involving 56 subjects in which intralesional TAC 20mg/mL after dilution with 2% lignocaine was administered on keloids monthly for patients in group1 while patients in group 2 applied SGS on keloids daily. Patients were treated for 12 weeks andfollowed-up for 16 weeks. Patient and Observer Scar Assessment Scale (POSAS) and DermatologyLife Quality Index (DLQI) were assessed to monitor treatment efficacy and patients’ QoL respectively.Results:There was 44.2% of improvement in the mean of total score of POSAS in group 1 as compared to11.6% in group 2 (p<0.001). Both groups showed significant improvement in vascularity, pigmentation,thickness and pliability but the improvement was more significant in group 1. Subjects in group 1demonstrated a 67.3% of DLQI score improvement as compared to 13.1% in group 2 (p<0.001). Sideeffects reported were pain during procedure in group 1 and pruritus in group 2.Conclusion:Intralesional TAC was superior than SGS in treating keloids as well as improving patients’ QoL andhence recommended as the first-line treatment. SGS can be considered as an alternative treatment forpatients who are intolerable to pain or as an adjunctive treatment.
ABSTRACT
Abstract Introduction: Due to the emergence of antibiotic resistance worldwide, the bacterial pathogens and susceptibility patterns causing skin infections should be monitored periodically to alert early intervention. This study aimed to analyse the bacterial profile and their antibiotic susceptibility patterns among the patients with cutaneous infections at Department of Dermatology, Hospital Kuala Lumpur (HKL). Methods: This retrospective analysis analysed the bacterial profile and the antibiotic susceptibility patterns of 1221 positive cultures obtained from skin swabs and biopsy specimens sent from the Department of Dermatology Hospital Kuala Lumpur (HKL) from 2013-2015. Results: Staphylococcus aureus (2/3 methicillin-sensitive, 1/3 methicillin-resistant) was the most frequent isolate (44%), followed by Pseudomonas aeruginosa (17.4%); Acinetobacter sp. (6.7%); Proteus sp. (6.1%); Klebsiella sp. (5.7%), Enterobacter sp. (3.0%), Escherichia coli (2.8%) and others. About 45% and 10% of MRSA was resistant to fucidic acid and mupirocin respectively. About 15% of Pseudomonas aeruginosa was resistant to ciprofloxacin. Majority of Acinetobacter sp. were resistant to most of the common antibiotics used. Conclusion: Staphylococcus aureus remained the main microorganisms isolated from patients with cutaneous bacterial infections. Empirical use of antibiotics prior to availability of culture sensitivity should be avoided for prevention of multi-resistant micro-organisms. We advocate judicious use of antibiotics based on results of the culture sensitivity and strict adherence to infection control measures to prevent development of antibiotic resistance.