Serum Vitamin B12 Level and Dietary intake in Adult Atopic Dermatitis: A Case Control Study

Background@#Vitamin B12 is a contributing factor in pruritus and peripheral nerve regeneration. Its role in atopic dermatitis (AD) is still unclear. This study aimed to compare vitamin B12 level between AD patients and healthy controls, determine its correlation with pruritus and AD severity, and evaluate dietary pattern with energy, macro and micronutrient intakes.@*Methods@#This was a case control study involving adult AD patients and age-, gender-, ethnicity- and body mass index-matched healthy controls. All adult patients who fulfilled UK Working Party AD diagnostic criteria were included. Exclusion criteria include patients on systemic agents, diseases known to affect B12 level and vegan diet. AD severity was determined using SCORing Atopic Dermatitis (SCORAD) index. Serum vitamin B12 level were measured. A three-day 24-hour dietary recall was collected and analyzed.@*Results@#A total of 42 AD patients and 42 controls were recruited. Mean SCORAD index was 39.2±16.6, and AD duration was 12.7 ± 8.1 years. Vitamin B12 was lower among AD (215.6 ± 110.2 pmol/L) versus control (295.1± 119.9 pmol/L), p<0.01 despite similar dietary B12 intake in both groups. There were no significant correlations between AD duration and severity with vitamin B12 level. Energy intake (kcal/ day) was significantly lower in AD (p=0.04). There were no significant differences in proportion of main food groups consumed and other macronutrient and micronutrient intakes.@*Conclusion@#Serum vitamin B12 level was significantly lower in AD patients despite similar dietary pattern and nutrient intake with healthy controls. There were no correlations with AD severity or disease duration. Dietary pattern of AD patients should be routinely assessed to ensure adequate nutrition.

Bringing the Treatment of Atopic Eczema Into a New Era with Janus Kinase Inhibitors: A Position Statement By the Persatuan Dermatologi Malaysia

Abstract@#Atopic eczema (AE) is a complex, chronic and recurrent inflammatory pruritic skin condition that impacts the quality of life and exerts an economic toll on patients and their families. One of the factors contributing to AE is the immune dysregulation of the Janus kinase-signal transducers and activators of transcription (JAK-STAT) inflammatory pathway. This has prompted the conduct of various large clinical trial programs to evaluate the efficacy and safety of Janus kinase inhibitors (JAK-i) for AE. The overall and significant benefit of these drugs from clinical studies resulted in regulatory approvals for JAK-i to treat moderate-to-severe atopic eczema. The objective of this position paper was to evaluate the safety, efficacy and role of upadacitinib, baricitinib and abrocitinib in managing AE and update the current recommended treatment algorithm within the 2018 Malaysian Clinical Practice Guidelines for the Management of Atopic Eczema. The Persatuan Dermatologi Malaysia recommends that these JAK-i can be considered as an option for systemic therapy in severe AE.

Evaluation of Knowledge, Disease Severity and Quality of Life of Patients with Psoriasis

Background@#Psoriasis vulgaris is a chronic immune-mediated inflammatory multi-system disease characterised by keratinocyte hyperproliferation. Data regarding patients’ disease severity, knowledge and quality of life (QOL) is important to optimize treatment strategies for psoriasis. This study aims to evaluate and investigate the relationship between disease severity, knowledge and QOL of patients with psoriasis. @*Methods@#A cross-sectional multicentre study utilizing a socio-demographic data collection form, Psoriasis Knowledge Assessment Questionnaire (PKAQ), Dermatology Life Quality Index (DLQI) and Psoriasis Area and Severity Index (PASI was conducted. Correlations between PKAQ, DLQI and PASI were analysed using Spearman’s test. @*Results@#A total of 114 subjects participated in this study. Majority of them had mild psoriasis (n=73, 64%) based on PASI. The mean score of PKAQ was fourteen out of a total possible score of twenty-five, whereas the DLQI had a non-parametric distribution with a median (interquartile range) of 7 (10). Most subjects (32.5%) stated that psoriasis had a ‘moderate effect’ on their QOL, while only 3.5% said that it had an ‘extremely large effect’ on their QOL. There was a statistically significant correlation between PASI and DLQI (rs = 0.264, p = 0.004), with higher PASI scores corresponding to higher DLQI scores. No statistically significant correlation was found between DLQI and PKAQ (rs = -0.048, p= 0.612), and between PASI and PKAQ (rs = 0.058, p= 0.542).@*Conclusion@#Impairment of QOL was positively associated with severity of psoriasis. However, there was no significant relationship between knowledge and quality of life, as well as between knowledge and psoriasis severity.

Case Series of Akurit-4 Associated DRESS

Summary@#We describe nine cases of anti-tuberculosis DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome, a potentially serious complication of treatment that led to interruption of treatment, systemic corticosteroid usage and the resumption of treatment with different regimens. All patients had skin rash, six out of nine patients with hepatitis, two out of nine patients had acute kidney injury, five out of nine patients died. All-cause mortality is high in our cohort.

Iatrogenic Phaeohyphomycosis: A Rare and Underrecognized Disease

Summary@#Phaeohyphomycosis refers to a heterogenous group of mycotic infections caused by dematiaceous fungi where unintentional traumatic inoculation accounts for majority of the cases. Herein, we are reporting a rare case of iatrogenic subcutaneous phaeohyphomycosis which is secondary to intravenous cannula placement.

Rituximab as First-line Therapy for Severe Pemphigus: A Case Series and Review of Current Literature

Summary@#Pemphigus refers to a group of life-threatening, autoimmune blistering disease that presents as blisters and erosions involving the skin and mucosa. Systemic corticosteroids and rituximab have been recommended as mainstay therapy for pemphigus vulgaris and pemphigus foliaceus. Herein, we report three cases of pemphigus vulgaris and a case of pemphigus foliaceus treated with rituximab as first-line therapy.

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.

Blistering Eruption and Fulminant Hepatitis: A Fatal Coinfection of Leptospirosis and Disseminated Herpes Simplex

Leptospirosis has a wide spectrum of nonspecific clinical manifestations ranging from mild diseaseto multiorgan failure with variable cutaneous manifestations. Disseminated herpes simplex virusinfection usually occurs in the setting of immunosuppression. Both these infections are rare infectivecauses of fulminant hepatitis. Herein, we report a case of fatal leptospirosis and disseminated herpessimplex virus coinfection, in the hopes that this report will increase awareness among health careproviders for relevant investigation and prompt management.

Dialysis-associated Pseudoporphyria: An Often Overlooked Cause

Pseudoporphyria is a condition clinically and histologically similar to porphyria cutanea tarda (PCT)but without abnormalities in porphyrin metabolism. Pseudoporphyria has also been described inpatients with chronic renal failure, with or without accompanying dialysis. Herein we report a caseof dialysis-associated pseudoporphyria in the hopes that increased awareness of this condition mayultimately lead to improved outcomes with the institution of specific treatment measures.

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.