RÉSUMÉ
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.
RÉSUMÉ
Background: Majority of the hospitals in Malaysia have limited allergen series for patch testing. Since January 2011, Department of Dermatology in Selayang Hospital has extended its number of allergen series available for testing. Objectives: The aim of this study was to evaluate whether other series besides the European baseline series (EBS) deserve to be tested on suspected patient with contact dermatitis. Methods: Patch test results of patients visiting Dermatology clinic in Selayang Hospital from January 2001 to June 2011 were reviewed retrospectively. Results: Out of 129 patients who were patch tested, 98 (76%) patients had positive patch test, 30 (23.3%) patients had negative patch test and 1 (0.7%) patient had ‘Angry back’ reaction. The most commonly positive allergens were Nickel sulfate 45 (34.9%), Cobalt chloride 21 (16.3%), Potassium dichromate 15 (11.6%) and Balsam Peru 15 (11.6%). None of the patient had positive patch test to Mercaptobenzothiazole, Sesquiterpene lactone mix, Fragrance mix II and Lyral in the (EBS). The number of patient that will be missed if certain series are not tested were Textile Colours & Finish (TF) (n=4/7, 57.1%), Plastic & Glues (PG) (n=4/19, 21.1%), Hairdressing (n=1/5, 20%), Cosmetic (n=2/12, 16.7%), Rubber Additives (n=12/77, 15.6%), Medicament (n=1/9, 11.1%), Plant (n=0/5, 0%), Cutaneous Adverse Drug Reaction (n=0/3, 0%) and Leg Ulcer (n=0/1, 0%). Conclusion: The absence of positive patch test to Mercaptobenzothiazole, Sesquiterpene lactone mix, Fragrance mix II and Lyral does not support inclusion in the EBS in our region. Additional series especially TF and PG are important series to be tested in suspected patient.
RÉSUMÉ
Background Nursing progress notes in Selayang Hospital was found to be non-compliance according to Malaysian local accreditation bodies in 2007. In June 2008, Department of Dermatology were assigned with dedicated nurses. Aim To look into the quality of monitoring of Dermatology patients by nurses which is reflected by the content in nursing progress notes before and after being taught by Dermatology nurses. Methodology A retrospective comparative audit of the quality of nursing progress notes in ward patients that required Dermatology management in May 2006 and May 2009 in Selayang Hospital was performed. Parameters assessed include the patient’s general condition, skin symptoms and signs, alerting doctor whenever there is change in skin condition and nursing intervention. Exclusion criteria include documentation by the same nurse at different times. Results 325 nursing progress notes were reviewed in 2006 and also in 2009. 70% of nurses described the symptoms and signs of skin lesions at that point of time in 2009 whereas only 5% of nurses did that in 2006. Documentation of intervention performed for the current skin lesions in 2009 and 2006 were 81% and 48% respectively. Only 4% of nurses informed doctor on finding a change in skin condition 2006 as compared to 71% in 2009. Conclusion The audit shows that designated skin nurses can assist the ward nurses to improve their clinical documentation.
RÉSUMÉ
Background Erythroderma is a serious condition in itself, quite apart from hazards associated with the underlying disease, and is sometimes fatal. Prognostic studies are rare in the literature and to date there are no published studies to identify the factors that can determine good prognosis. Objectives The aim of the study is to determine the factors that can prognosticate the good outcome of erythroderma. Methodology Cross sectional study from patients diagnosed to have erythroderma between 2003 and 2007 were analyzed with regard to age, sex, race, underlying medical illness, aetiology, duration of rash before diagnosis of erythroderma, response to topical therapy and prognosis. Results Four variables (aetiology, gender, duration of rash before being diagnosed as erythroderma and response to topical therapy) were associated with good prognosis. These variables were statistically significant from univariate analysis. When these variables were included into the binary logistic model, the study did not have enough evidence to proof that ‘aetiology’ and ‘gender’ can determine good prognosis. Response to topical therapy and shorter duration of rash (equal and less than 120 days) were significant with odds ratio (CI) of 4.11 (1.556, 10.885) and 4.608 (1.903, 11.155) respectively. Conclusion Shorter duration of rash and response to topical therapy are important factors to determine a good prognosis.
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ENL is a type ll leprosy reaction and occurs in people with borderline lepromatous and lepromatous leprosy, usually as a complication following treatment. The treatment of choice for ENL is prednisolone in view of its’ ready availability and affordability1. Howeve r, glucocorticoid therapy, even in low doses, can produce substantial toxicity. The risk is clearly greater as the dose increases. However, in cases where there are steroid-induced complications, high-dosed clofazimine may be used to reduce or withdraw corticosteroids in steroid-dependant cases2,3. We described 2 steroid-dependent ENL patients with steroid-induced complications who are successfully managed with the addition of highdosed clofazimine and the resultant weaning down of systemic glucocorticoids.