Skin diseases during floods in Thailand.

BACKGROUND: Floods are natural disasters that occur occasionally in Thailand. The most common form skin diseases due to floods are infectious dermatoses especially superficial fungal infection. However the microbiologic evidences have not been evaluated. OBJECTIVE: To evaluate the most common skin diseases during floods and identify the organism that causes skin maceration at web space(s) of toes (Hong Kong foot). MATERIAL AND METHOD: Patients who complained of skin problems were evaluated at the temporary outpatient clinic during October 2006. Skin specimens from all patients who had itches and skin maceration at web space(s) of toes were cultured. RESULTS: Ninety-six patients were evaluated (38 males and 58 females). Eczema was the most prevalent dermatosis, which accounted for 34.5% of the total skin problems and the great majority of these cases were irritant contact dermatitis. Sixteen cases presented with itch and skin maceration at web space(s) of toes. All of them were colonized with various microorganisms. Gram-negative bacilli were the most prevalent ones and were found in 14 out of 16 specimens. Fungal culture was positive in only two specimens. CONCLUSION: Eczema is the most common dermatosis during floods. Skin maceration at web space(s) of toes, which were thought to be fungal infection, are chronic irritant dermatitis with secondary bacterial colonization. Only a few cases were fungal infection. Microbiologic investigation should be done in these patients. Unfortunately, it is not practical in such a situation. Topical medications that have the combination of antiinflammatory, antibacterial and antifungal properties are the most suitable medications.

Drug eruptions at five institutes in Bangkok.

The study was performed in five hospitals in Bangkok for a period of one year. All in- and outpatients who developed drug eruption from January to December 2001 were enrolled into the study. Physical examinations and complete history-taking were performed by one of the authors. A skin biopsy was done to confirm the diagnosis in every suspected case. Oral challenge test was performed to obtain a definite diagnosis only in some patients with informed consent. Among 212 patients, the most common causative drugs were antimicrobial agents with cephalosporin group in the highest rank. Maculopapular rash was the most common type of drug eruption followed by urticaria and photosensitivity reaction. It was concluded that antimicrobial agents were the predominant causative agents and maculopapular eruption was the most frequent clinical manifestation. New kinds of antimicrobial agents, anti-inflammatory drugs and lipid lowering agents could cause various patterns of drug eruption.

Herpes zoster, clinical course and associated diseases: A 5-year retrospective study at Tamathibodi Hospital.

OBJECTIVE: Herpes zoster was more frequently found in immunocompromised hosts and elderly persons than in general population. The aim of this study is to find out the distributions of skin lesions, treatments, complications of herpes zoster and associated diseases that occur in concomitant with or after herpes zoster infections. MATERIAL AND METHOD: The medical records of the patients diagnosed as herpes zoster between January 1995 - December 2000 were reviewed. Only the patients who were followed up regularly at Ramathibodi hospital for at least 3 years after the first diagnosis of herpes zoster were enrolled into the study. Demographic data, distribution of skin lesions, treatments, complications of herpes zoster and associated diseases were recorded. RESULTS: Three hundred and ninety-nine cases were enrolled in the study. Three hundred and ninety-eight patients (99.7%) had one dermatomal involvement. Sixty-seven patients (16.8%) had postherpetic neuralgia. Fifty-six patients had associated HIV infection. In 3 years followed up, 17 patients developed HIV infection, 3 patients developed acute leukemia, 2 patients developed mycosis fungoides.

Sarcoidosis presenting as papulonecrotic tuberculid-like lesions: report of a case.

A 50-year-old Thai woman presented with papulonecrotic tuberculid-like eruptions on her back and inframammary area with fever, nonproductive cough and weight loss. Chest radiograph showed diffuse bilateral reticulonodular opacities in both lungs with bilateral hilar lymph node enlargement. High resolution computed tomography (HRCT) of the lungs showed peribronchovascular interstitial thickening with multiple lymph nodes enlargement. Sputum for AFB was negative. Monotest (PPD) was negative. Skin biopsy revealed multiple naked granuloma compatible with sarcoidosis. She was treated with isoniazid, 300 mg/d, rifamipicin, 600 mg/d, ethambutal, 800, mg/d and pyrazinamide, 1000 mg/d for 2 months without improvement of skin and lung lesions. Prednisolone 45 mg/d was then administered adjunctive with isoniazid and rifampicin. After two weeks of treatment with prednisolone, the cutaneous and pulmonary lesions markedly improved Prednisolone was tapered in 6 months. Skin lesions, fever; dry cough disappeared and chest radiograph, HRCT of the chest were markedly improved.

Sweet's syndrome: a reaction to non-tuberculous mycobacterial infections.

Sweet's syndrome has been reported to be associated with many underlying conditions, such as non-tuberculous mycobacterial infections (NTMI). In the literature, only twelve patents with Sweet's syndrome in association with NTMI have been reported (most of the patients were from Thailand). Here, the authors report six more patients who developed Sweet's syndrome as a reaction to NTMI. Four patients had Mycobacterium chelonae/abscessus group infection; one patient had been infected with Mycobacterium avium complex first and became infected with M. chelonae/abscessus group 17 months later; and, the other one had Mycobacterium fortuitum infection. In each patient, the skin lesions of Sweet's syndrome relapsed many times while they still had NTMI, and these lesions usually responded well to short courses of systemic steroids without any deterioration of NTMI.

Long-term follow-up of erythema nodosum.

One hundred and fifty-four patients with erythema nodosum who attended the skin clinic at Ramathibodi Hospital from January 1990 to December 2000 were evaluated retrospectively with regard to the etiology of erythema nodosum. Of 49 patients who attended the skin clinic during that time 26 returned for reevaluation. Of the 154 patients, their ages ranged from 10-72 years old; 138 were females, 16 were males. The most common cause of erythema nodosum was tuberculosis (12.3%). Upper respiratory tract infection was found in 3.9 per cent. Other causes included Behcet's disease, sytemic lupus erythematous, drugs, pregnancy, chronic myeloid leukemia, leprosy, Reiter's syndrome and inflammatory bowel disease. Of the 26 patients who returned for reevaluation, pulmonary tuberculosis was identified in only one patient who had developed erythema nodosum 16 months earlier. In conclusion, it was found that tuberculosis is still a predominant cause of erythema nodosum among Thai patients.

Prevalence of thyroid antibodies in Thai patients with chronic idiopathic urticaria.

One hundred Thai patients with chronic idiopathic urticaria (CIU) were studied to determine the prevalence of thyroid antibodies in comparison to 100 age- and sex-matched healthy volunteers. It was found that 21 patients (21%) with CIU were positive for thyroid antibodies. Among normal volunteers, only nine cases (9%) had elevated titers of thyroid antibodies. The frequency of thyroid antibodies in the chronic urticaria group was significantly more common than the control group (chi-square = 4.75, p=0.03). Among 21 patients with CIU who were positive for thyroid antibodies, 9 cases were negative for thyroid antibodies when repeating the tests after 3 months. Only 12 patients still had persistent elevation of antibodies after 3 months and thyroid function test was performed in these 12 patients. It was found that 9 cases had autoimmune thyroiditis with euthyroidism. One case had subclinical hyperthyroidism. One case had autoimmune hyperthyroidism, One case had subclinical hypothyroidism.

Comparative study of the efficacy of topical corticosteroid: five locally made and one brand name creams.

The aim of this study was to evaluate the efficacy of 5 locally made clobetasol propionate creams compared with a brand name product. The study was divided into 3 parts 1) pharmacological study, 2) vasoconstriction test, and 3) double blind clinical trial. The results showed that the pharmacological properties of the locally made products were not different from the brand name product. Product C and D could diffuse through cellulose acetate membrane 3 fold more than the brand name product. Product D and E caused less vasoconstriction than the brand name product. This double blind study showed that all locally made products could improve psoriasis to the same extent as the brand name product, but there was more recurrence of psoriasis while using all the locally made products. It was concluded that locally made products were as effective as the brand name product in the treatment of psoriasis evaluated over a 2 week peroid, but more recurrence was observed with locally made products.

Correlation of histological subtypes of basal cell carcinoma with age, sex and distribution of skin lesions: a five-year study at Ramathibodi Hospital.

Records and histopathology of skin lesions of patients with basal cell carcinoma (BCC) who attended the skin clinic at Ramathibodi Hospital from 1993 to 1997 were reviewed to find the correlation of histological subtypes with age, sex and distribution on the body of BCC. It was found that superficial BCC was significantly more common on the trunk, while other types were significantly more common on the head and neck. The mean age and sex of the patients with superficial BCC were not different from those other subtypes. It was concluded that superficial BCC tended to be more common on the trunk while other types were more common on the head and neck. The pathogenesis of superficial BCC may be different from other types of BCC.

Drug eruptions: the value of oral rechallenge test and patch test.

All in-and out-patients, who came for drug eruption consultation at the Dermatology Clinic, Ramathibodi Hospital from December 1997 to November 1998 were included in this study. Medical histories and physical examinations were performed by one of the authors. In suspected cases, a skin biopsy was performed to confirm the diagnosis. Patch test and oral challenge test were performed in some patients who had maculopapular, fixed drug eruption and acute generalized exanthematous pustulosis, with informed consent. Among 80 patients, the most common cutaneous reaction was maculopapular rash. Antimicrobial, drugs were the most common causative agents. The patch test was positive in only one patient from 12 cases. The oral provocative test was positive in two patients from 4 cases. It is concluded that oral provocative test is still necessary to get a definite diagnosis of causative agent. The value of patch test needs further study.