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@#Allergic contact dermatitis affects 15 to 20% of the population. The pattern of contact allergy varies across nations. Therefore, many countries utilize their unique individual baseline series for patch testing. In this study, we aimed to assess the outcome of rubber and fragrance allergy detection with the addition of 1,3-Diphenylguanidine. N-Cyclohexyl-N-Phenyl-4-Phenylenediamine, N-Cyclohexylthiophthalimide and Ylang ylang oil.
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@#Objectives: High rates of syphilis have been reported worldwide among men who have sex with men (MSM). This study aims to describe the clinical pattern and treatment response of syphilis among human immunodeficiency virus (HIV)-infected MSM in Malaysia. Methods: This is a retrospective study on all HIV-infected MSM with syphilis between 2011 and 2015. Data was collected from case notes in five centres namely Hospital Kuala Lumpur, Hospital Sultanah Bahiyah, Hospital Umum Sarawak, University of Malaya Medical Centre and Hospital Sungai Buloh. Results: A total of 294 HIV seropositive MSM with the median age of 29 years (range 16-66) were confirmed to have syphilis. Nearly half (47.6%) were in the age group of 20-29 years. About a quarter (24.1%) was previously infected with syphilis. Eighty-three patients (28.2%) had other concomitant sexually transmitted infection with genital warts being the most frequently reported (17%). The number of patients with early and late syphilis in our cohort were almost equal. The median pre-treatment non-treponemal antibody titre (VDRL or RPR) for early syphilis (1:64) was significantly higher than for late syphilis (1:8) (p<0.0001). The median CD4 count and the number of patients with CD4 <200/μl in early syphilis were comparable to late syphilis. Nearly four-fifth (78.9%) received benzathine-penicillin only, 5.8% doxycycline, 1.4% Cpenicillin, 1% procaine penicillin, and 12.4% a combination of the above medications. About 44% received treatment and were lost to follow-up. Among those who completed 1 -year follow-up after treatment, 72.3% responded to treatment (serological non-reactive – 18.2%, four-fold drop in titre – 10.9%; serofast – 43.6%), 8.5% failed treatment and 17% had re-infection. Excluding those who were re-infected, lost to follow-up and died, the rates of treatment failure were 12.1% and 8.8% for early and late syphilis respectively (p=0.582) Conclusion: The most common stage of syphilis among MSM with HIV was latent syphilis. Overall, about 8.5% failed treatment at 1-year follow-up.
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Introduction:Allergic contact dermatitis (ACD) was thought to be infrequent in children. However, there isincreasing number of case reports and cross-sectional studies that indicate ACD is not as rare aspreviously thought. This study aims to explore the pattern of allergic contact dermatitis in childrenand adolescent patients.Methods:This is a retrospective study of children and adolescent patients between 5 and 19-years-old whounderwent patch test in the Department of Dermatology, Hospital Kuala Lumpur, Malaysia fromJanuary 2010 to December 2016. Patch tests were performed with European Baseline Series andother additional commercial series. Readings were recorded according to the International ContactDermatitis Research Group recommendation.Results:There were 116 children and adolescent patients who underwent patch test. The median age of patientswas 14 years (range: 5-19) with a male to female ratio of 1: 2.7. Seventy patients had dermatitisinvolving the upper limbs (60.3%), followed by 61(52.6%) patients with dermatitis involving thelower limbs, 36(31.0%) patients with face and ears involvement and 31(26.7%) patients with truncalinvolvement. Of the 116 patients, 74(63.8%) had at least one positive patch test reaction. The 5most common allergens were nickel sulfate (39.2%), fragrance mix (17.6%), potassium dichromate(14.9%), cobalt chloride (12.2%), methylcholoroisothiozolinone and methylisothiozolinone (KathonCG) (8.1%) and thimerosal (8.1%).Conclusion:Around 64% of our children and adolescents had a positive patch test reaction. Patch testing shouldbe recommended for children and adolescents suspected to have allergic contact dermatitis.
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Leprosy is still a relevant public health concern in Malaysia. Efforts made to eliminate leprosy gobeyond the elimination phase. Aspects that need to be taken into consideration include disabilityprevention, rehabilitation and ensuring maintenance of skills for diagnosing and treating the smallnumber of new cases that will continue to occur. This review article discussed about the experiencesof the past, achievement at present and the future challenges during the implementation of NationalLeprosy Control Program in Malaysia.
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Introduction:Cutaneous adverse drug reactions are one of the most common adverse drug reactions. Publicationson clinical correlation between cutaneous presentations and causative agents are limited among thelocal population. This study aims to determine the clinical presentations of cutaneous adverse drugreactions and the causative drugs in the local population.Methods:A retrospective, cross sectional study was conducted from the pharmacy cutaneous adverse drugreaction database from January 2014 to December 2016 in Tawau, Keningau & Queen Elizabeth (KotaKinabalu) Hospitals.Results:A total of 859 cases of cutaneous adverse drug reactions were identified. Out of these, 53.3% (n=458)were females and 46.7% (n=401) were males. The mean age was 36 years old. Majority of patients were20-29 years old (16.6%) followed by 50-59 years old (15.1%). Most of the cases were reported amongthe Chinese community (16.4%), followed by the Malay (15.9%), Dusun (14.7%) and Bajau (14.0%)populations. The most common cutaneous manifestations were urticaria and or angioedema (49%, n=421) and maculopapular rash (39.6%, n=340). Severe cutaneous adverse reactions (SCAR) constituted2.8% in total. The major causative agent was antibiotic which accounted for 55.1% (n=473), followedby nonsteroidal anti-inflammatory drugs (NSAIDs), 28.1% (n=241) and analgesics, 10.8% (n=93).Conclusion:The types of cutaneous manifestations and causative drugs in Sabah are similar to those reported inother states of the country and abroad. This study provides evidence of local cutaneous adverse drugreaction characteristics in different ethnic group.
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Introduction:Dual infection with Neisseria gonorrhoeae and Chlamydia sp has been reported in several studies worldwidein men presenting with urethral discharge. The rate of co-infection has been reported to be between 1.5 to 51%.This study aims to determine the demographic characteristics and sexual behaviour of men diagnosed to haveurethritis.Methods:This is a retrospective study on all men who presented with urethral discharge and diagnosed to havegonococcal (GU) and non-gonococcal urethritis (NGU) for the year 2011 to 2015 in Genito-UrinaryMedicine Clinic (GUM), Hospital Kuala Lumpur. The case notes were retrieved and reviewed.Results:There were a total of 307 men who attended the GUM clinic with urethral discharge. The mean ageof patients was 26.4 years (range 16-57 years). Majority (64.5%) were in the age group between 20-29 years. Around 95% were Malaysians and of these about 80% were Malays. Thirty-seven patients(12%) completed their tertiary education. There were 24 patients (8%) documented to have substanceabuse. Majority (78%) were heterosexual. About 36% of patients had 2 or more partners (range 2-10)6 months before the symptoms developed. The most common cause of urethritis was gonococcalurethritis (66.4%), followed by NGU (24.4%). Among the NGU, nine were detected to have Chlamydiasp infection (12%). Co-infection with Neisseria gonorrhoea and Chlamydia sp were detected in 28men (9.1%). Seven (2.3%) were HIV seropositive.Conclusion:Majority of males diagnosed with gonorrhoea were heterosexuals acquired mainly via casual partners.About 10% had co-infection with Neisseria gonorrhoeae and Chlamydia sp.
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Background: The pattern of contact sensitisation should be monitored in order to detect the changing trend of sensitising allergens. We aim to evaluate contact sensitisation in adults suspected to have allergic contact dermatitis. Methods: This is a five-year retrospective review on contact sensitisation in adults patch-tested with the European Standard and extended series between 2011 and 2015 in the Department of Dermatology, Hospital Kuala Lumpur. Results: There were 689 adults (M:F= 1:2.04; mean age 40.5 years) who were patch-tested. The majority (175, 25.4%) were white collar workers and 118 (17.1%) were healthcare workers. The provisional diagnoses of patients included contact dermatitis (80.8%); endogenous eczema (7.9%); hand eczema (3.2%); hand and foot eczema (3.5%); foot eczema (1.4%) and photodermatitis (1.2%). The allergens selected for testing were based on past and present history of exposure. Almost all (688, 99.8%) were patch-tested with the European standard allergens and 466 (67.6%) were tested with the extended series. About three quarter (528, 76.6%) developed at least one positive reaction. The top five most frequent reactions were to nickel sulphate (35.3%); potassium dichromate (16.5%); methylchloroisothiazolinone (12.9%), fragrance mix I (12.6%), and cobalt chloride (10.2%). The commonest sensitisations identified in the extended series were palladium chloride (23/105, 21.9%), stannous chloride (18/85, 21.2%), miconazole (7/44, 15.9%), gold(I)sodium thiosulfate (16/105, 15.2%) and thimerosal (29/202, 14.4%). Conclusion: Contact sensitisation was detected in 76.6% of adults patch-tested. Nickel sulphate was found to be the most frequently sensitising allergen. The rising prevalence of methylchloroisothiazolinone/methylisothiazolinone sensitization poses significant concern.
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Dermatitis, ContactABSTRACT
Cases referred to a tertiary hospital tend to be more difficult to manage. Therefore, the demographic pattern may differ and changes with time. To determine the prevalence and changing trend of skin diseases according to age, gender and ethnicity in Hospital Kuala Lumpur. Methods: This retrospective, cross sectional study was conducted in the Department of Dermatology, Hospital Kuala Lumpur from 1st January 2008 to 31st December 2014. Results: The top five skin diseases in descending order of frequency were eczema, infection, acne and acneiform disorders, psoriasis and urticaria/angioedema. Eczema is now the most common skin disease as compared to an earlier study from 1995 to 1999 where infection was the most common. A total of 58,252 clinic attendees consist of Malays (61.0%), followed by Indians (20.1%) and Chinese (18.9%). Out of these, 51.6% were females and 48.4% were males. Majority of patients were 20-29 years old (n = 11546, 24.6%) followed by 30-39 (n= 6621, 14.1%) and 10-19 years old (n= 6335, 13.5%). Conclusion: As eczema is now the most common skin disease encountered, the management of each patient need to be tailored according to the different type of eczema. Training for eczema and other skin diseases can be provided by primary care health providers as treatment for these cases are available at primary care level.
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Background Multiple drug therapy for leprosy has been in use in Malaysia since 1985. The SBAMDT is a modified WHO-MDT with an initial intensive phase and a longer duration of treatment. Objective The aim of the study is to compare the efficacy and safety of SBA-MDT against WHOMDT in the Treatment of Leprosy in Malaysia. Methodology A retrospective study was conducted between 1985 and 2009 in thirteen Malaysian dermatology centres. Data collected were analysed for comparison of relapse rates, compliance rates and adverse drug effects between the 2 regimes. Results A total of 1113 patients were included, of which 966 patients completed the SBA-MDT and 147 patients completed the WHO-MDT. Both the MDT regimes had a treatment failure rate of less than 2%. The relapse rate was 1.7% with SBA-MDT and 1.4% with WHO-MDT (p = 0.79). For multibacillary leprosy, the relapse rates were 0.9% with the former and 0 with the latter (p = 0.32). For paucibacillary leprosy, it was 3.1% and 5.0% respectively (p = 0.52). Patients on SBA-MDT had higher type 1 (16.1% vs. 8.8%, p = 0.03) and type 2 lepra reactions (19.2% vs. 6.1%, p < 0.001). Similarly, those on SBA-MDT also had higher rate of severe adverse drug reactions (11.1% vs. 5.6%, p = 0.01). Conclusion Both the SBA-MDT and the WHO-MDT regimes were effective in inducing clinical remission. Incidence of lepra reactions and severe adverse drug reactions were higher in patients with SBA-MDT.