The Socio-demographic and Quality of Life of People Living with HIV (PLHIV) Presenting with Cutaneous Manifestation: A Cross-Sectional Study in the Department of Dermatology, Sarawak General Hospital

Background@#People living with Human Immunodeficiency Virus (PLHIV) are living longer with the advent of highly active antiviral therapy (HAART). Aside from extending the life span, quality of life is vital in PLHIV management. However, there is a paucity of data on the cutaneous manifestations in PLHIV on HAART. The objective of this study is to ascertain the prevalence of cutaneous manifestations, effect on daily lives, and relation to CD4 levels.@*Methods@#This is a prospective cross-sectional study comparing 2 groups of PLHIV patients on HAART and not on HAART therapy done from March 2020 to November 2020.@*Results@#A total of 259 patients were recruited in this study with a mean age of 40 years. There were 216 (83.4%) male and 43 (16.6 %) female. Men having sex with men accounts for 49%. The most common cutaneous disorder was post-inflammatory pigmentation (20.4%). Infective dermatoses were 43 (6.7%), and cutaneous malignancy 3 (0.6%). Mean DLQI in PLHIV on HAART were 2, as compared to PLHIV not on HAART which scored 3. Bidayuh ethnicity accounts for 30% of adverse drug reactions with Bactrim being the most common drug.@*Conclusion@#There is a high prevalence of dermatoses in PLHIV. HAART increases the CD4 count of patients thereby reducing the risk of opportunistic infection and related disorders. However, it did not reduce the cutaneous manifestations in PLHIV, as HAART itself may increase the risk of adverse cutaneous drug reactions. DLQI is not the best tool to assess quality of life.

Morbilliform rashes as sole manifestation of COVID-19

@#Coronavirus Disease 2019 (Covid-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is recognized as a worldwide public health crisis. It has rapidly spread from Wuhan City in China after an outbreak of flu-like illness. Respiratory symptoms remain the most common manifestation of Covid-19. However, dermatologic manifestations have been observed in patients with COVID-19 infection. Kulkharni, et al. published a case report of morbilliform rashes as a probable herald of Covid-19 being its initial and only manifestation of COVID-19.1 This is a case of a 45-year-old female who presented with worsening morbilliform rashes on both upper extremities and was initially diagnosed with allergic contact dermatitis. She had no respiratory symptoms and was eventually diagnosed with Covid-19 in a routine Reverse Transcription Polymerase Chain Reaction test (RT-PCR). She was subsequently admitted for treatment and recovered after 2 weeks of hospital stay.

Variant Cutaneous Manifestations of Extra Pulmonary Tuberculosis

Background: Ulcers and surgical wounds not healing well andexpectedly are common problems among patients in countrieslike us. Ulcers may develop spontaneously or following apenetrating injury. Wounds not healing well are commonamong poor, lower middle class and middle class people.Postsurgical non-healing wound or chronic discharging sinusesat the scar site are also common in that class of people.Suspecting malignancy or tuberculosis in these types ofwounds we have sent wedge or excision biopsy for theseulcers in about 500 cases and found tuberculosis in 65 cases.In rest of the cases histopathology reports found as nonspecific ulcers, malignant melanoma, squamous or basal cellcarcinoma, Verruca vulgaris.Objectives: To find out the relationship of tuberculosis withchronic or nonhealing ulcers.Methods: This is a prospective observational study conductedfor patients coming to our chambers, OPD of a district generalhospital and Shaheed Suhrawardy Medical College Hospital,Dhaka.Results: Mean age of the study subjects were 28±2. Amongthe study subjects nonspecific ulcer or sinus tracts were foundin 418 (83.6%), tuberculosis in 65 (13%), Malignant melanoma7 (1.4%), Verruca vulgaris 5 (1%), squamous cell carcinoma3(0.6), basal cell carcinoma 2 (0.4%). Biopsy done only forvery suspicious ulcers or wounds.Conclusion: With this very small sample size it is difficult toconclude regarding incidence of cutaneous involvement ofextra pulmonary tuberculosis, but every clinician should think ofit in case of suspicious non healing wounds, ulcers andprolonged discharge from a surgical incision site.

Association between thrombocyte and neutrophyl count with cutaneous manifestations in children with acute lymphocytic leukemia and acute myelocytic leukemia

Background: Acute leukemia is a hematopoietic stem cell malignant disease, with abnormal proliferation of leukemic and immature cells that suppress the production of normal blood cell and extensively invade peripheral tissues organs including skin. Homeostatic abnormalities that occur in leukemia e.g. thrombocytopenia and neutropenia. Various cutaneous manifestations can be observed in leukemia but the etiology is usually unknown, because many factors are responsible for this cutaneous manifestation. The aim of the present study was to determine association between thrombocyte and neutrophyl count with cutaneous manifestations in children with Acute Lymphocytic Leukemia (ALL) and Acute Myelocytic Leukemia (AML).Methods: This is an observational analytical cross-sectional study involving 51 children with acute leukemia (ALL and AML) were hospitalized in H. Adam Malik General Hospital Medan during April – September 2018. Interview, dermatology examination and recording thrombocyte and neutrophil count were performed to the subjects. Differences between thrombocyte and neutrophyl count with cutaneous manifestations were analyzed using Mann Whitney test. Association between thrombocyte and neutrophyl count with cutaneous manifestations were analyzed using Kolmogorov Smirnov test.Results: Children with Acute Leukemia in this study most of them were girls (51.0%), age between 0 - 5years old (39.2%). There were no significant differences between thrombocyte and neutrophyl count with cutaneous manifestations in children with acute leukemia (p value 0.692 and 0.814). There was no significant association between thrombocyte and neutrophyl count with cutaneous manifestations in children with acute leukemia (p value 0.490 and 0.803).Conclusions: There is no significant association between thrombocyte and neutrophyl count with cutaneous manifestations in children with acute leukemia.

A Clinical Study about Cutaneous Manifestations of Diabetes Mellitus in a Tertiary Care Hospital

Background: Diabetes mellitus (DM) is the most common endocrine disorder. Mucocutaneous manifestations of DM are many and vary from trivial to life-threatening and often herald the onset of diabetes. Aims: To study the incidence of mucocutaneous manifestations in diabetes mellitus with respect to demographic data such as age, sex and duration of diabetes mellitus. Methods: This is cross-sectional observational study of 200 diabetic patients with cutaneous manifestations attending skin and diabetic clinic OPD. Detailed history, clinical examination and relevant investigations were done to diagnose the mucocutaneous disorders and complications of diabetes. Results: Demographic profile showed majority of cases belonging to 5th decade (33%) and 4th decade(27%) with male preponderance. Cutaneous infections were most common (62%) followed by the dermatoses more commonly associated with diabetes (58%). Some patient had more than one cutaneous manifestation. Conclusion: Proper skin care and long-term control of blood glucose may reduce the risk of complications and is immensely beneficial to patient in long run.

A Case of Adult-Onset Still's Disease Presenting with Periorbital Edema

Adult-onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown etiology that is characterized by high-spiking fever, arthralgia, sore throat, and skin rash. The typical rash of AOSD is an evanescent, salmon-colored erythema, which is considered to be the major diagnostic criterion. Recently, other cutaneous manifestations of AOSD, such as persistent plaque and urticaria, have been reported. Here, we report a rare case of AOSD presenting with periorbital swelling and erythema. A 47-year-old woman was presented with periorbital swelling, erythema, high fever, arthritis, and a sore throat. One year prior to admission, she was diagnosed with AOSD based on the diagnostic criteria of Yamaguchi. The patient's periorbital swelling and erythema may not have been associated with periorbital cellulitis because they did not respond to antibiotics but did improve after treatment with steroids. Considering all of her signs and symptoms with a history of AOSD, periorbital lesion was suspected as atypical cutaneous manifestation of AOSD.

Three Cases of Cryptococcosis with Cutaneous Manifestations / 대한피부과학회지

Cryptococcosis is the infection caused by the encapsulated yeast Cryptococcosis neoformans. Cutaneous manifestation can develop as a result of the dissemination from pulmonary lesion or, rarely, through inoculation. They have variable morphologies, including papules or pustules, nodules, eczematoid plaques, ulcers, cellulitis, purpura and cold abscess. The authors experienced one case of disseminated cryptacoccosis by multiple papules and two cases of primary cutaneous cryptococcosis manifested by ulcerative lesions. We present 3 cases of cryptococcosis with cutaneous manifestations with review of literatures, especially in point of clinical manifestations.

A Clinical Study of Acute Graft-versus-host disease after Allogeneic Bone Marrow Transplantation: Cutaneous Manifestation / 대한피부과학회지

BACKGROUND: Acute graft-versus-host disease(GVHD) has been a major obstacle of successful allogeneic bone marrow transplantation(BMT). Because the onset of cutaneous graft-versus-host reaction (GVHR) is usually the earliest and certainly the most common form of the disease, cutaneous manifestation of acute GVHD is important to detect as early as possible. Except for a few case reports, there has been no clinical study of acute cutaneous GVHR in Korea so far. OBJECTIVE: We investigated the clinical characteristics of acute cutaneous GVHR in recepients receiving allogeneic BMT from human leukocyte antigen(HLA)-identical sibling donor. METHODS: On the basis of the patients' charts and the records of Catholic BMT center, we investigated the incidence of acute GVHD and the clinical manifestation of acute GVHD occurring in 102 patients of whom 66 patients were confirmed by histopathology. RESULTS: 1. The incidence of acute GVHD was 23.5 %, and the incidence of male and female were 22.4 %, 25.0 % respectively. 2. The cutaneous GVHR usually developed within 10-40 days after BMT and usually the earliest and most common form of the GVHD. 3. The most common cutaneous involvement site were upper extremities and chest and 51.4 % of cutaneous GVHR patients complained pruritus, pain and tenderness. 4. The over all clinical grade was lower than that in western countries. CONCLUSION: We speculate that the lower incidence of acute GVHD and milder clinical characteristics than the reports in the western countries might be related to differences in genetic background.

Cutaneous Manifestations and Nail Changes in Diabetes Mellitus / 대한피부과학회지

BACKGROUND: At least 30 per cent of diabetics, which is said to comprise over 3% of general population in Korea, have one or more cutaneous complications during the course of the disease. These skin changes may be the consequences of microangiopathy, arteriosclerosis, direct metabolic disturbances and/or the sequelae of chronic therapy. OBJECTIVE: We tried to observe certain cutaneous and nail changes in diabetics and to relate them with systemic complications, blood sugar level and duration of diabetes. METHODS: During the period of 12 months from March, 1992 to February, 1993, a total of 1858 outpatients diagnosed as diabetes mellitus at Eulji General Hospital were examined. RESULTS: The cutaneous manifestations are observed in 79.5% of diabetics examined and cutaneous infections are the most prevalent(52.3%). Pruritus(p<0.01), anogenital pruritus(p<0.01), peripheral dedema(p<0.05) are more common in females and infections, shin spots, finger pebbles(p<0.01) are more common in males. Systemic complications are observed in 50.7% and the cutaneous manifestations are observed more frequently in patients with systemic complications(p<0.05). Shin spots, diabetic foot, peripneral edema diabetic bullosis are observed frequently associated with systemic microangiopathic complications such as retinopathy, nephropathy and neuropathy(p<0.01). There is a significant correlation between blood sugar level and fungal infections and anogenital pruritus(p<0.01). The frequencies of shin spots, diabetic foot and diabetic bullosis increase with the length of time diabetes has been present. Nail changes are observed in 39.6% of diabetics and onychomycosis is the most frequent(34.5%). CONCLUSION: It is suggested that cutaneous shgns especially fungal infections in diabetics are on the increase in Korea. A variety of skin conditions are encountered with diabetes mellitus and the dermatologist may be able to make a significant contribution in the control of diabetes mellitus by identifying skin signs and conditions as diabetic complications.

Cutaneous Manifestations of Behcet's Syndrome

The clinical features of cutaneous manifestations in 411 patients with Behcet's syndrome were studied. 302 patients (73.5%) had skin lesions. The frequency with which the following skin lesions were noted was, in decreasing order; erythema nodosum-like lesion, papulopustular eruption, erythema multiforme-like lesion, thrombophlebitis, ulcer and Sweet's syndrome-like lesion. More than two types of skin lesions were seen in 86 patients (28.5%), the combination of the skin lesions being in decreasing order, erythema nodosum-like lesion and papulopustular eruption; erythema multiforme-like lesion and papulopustular lesion; erythema nodosum-like lesion and thrombophlebitis. A skin pathergy test was performed on 245 patients, and a positive reaction was seen in 97 patients (39.6%). This study showed the high incidence, wide spectrum and importance of skin lesions as a major symptom in Behcet's syndrome.

Statistical Study of Cutaneous Manifestations and Systemic Complications in Diabetes Mellitus / 대한피부과학회지

Cutarieous manifest,ations and systemic complications were observed in 521 patient., with diabetes mellitus. The results were as follows: Total 70, 8% of patients had complications', In 16. 5%, cutaneous manifestation were observed. Systemic complications were observed in 27 6%, Both eutaneous manifestations and systemic complications were observed in 26 7% 2 The cutaneous mariifestations observed in 43 2%, were cutaneous infection, pruritus, shin spot, diabetic foit, peripheral edema, diahetic bulla, foot gangrene and rutieosis in the order of frequency, 3, The cutaneous manifestations were much more observed in patients with systemic complications than without them(p<0 05), and with longer duration more than 10 years history, 4. It seems to be no relationship between the cutancous manifestations and fasting blood sugar level.