Prevalence and Types of Mucocutaneous Disorders, Their Correlation to CD4 Count and Their Impact on Quality of Life in Adults with HIV Infection

Background@#Data on prevalence and type of mucocutaneous diseases in HIV-positive patients and their impact on quality of life (QoL) are sparse. We aim to determine prevalence and type of mucocutaneous disorders, their correlation to CD4+ counts and impact on QoL for adults with HIV, using the Dermatology Life Quality Index (DLQI).@*Methods@#A cross-sectional study of HIV-infected adults seen in HIV and Dermatology Clinic.@*Results@#The majority (90%) of 174 participants recruited was male. Median age at diagnosis of HIV infection was 29 years (IQR 10). Mucocutaneous disorders were present in 90.2%, out of which 58.6% had two or more mucocutaneous disorders. Mean CD4+ count was significantly lower in patients with, compared to those without mucocutaneous disorders (363 vs 548 cells/µL; p=0.030). Infections accounted for 67.2% of all mucocutaneous disorders seen, followed by inflammatory dermatoses (51.7%), cutaneous adverse drug reactions (17.8%) and neoplasm (2.3%). The five most frequent manifestations were eczema (22.4%), anogenital warts (21.2%), candidiasis (16.7%), dermatophytosis (15.5%) and secondary syphilis (12.0%). Oral candidiasis, pruritic papular eruption, drug-induced maculopapular eruption and drug rash with eosinophilia and systemic symptoms were significantly more prevalent in patients with CD4+ counts <200 cells/µL but anogenital warts were more prevalent in patients with CD4+ counts ≥200 cells/µL. The mean DLQI score was 8.39 (SD ± 6.83). QoL was severely impaired (DLQI >10) in 34.4%.@*Conclusion@#Mucocutaneous disorders were common in HIV patients causing significant impairment in quality of life. Prevalence co-related with low CD4+ counts. Adequate management of HIV may reduce the prevalence of mucocutaneous disorders and improve QoL.

The Association of Skin and Nasal Colonisations of Staphylococcus aureus in Children with Atopic Dermatitis with Disease Severity and Its Impact on Quality of Life

Background@#Atopic dermatitis (AD) is a chronic, recurrent, pruritic inflammatory skin disease that causes significant burden to affected children. Staphylococcus aureus plays a vital role in AD, and its resistance to current topical antibiotics is worrying. This study aims to determine the frequency of Staphylococcus aureus colonisation and its resistance pattern. It further assesses the association between Staphylococcus aureus colonisation and disease severity; as well as its impact on quality of life.@*Methods@#A cross-sectional study was conducted among 153 children with AD. Skin and nasal swabs were collected. Antibiotic sensitivity to penicillin, cefoxitin, erythromycin, methicillin, clindamycin, gentamicin, trimethoprim/sulfamethoxazole, tetracycline, rifampicin, fusidic acid and linezolid were tested. Clinical evaluation was performed using the SCORing Atopic Dermatitis index (SCORAD). Quality of life was assessed with the Dermatological Life Quality Index (DLQI).@*Results@#Twenty-nine patients had positive skin swab results. One patient had methicillin-resistant Staphylococcus aureus isolated from nasal swab. Skin colonisation with Staphylococcus aureus (p=0.03) and DLQI (p<0.01) were significantly associated with disease severity. The resistant rate is highest in penicillin, followed by fusidic acid, tetracycline, and erythromycin.@*Conclusion@#Skin colonisation with Staphylococcus aureus is an indicator of disease severity in children with AD. Patients with severe disease have lower quality of life. Clinicians need to be aware of high resistance rates towards penicillin and fusidic acid and be prudent in the choice of antibiotics. Antiseptic wash can be considered in patients with Staphylococcus aureus colonisation.

Consensus Guidelines in Usage of Biologics in Dermatology during COVID-19 Pandemic: Biologic Advisory Group Malaysia

@#The aim of this Biologic Advisory Group (BAG) Malaysia consensus guideline is to provide clinicians managing cutaneous diseases with biologics relevant parameters to consider prior to initiating or stopping or continuing any biologic treatment in the current landscape of the COVID-19 pandemic. Besides reviewing the medical literatures on COVID-19 and evidences related to other human coronavirus or influenza, expert opinions and clinical experiences are shared and debated in formulation of this biologic consensus guideline.

Validation of the Malay version of Autoimmune Bullous Disease Quality of Life (ABQOL) questionnaire

@#Autoimmune blistering diseases (AIBD) represent a group of rare and chronic disorders with significant impact on quality of life (QoL). The aim of this study was to assess the validity and reliability of the Malay translation of the autoimmune bullous disease quality of life (ABQOL) questionnaire.

Phacomatosis Pigmentovascularis Type II: Case Report

Phacomatosis pigmentovascularis is a rare syndrome first described by Ota et al, in 1947. It ischaracterized by a combination of capillary malformation and other pigmented naevi. It had originallybeen classified into four major types. A fifth type, in which the vascular lesion is cutis marmoratatelangiectatica congenita (CMTC), was subsequently added. Each type was further categorizedaccording to the absence or presence of associated extra-cutaneous signs as types (a) and (b),respectively. We reported this case due to its rare clinical presentation, with probable overlap Klippel-Trenaunay syndrome.

Angiosarcoma Mimicking Rhinophymatous Rosacea

Cutaneous angiosarcoma is a rare, highly malignant vascular tumor. More than 50% of them arelocalized to the skin of the head and neck regions.It usually present as nodules with ulceration, plaques,or bruise-like lesions. However, the clinical features may vary. We reported this case due to its atypicalclinical presentation, which presented with rhinophyma-like features, making it a diagnostic challengeto the clinicians.

Clinical features and prognostic factors of cutaneous vasculitis among dermatology patients in Johor Bahru, Malaysia

Background: Cutaneous vasculitis is common, yet the riskfactors for its chronicity have not been established.Objective: To describe the clinical spectrum and identify riskfactors for chronicity of cutaneous vasculitis.Methods: Retrospective data analysis of 275 patientsdiagnosed with cutaneous vasculitis from January 2008 toDecember 2013.Results: The mean age was 33.7 (±17.89) years, with femalepredominance. The majority of patients were Malays (67.3%).Skin biopsy was performed in 110 (40%) patients. Thecommonest sign was palpable purpura (30.6%). Theaetiology remained elusive in 51.3% of patients. Commonidentifiable causes include infection (19.7%) and connectivetissue disease (10.2%). Extracutaneous features were notedin 46.5% of patients. Erythrocyte sedimentation rate andantinuclear antibody were raised in 124 of 170 and 27 of 175patients with documented results respectively. Cutaneousvasculitis was the presenting symptom in seven patientswith newly diagnosed systemic lupus erythematosus. AntiStreptolysin O Titre was positive in 82 of 156 patients withdocumented results. Despite antibiotics, 31.7% of them hadchronic lesions. Prednisolone alone was used in 20% ofpatients while 16.4% needed steroid-sparing agents. Mostpatients who needed systemic therapy (62%) hadunidentifiable aetiology. Among the 155 patients whoremained under follow up, 36.4% had chronic disease, onepatient succumbed due to septicaemia, and the rest fullyrecovered within three months. The presence of ulcerativelesion was significantly associated with developing chronicvasculitis (p=0.003).Conclusion: The clinical spectrum of cutaneous vasculitis inour population was similar to other studies. Ulcerativelesion predicts a chronic outcome

A Case Report of Acne Agminata

Granulomatous facial skin lesions are a rare and challenging clinical problem. Differential diagnoses include cutaneous tuberculosis, sarcoidosis, granulomatous rosacea and acne agnimata. We reported a case of acne agminata presented with granulamatous facial papules.

Clinico-epidemiological profile, including body mass index of Malaysian children with psoriasis

background: Limited information exists regarding paediatric psoriasis and its association with body mass index (bMI) in Asia. Objectives: to determine the clinico-epidemiological profile and to compare the bMI of children with and without psoriasis. Methods: A case-control study of 92 children with psoriasis versus 59 with atopic eczema and 56 with non-inflammatory skin conditions. results: Psoriasis was more common in Malay and Indian children when compared to Chinese with odds ratios (Or) of 4.30 (95% CI, 1.85-9.99) and 3.00 (95% CI, 1.02-8.81) respectively. Prevalence of psoriasis was similar between Malay and Indian children (Or 1.43, 95% CI, 0.63-3.25). Male:female ratio was 1:1.09. the mean onset age of psoriasis was 7.9 years. Median onset age was earlier in males (6.5 years versus 9.0 years in females, p=0.05). Plaque psoriasis was the most common phenotype (89.1%) and 94.5% had scalp lesions. Arthritis was seen in 4.3%. Odds of excess adiposity, defined as bMI ≥85th percentile, was higher in children with psoriasis versus noninflammatory controls (Or 2.35, 95% CI 0.99-5.56, p= 0.052). No increased risk of adiposity was noted between children with psoriasis and eczema (Or 1.14, 95% CI 0.5-2.62, p=0.753). More children with psoriasis (17.4%) and eczema (20.3%) were underweight (bMI <5th percentile) compared to non-inflammatory controls (10.7%). Conclusion: Malays and Indians are three to four times more likely than Chinese to have psoriasis in multi-ethnic Malaysia. Plaque psoriasis is the most common phenotype. Odds of excess adiposity is about two times higher in children with psoriasis compared to non-inflammatory controls although this observation just missed conventional statistical significance.