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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.
Subject(s)
Janus Kinase InhibitorsABSTRACT
Background@#Acne vulgaris is a chronic inflammatory condition of the pilosebaceous unit. Isotretinoin is used to treat moderate to severe acne that is resistant to antibiotics and topical agents. However, it may cause alterations in lipids and liver enzymes.@*Methods@#A total of 129 patients with acne vulgaris (moderate to severe facial acne) treated with isotretinoin were recruited between May 2020 and July 2021 from the dermatology clinics at Hospital Serdang and Hospital Kuala Lumpur. Of these, 120 patients with complete data of lipid panel (total cholesterol, low density lipoprotein cholesterol [LDL], triglycerides [TG], and high density lipoprotein cholesterol [HDL]) and hepatic panel (alanine transaminase [ALT] and aspartate transaminase [AST]) levels at baseline, and in three subsequent follow-up visits (i.e., one, three, and six months) were included in the analyses. Abnormalities were graded according to standard laboratory values and their severity according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE)grading system.@*Results@#Of the 120 study participants, 83% were female and 37% were male between the ages of 15 and 36 years. We observed a significant increase in median values at baseline and at the six-month follow-up for total cholesterol (p<0.0001), triglycerides (p<0.0001), LDL (p<0.0001), ALT (p<0.0001), and AST (p<0.0001). We observed a significant correlation between body mass index and the HDL (r2 =- 0.26, p=0.01) and ALT (r2 =0.383, p=7.9x10-06) levels. Based on the CTCAE grading system, almost all study participants with abnormal results had grade 1 abnormalities. Only one patient had a grade 2 abnormality in ALT, which required treatment discontinuation.@*Conclusion@#Low dose isotretinoin therapy for acne vulgaris may cause mild and non-progressive elevation of LDL, total cholesterol, and liver transaminases which do not require treatment withdrawal in most cases.
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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.
Subject(s)
Dermatitis, Allergic ContactABSTRACT
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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Introduction: Cryotherapy and salicylic acid ointment are the two most common treatments used for treating plantar warts. The aim of this study is to compare the clearance rate of plantar warts at 12 weeks between liquid nitrogen cryotherapy and 20% salicylic acid ointment. Methods: Patients with plantar warts were randomized into cryotherapy and 20% salicylic acid groups. Patients assigned into cryotherapy group received a maximum of four treatments given two weeks apart. Patients recruited into 20% salicylic acid group were instructed to apply the salicylic acid ointment onto the wart nightly and to cover the treated area with a hypoallergenic plaster. Both groups were also provided with a personal foot file to thin out the surrounding callus daily at home. Digital pictures were taken at first visit and 12 weeks after enrolment to assess the resolution of plantar wart. Results: Eighty patients with plantar warts were included. Thirty-nine patients were randomized into cryotherapy group and forty-one patients were randomized into 20% salicylic acid ointment group. Thirteen (33.3%) patients had a complete clearance of the warts with cryotherapy whereas eleven (26.8%) patients had a complete clearance of the warts with topical 20% salicylic acid ointment (p=0.526). Nine patients were lost to follow-up. With cryotherapy, two patients reported blister formation and one patient developed hyperpigmentation. No side effects were reported with 20% salicylic acid ointment. Conclusion: There is no difference in effectiveness between cryotherapy and 20% salicylic acid ointment in the treatment of plantar wart.
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Background: Allergic contact dermatitis (ACD) was thought to be infrequent in children. However, there was an increasing number of case reports and cross-sectional studies in the past three decades indicating that ACD is not as rare as previously thought. Understanding the pattern of allergic contact dermatitis in children would help with the diagnosis and prevention of this disease. Aim: This study explored the spectrum of contact allergens in schoolchildren. Methodology: This is a retrospective analysis of all primary and secondary schoolchildren who underwent patch test at the Department of Dermatology, Hospital Selayang, Malaysia between January 2012 and March 2013. Patch tests were performed with European Baseline Series and other additional commercial series from Chemotechnique Diagnostics in IQ chambers. The parameters studied included sites of dermatitis, positive patch test reactions and sources of the allergens. Readings were recorded according to the International Contact Dermatitis Research Group recommendation. Results were analyzed using the SPSS Version 12.0. Results: 84 out of 327 (25.7%) patients who underwent patch tests were primary and secondary schoolchildren. Of the 84 schoolchildren, 60.7% had at least one positive patch test reaction. The most common allergens were preservatives found in cosmetic series (51%), rubber chemicals (47.1%), nickel sulfate (31.3%), fragrances (19.6%) and topical medicaments (19.6%). The majority (86%) of patients with facial dermatitis were positive to allergens in dental series, whereas 41.9% of patients with dermatitis involving the upper limbs and 50% of patients with dermatitis involving the lower limbs had positive patch test to rubber chemicals. Patients with dermatitis involving the trunk mostly had positive patch test to fragrances (50%). Sources of fragrances were mainly found in toiletries, topical medicaments and cosmetics. Discussion: This results of this study were interesting because of the high rate of sensitization to preservatives, mainly paraben mix. There were also high sensitization rates to rubber chemicals, which could be due to contact with rubberized shoes, sports equipment and stationery. Conclusions: Schoolchildren with face, limbs or trunk dermatitis should be patch tested with additional dental, rubber and fragrance series respectively.