No Epidermis: Is it the drug, COVID-19 or Something Else?

Summary@#Staphylococcal toxic shock syndrome (TSS) is a clinical disease with acute onset of fever, rash, hypotension and multi-organ system involvement. Staphylococcal scalded skin syndrome (SSSS), mostly described in neonate and children, is a superficial blistering disease caused by the exfoliative toxin of specific strains of Staphylococcus aureus. TSS and SSSS rarely occur concurrently in adults. We here describe a 35-year-old woman who was initially referred to dermatology team as toxic epidermal necrolysis. She presented with a rapid epidermal detachment without mucosal involvement, fever and shock, associated with acute kidney injury and transaminitis, severe metabolic acidosis, complicated by COVID-19 infection, and finally succumbed within 36 hours of hospitalization. Early recognition and prompt treatment are the key factors in the management as TSS itself can lead to mortality. Staphylococcal TSS and SSSS are important differential diagnosis to consider in acute epidermal detachment, as not all cases are drug-induced.

Clinical Characteristics of Anogenital Warts Among Patients Attending Genitourinary Medicine Clinic Hospital Kuala Lumpur Between 2015 and 2020

Background@#Anogenital human papillomavirus (HPV) is the most frequent reported sexually transmitted infection in the world. We aim to describe the local demographic data and the clinical characteristics of anogenital warts (AGWs).@*Methods@#This is a retrospective study on all patients with AGWs who attended the GUM clinic between 2015 and 2020. Data was obtained from case notes and further analysed.@*Results@#A total of 935 patients with AGWs attended the GUM clinic between 2015 and 2020. The mean age was 30.4 years (range 12-84). The male to female ratio was 2.35:1. Majority were Malaysian (97%). Majority of the Malaysian were Malays (61.5%) followed by Chinese (27.7%) and Indian (8.9%). About 5.6% had a history of substance abuse. While the majority (57.9%) were heterosexual, 34.8% were homosexual and 6.4% were bisexual. About 59.8% had more than one sexual partner. A quarter (25.6%) was infected with the human immunodeficiency virus. The most frequent site of AGWs in males was the perianal area (52.6%), followed by the penis (45.7%), and with a fifth of them having lesions at multiple sites. For female patients, the most frequent site of AGWs was the posterior fourchette (45.2%) followed by the labia minora (33%) with 46.6% had involvement at multiple sites. Approximately 17.6% had other concomitant sexually transmitted infections. Local treatment application used included cryotherapy (86.4%), podophyllin (35.3%), tri-chloroacetic acid (26.8%) and imiquimod (2.6%). About 41.5% required combination of these modalities. Nearly 6.2% experienced recurrence. About 2% required surgical intervention.@*Conclusions@#AGWs was more commonly observed in male. The most frequent site of involvement was perianal for male (52.6%) and posterior fourchette in female (45.2%).

Psoriasis Patients with Human Immunodeficiency Virus Infection: Data from the Malaysian Psoriasis Registry

Background@#Psoriasis can be a presenting feature of human immunodeficiency virus (HIV) infection. Our objective was to determine the frequency of HIV infection among patients with psoriasis and to describe the clinical features, treatment and quality of life in this population.@*Methods@#This is a multi-centre retrospective cross-sectional study of psoriasis patients who were registered to the Malaysian Psoriasis Registry (MPR) from January 2007 to December 2018.@*Results@#Of a total of 21,735 patients registered, 105 (0.5%) had HIV infection. Among these patients, 90 (85.0%) were male, mean age was 40.90 ± 10.85 years, and plaque psoriasis was the most frequently encountered presentation (85.7%). Significantly more patients with HIV had severe psoriasis (61.3% vs 49.9%, p=0.043), face and neck (62.7% vs 51.4%, p=0.022) involvement, and nail disease (69.9% vs 56.2%, p=0.005) compared to those without HIV. Only n patients (8.7%) had psoriatic arthropathy, and only 9 (8.8%) received systemic therapy, namely acitretin and methotrexate. None received a biologic, and only one patient was treated with narrowband ultraviolet-B therapy. The mean Dermatology Life Quality Index (DLQI) score at enrolment was 10.98 ± 7.07 for the HIV cohort compared to 8.68 ± 6.60 for the non-HIV cohort (t=2.190, p=0.029). More patients with HIV reported a DLQI score >10 compared to those without HIV (51.5% vs 40.2%, p=0.021).@*Conclusion@#The frequency of HIV infection among patients with psoriasis in the MPR was 0.5%. Patients with HIV had more severe disease, more nail, face and neck involvement, and greater impairment of quality of life. Treatment of HIV patients with psoriasis remains conservative in Malaysia.

The Clinical Characteristics of Inpatients: An Audit in the Department of Dermatology Hospital Kuala Lumpur Between 2016 and 2020

Background@#Although Dermatology is primarily a non-acute, outpatient-centered clinical specialty, some of them require in-patient care for intensive skin management. We aim to describe the demographic data, clinical characteristics, and outcomes of Dermatology inpatients in Hospital Kuala Lumpur (HKL).@*Methods@#This is a retrospective study on all dermatology inpatients in HKL between 2016 and 2020. Data was obtained from admission records and further analyzed.@*Results@#A total of 1567 patients were admitted to the Dermatology ward between 2016 and 2020 accounted for 2292 admissions. The mean age was 45 years (range 8-93). The male to female ratio was 1.16:1. The majority were Malaysian (99.2%). Most Malaysian were Malays (60%) followed by Chinese (19.3%) and Indian (17.1%). About 91% of the admissions were arranged from the dermatology clinic. The mean length of stay was 5.06 days (range 0-63). About 20% of the patients required multiple admissions. The main dermatological diagnosis requiring inpatient care were non-infective dermatoses (60.4%) which included eczematous dermatoses, autoimmune dermatoses, psoriasis, cutaneous adverse drug reactions, inflammatory and non-inflammatory dermatoses. This was followed by cutaneous infections (24.5%) and drug allergy testing & drug provocation tests (7.9%). About 3% of patients were transferred to other departments for further intensive management, and the rest were discharged home well. No mortality occurred in the Dermatology ward.@*Conclusion@#The Dermatology ward HKL managed 2292 admissions between 2016 and 2020. The three main dermatological diagnoses requiring intensive skin management were eczematous conditions, cutaneous infections, and autoimmune dermatoses.

Oral Lichenoid Reactions and Contact Sensitization: A 5-year Review in the Department of Dermatology, Hospital Kuala Lumpur, Malaysia

Background@#Oral lichen planus is an idiopathic autoimmune inflammatory condition and oral lichenoid reactions are lesions that resemble oral lichen planus clinically and histopathologically, but develop secondary to various underlying causes. Oral lichenoid reactions have been reported to be caused by contact allergy to dental materials. This study aims to describe the characteristics of patients with a clinical and/or histopathological diagnosis of oral lichen planus who underwent patch testing in Hospital Kuala Lumpur, Malaysia.@*Methods@#This is a 5-year retrospective study of patients who had oral lichen planus and had undergone patch testing at the Department of Dermatology, Hospital Kuala Lumpur, Malaysia between January 2015 and Cecember 2019. Patch tests were performed with European Baseline Series and relevant extended series, which include dental and metal series as well as patients’ own products. Patch test results were recorded according to the International Contact Dermatitis Research Group recommendation.@*Results@#There were 41 patients with oral lichen planus who underwent patch test. The median age was 56 (range 21 to 73) with 70.7% of patients being female. There were 29 (70.7%) patients who developed at least one positive reaction. The most frequent sensitizing allergens were nickel sulfate (34.1%), gold(I)sodium thiosulphate dihydrate (22.0%), fragrance mix I (19.5%), cobalt chloride (14.6%), Peru balsam (12.2%) and sodium tetrachloropalladate (II) hydrate (12.2%). Current relevance was recorded in 16 patients (39.0%) and of these patients, 12 of them had positive patch test reactions to allergens found in dental materials such as dental fillings, dental implants, orthodontic braces, dentures and dental crowns.@*Conclusion@#Contact sensitization was detected in about 70% of our patients with oral lichen planus. The most common sensitizing allergen was nickel sulfate. Current relevance was found mainly towards dental materials.

Prevalence of Sexually Transmitted Infections (STIs) among Adolescents Attending Genitourinary Medicine Clinic Hospital Kuala Lumpur between 2014 and 2018

Background@#Adolescents, who aged between 10 and 19 years old, comprise about 20% of the world’s population. They are vulnerable to acquisition of sexually transmitted infections (STIs). Here, we aim to determine the demography and pattern of STIs among adolescents attending Genito-Urinary Medicine (GUM) Clinic, Hospital Kuala Lumpur (HKL).@*Methods@#This is a retrospective study on all adolescents attending GUM clinic between 2014 and 2018. Data was obtained from case notes and further analysed.@*Results@#A total of 111 adolescents attended GUM clinic between 2014 and 2018. The mean age was 18 years (range 12-19). The male to female ratio was 2.26:1. All patients were Malaysian. Only 2 were foreign nationals. The majority were Malays (85.3%) followed by Indians (11%) and Chinese (3.7%). About 46.8% were still schooling, 28.8% were employed and 23.4% were unemployed. About 8.3% had a history of substance abuse. The majority (67.6%) were heterosexual, about 17.1% were homosexual and 3.6% were bisexual. Nearly 95% engaged in unprotected sex. Majority (46%) had casual sex. The most frequent presenting symptoms for male and female adolescents were discharge (43.2%) followed by swelling/growth (23.4%). About 83% had confirmed STIs. The most common STIs among the male were gonorrhoea (44.1%), genital warts (23.4%) and non-gonococcal urethritis (14.7%). The most common STIs among the female were herpes genitalis (50%), genital warts (33.3%) and syphilis (8.3%). Six patients were infected with the human immunodeficiency virus (HIV).@*Conclusion@#The most common STI among adolescents between 2014 and 2018 was gonorrhoea for male and herpes genitalis for female.

Drug hypersensitivity reactions in Asia: regional issues and challenges

There are geographical, regional, and ethnic differences in the phenotypes and endotypes of patients with drug hypersensitivity reactions (DHRs) in different parts of the world. In Asia, aspects of drug hypersensitivity of regional importance include IgE-mediated allergies and T-cell-mediated reactions, including severe cutaneous adverse reactions (SCARs), to beta-lactam antibiotics, antituberculous drugs, nonsteroidal anti-inflammatory drugs (NSAIDs) and radiocontrast agents. Delabeling of low-risk penicillin allergy using direct oral provocation tests without skin tests have been found to be useful where the drug plausibility of the index reaction is low. Genetic risk associations of relevance to Asia include human leucocyte antigen (HLA)-B*1502 with carbamazepine SCAR, and HLA-B*5801 with allopurinol SCAR in some Asian ethnic groups. There remains a lack of safe and accurate diagnostic tests for antituberculous drug allergy, other than relatively high-risk desensitization regimes to first-line antituberculous therapy. NSAID hypersensitivity is common among both adults and children in Asia, with regional differences in phenotype especially among adults. Low dose aspirin desensitization is an important therapeutic modality in individuals with cross-reactive NSAID hypersensitivity and coronary artery disease following percutaneous coronary intervention. Skin testing allows patients with radiocontrast media hypersensitivity to confirm the suspected agent and test for alternatives, especially when contrasted scans are needed for future monitoring of disease relapse or progression, especially cancers.

The Value of Adding 1,3-Diphenylguanidine, N-Cyclohexyl-N-Phenyl- 4-Phenylenediamine, N-Cyclohexylthiophthalimide and Ylangylang oil to the European Baseline Series to Improve the Detection of Rubber and Fragrance Allergy Among Patients Suspected with Contact Dermatitis in Hospital Selayang

@#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.

Cutaneous Manifestations in Patients Infected with Human Immunodeficiency Virus: An Audit in the Department of Dermatology Hospital Kuala Lumpur

@#Patients with human immunodeficiency virus (HIV) may have significant cutaneous morbidities which can potentially affect their quality of life or be life-threatening. This study aimed to describe the demographic data and the pattern of cutaneous manifestations of patients infected with HIV.

Adult Onset Still’s Disease: A Case Report in Hospital Kuala Lumpur

@#Adult onset Still’s disease (AOSD) is a sporadic complex autoinflammatory syndrome first described in 1971.1 It is characterised by high spiking fever, polyarthritis, sore throat, lymphadenopathy, hepatosplenomegaly, serositis, and evanescent skin eruptions.1,2 It is associated with life-threatening complications too. Diagnosis of AOSD is laborious as it requires extensive investigations to exclude infections, autoimmune diseases and malignancy. Here we illustrate a young female who exhibited a turbulent presentation of ASOD.

Human Immunodeficiency Virus-infected men who have sex with men with syphilis: A 5-year multicentre study in Malaysia

@#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.

Patch Testing in Children and Adolescents: 7 Years’ Experience in Hospital Kuala Lumpur

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.

Dapsone Hypersensitivity Syndrome and Dapsone-induced Liver Injury in Four Malaysian Indigenous Individuals with Leprosy

Dapsone is part of the multi-drug therapy used in the treatment of leprosy. It can cause life-threateninghypersensitivity syndromes resulting in significant morbidity and mortality, especially amongsusceptible individuals such as those who are carriers of HLA-B*13:01 allele. Avoidance of dapsonein these susceptible individuals reduces the risk of dapsone-related adverse events. Herein, we reportfour indigenous patients with leprosy who developed dapsone hypersensitivity syndrome.

Leprosy in Pregnancy: A Case Series in 4 Dermatology Clinics in Malaysia

IntroductionManagement of leprosy in pregnancy is challenging. Here we aim to describe the clinical characteristicsand the management of leprosy in pregnancy.MethodsThis is a retrospective study on pregnant women with leprosy managed in the Department ofDermatology in Hospital Kuala Lumpur, Hospital Pulau Pinang, Hospital Sultanah Bahiyah andHospital Queen Elizabeth between 1994 and 2015.ResultsThere were ten patients with 12 pregnancies with a median age of 27.5 years (range: 16-33). Fivewere foreigners. There were four cases of lepromatous leprosy, two cases of borderline lepromatous,two cases borderline tuberculoid leprosy and one case each for tuberculoid and mid borderline leprosy.Seven pregnancies (58%) were documented to have reactions. Four reversal reactions (33%), threeerythema nodusom leprosum (25%) and two Lucio’s phenomenon (17%) were documented. Bothpatients with Lucio’s phenomenon had undiagnosed leprosy and presented with preterm labour,anemia, oligohydramnios and intrauterine growth restriction. Mortality was recorded in one patientdue to dapsone induced hypersensitivity syndrome complicated with septicaemia. All patients wereprescribed multidrug therapy but in three pregnancies, the patients chose to defer the treatment. Therewas a spontaneous miscarriage at second trimester and a case of early neonatal death. The neonatalcomplications recorded for the 10 live deliveries were low birth weight, jaundice and clofazimineinducedhyperpigmentation.ConclusionThe majority of our patients with leprosy had complications throughout the pregnancies. Earlydetection and prompt treatment can prevent unfavorable fetal outcome & threatened maternal health.

From Red Herring to Malignancy

Angiosarcoma is a rare but aggressive malignant tumor of vascular endothelial cells accounting for1-2% of soft tissue sarcoma. Due to its rarity and heterogeneity in clinical presentation, delay indiagnosis and treatment is not uncommon. Hence, prognosis is usually guarded. Here we report acase of primary cutaneous angiosarcoma arising from the right cheek which progressed rapidly andresulted in perforation of buccal mucosa despite combination therapy of paclitaxel and propranolol.

Vascular Anomalies: A 3-Year Review in the Paediatric Institute Hospital Kuala Lumpur Between 2013 And 2015

Introduction:Vascular anomalies, regardless of tumour or malformation, may result in significant morbidity. Thediagnosis of vascular anomalies in the paediatric group is always challenging. We aim to describe thepattern of vascular anomalies referred to the Paediatric Institute Kuala Lumpur Hospital (PIKLH).Methods:This is a 3-year retrospective review on vascular anomalies among children referred to PIKLH between2013 and 2015.Results:There were 289 children; male to female ratio of 1:2.1; aged from birth to 14 years with median age of5 months recruited. The referring diagnoses included haemangioma (71.3%), capillary malformation(13.8%), lymphatic malformation (1.7%), kaposiform hemangioendothelioma (1.0%) and others. Ahundred and sixty-one (55.7%) had lesions located at the head and neck region, followed by trunk(14.2%), lower limbs (9.3%), upper limbs (7.6%), perineum (3.8%) and multiple sites (6.9%). In 197patients (68.2%), there were no further investigations performed, 13.5% had ultrasonography, 7.3%had MRI, 4.8% had both ultrasonography and MRI; 4.1% had skin biopsy, 0.3% had angiogram.The final diagnoses were haemangioma (72.3%) of which 10 were ulcerated; capillary malformations(17.6%), combined vascular malformations (2.4%), kaposiform hemangioendothelioma (2.8%),lymphatic malformations (2.1%); venous malformations (1.4%); tufted angioma (1.0%) andarteriovenous malformations (0.3%). One hundred and nine patients (37.7%) received beta-blockers;71(24.6%) underwent laser, 16(5.5%) received sirolimus, 9(3.1%) received systemic corticosteroidswith vincristine, 4(1.4%) had systemic corticosteroids, 3(1.0%) had excision and 2(0.7%) hadsclerotherapy. The remaining patients were put under observation.Conclusion:Three-quarters of the vascular anomalies referred were hemangioma followed by vascularmalformations. Vascular anomalies have a large variation in clinical presentation. Expertise inthe diagnosis and management modalities are essential to achieve optimum outcomes. Thereforevascular anomalies are best managed in a multidisciplinary setting.

The Utilization of Cutaneous Laser Therapy at the Department of Dermatology, Hospital Kuala Lumpur: A 5-year review

Introduction:The Department of Dermatology, Hospital Kuala Lumpur has been providing cutaneous laser therapyservices for over 20 years. We aim to describe the utilization of cutaneous laser therapy at the Departmentof Dermatology, Hospital Kuala Lumpur and the post treatment complications.Methods:We reviewed all patients who received cutaneous laser therapy at the Department of Dermatology, HospitalKuala Lumpur from January 2012 till December 2016. Complications were defined as dyspigmentation,infection, scarring, blisters, ulcerations, skin textural changes or contact dermatitis secondary to post/ pre-lasertopical therapy.Results:A total of 1190 patients with a male to female ratio of 1:2.21 and a mean age of 35.8 years received single,repeated or combination cutaneous laser therapy from 2012 till 2016 for 48 different skin conditions. Annually,an average of 1314 laser sessions were performed. Indications included seborrhoeic keratosis (249, 20.9%),port wine stain (162, 13.6%), solar lentigines (144, 12.1%), syringoma (105, 8.8%), viral warts (88, 7.4%),and Naevus of Ota (82, 6.9%) among others. Majority underwent Q-switched Nd:YAG laser (36.5%) followedby pulsed dye laser (33.6%), ablative conventional carbon dioxide laser (29.2%) and fractional carbon dioxidelaser (0.7%). Over the past 5 years, 3 patients developed severe complication post laser therapy which wasblisters. Pain was tolerable with application of topical 5% EMLA? (lidocaine 2.5% and prilocaine 2.5%) creampre-laser treatment.Conclusion:Q-switched Nd:YAG laser therapy was the most frequently employed laser in the Department ofDermatology, Hospital Kuala Lumpur. Our centre has a high volume of cases with a low rate of posttreatment complication.

Mycology of Onychomycosis: A 5-year retrospective review (2011 – 2015) in Hospital Kuala Lumpur

Onychomycosis is a common nail disease with numerous etiological pathogens. In order to determine and trend the local mycological pattern of culture-positive diseased nail samples sent from the Department of Dermatology, Hospital Kuala Lumpur, a five-year retrospective audit was carried out, which revealed that non-dermatophyte molds were the predominant fungi isolated, followed by yeasts and dermatophytes. This is similar to two previous studies in Malaysia, but varies greatly from other studies around the world which showed a dermatophyte-predominant prevalence. This could be due to the nature of the environment our patients encountered.

Contact sensitisation in adults: a 5-year retrospective review in hospital Kuala Lumpur

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.

Behçet’s Disease: A Case Series of 5 Patients in the Department of Dermatology, Hospital Kuala Lumpur, Malaysia

Behcet’s disease (BD) is a variant of systemic vasculitides characterized by recurrent oral aphthous ulcers, recurrent genital ulcers with eyes, cutaneous, gastrointestinal, joints, neurological and others organ involvement. Here we aim to describe the demography, clinical patterns and the treatment of 5 cases of BD presented to the Department of Dermatology Hospital Kuala Lumpur between 2002 and 2016. All the patients had a delay in their diagnosis. The clinical characteristics and the choices of treatment in our patients did not differ greatly compared to the reports from other countries. BD could be under-diagnosed in Malaysia as the presenting symptoms are non-specific. Therefore, a high index of suspicion is needed.