A Retrospective Review Of Tinea Capitis Infection

Background: Tinea capitis (TC), a fungal infection of the scalp, hair follicles and hair shafts, is common among the paediatric population especially under tropical conditions1. The etiological factors vary between different regions of the world. Clinical presentation of tinea capitis varies widely from non-inflammatory to severe, painful inflammatory lesions. Aim: To look into the clinical manifestations, causative agents and the treatment pattern for tinea capitis in Penang Hospital. Methods: A retrospective study of all patients who were treated clinically for tinea capitis in Penang Hospital from January 2011 to June 2013. Results: There were a total of thirty nine patients treated for tinea capitis during this period. Tinea capitis was found to be most common in the 7-12 year age group (44%) with a male to female ratio of 2:1. Non-inflammatory type (54%) was more common then the inflammatory type. Twenty seven of them (69%) had positive fungal culture of their pluck hair roots. The most common dermatophyte detected was Microsporum canis (92%) followed by Trichophyton rubrum (4%) and Trichophyton metagraphyte (4%). Thirty-one (80%) of them were treated with griseofulvin at a dose of 10-15mg / kg /day. The rest were treated with itraconazole, terbinafine or fluconazole. All of them responded well to the treatment. In this cohort only one patient, has a second episode of infection a year later. He is a child who was concomitantly undergoing chemotherapy for acute lymphoblastic leukaemia. Conclusion: Tinea capitis is predominantly an infection of pre-adolescent children and M. canis was the most common dermatophyte isolated.

Adequacy of Care in patient with Psoriasis (ADECAP) Study

Introduction: Psoriasis is a chronic recurrent inflammatory skin disease and poses a lifelong burden. Psoriasis is now considered a systemic inflammatory disease. Increasing epidemiological studies have established the role of psoriasis as an independent risk factor in the development of metabolic syndrome and its components. This has led to changes in standard of care recommendations for patients with psoriasis. We conducted a clinical audit on “adequacy of care in patient with psoriasis”. Objective: To examine current trend of practice in the treatment of adults with psoriasis in Dermatology clinic (tertiary referral centre), Penang Hospital. This study also aims to determine the adequacy of care in psoriasis patients in general, and those on systemic agents in specific. Method: A retrospective study examined all adult psoriasis patients who visited Dermatology Clinic, Penang Hospital within 1st July - 31st July 2009. Only those who have been on follow-up for at least 1 year were included in the study. Demographic characteristics, disease burden and details of psoriasis management were documented and analysed. Standards were derived from recommendations of the British Association of Dermatologists (BAD) and American Academy of Dermatology (AAD). Results: Of the 112 patients, 67 were males (59.8%). The mean age of patients was 48.8 years. Fifty (44.6%) were Chinese, 35 Malay (31.3%), 26 Indians (23.2%) and 1 foreigner (0.9%). The mean frequency of clinic visit was 8.2. Forty-seven patients required systemic agents to achieve better disease control. Eighty-three (74.1%) patients were offered “Psoriasis Education Programme”. Percentage of patients who had their severity scoring done by using the DLQI, BSA & Pain score were 73.2%, 90.2% and 85.7% respectively. Only less than 50% of our patients were offered “Metabolic Syndrome Risk Factors Screening”. Of those on systemic agents, only 87.2% and 46.8% of patients, had their baseline and follow up blood investigations done respectively. Conclusion: The care of psoriasis patients in Dermatology Clinic, Penang Hospital is still not adequate. Particular areas of concern include blood monitoring for those on systemic agents and screening for metabolic syndrome risk factors. Remedial measures: Guidelines have been designed to create awareness and to educate doctors and patients on psoriasis and its association with metabolic syndrome. This includes a flow chart / tables to facilitate monitoring and screening of patients. Patients will be given pamphlets on the general knowledge on psoriasis, treatments and the risk of co-morbidities.

Churg Strauss Syndrome in a 40 year old woman

Cutaneous vasculitis is a common manifestation of many systemic diseases. In the setting of asthma, eosinophilia and multiple disparate signs and symptoms, more serious cause of vasculitis like Churg-Strauss syndrome (CSS) should always be considered.