Novel transdermal device for delivery of triamcinolone for nail psoriasis treatment

INTRODUCTION@#Nail psoriasis treatment is challenging due to difficult drug delivery and systemic therapy toxicities. Self-dissolvable microneedle patches embedded with corticosteroids offers a potentially rapid, minimally invasive drug delivery platform with good efficacy and minimal adverse side effects.@*METHODS@#We conducted a 4-month prospective randomised controlled trial. Subjects with psoriatic nails were randomised to receive microneedle device delivered topical steroids on one hand and control treatment (topical Daivobet gel) on the other. Two independent dermatologists blinded to the treatment assignment scored their Nail Psoriasis Severity Index (NAPSI) during visits at baseline, 2 and 4 months. All treatment was discontinued after 2 months. Average NAPSI score on each hand was analysed.@*RESULTS@#A total of 25 participants were recruited, aged 22 to 73 years. Majority were Chinese (72%), followed by Indian and Malay. There was equal randomisation of treatment to the left and right nail. While there was a rapid significant improvement in average NAPSI score for the control arm at 2 months, the treatment arm had a greater, more sustained improvement of the NAPSI score at 4 months. The average NAPSI score improved for both treatment and control group at 4 months compared to baseline. However, only the NAPSI value improvement in the controls at 2 months compared to baseline was statistically significant (P=0.0039). No severe adverse effects were reported.@*CONCLUSION@#To the best of our knowledge, this is the first prospective randomised control trial comparing microneedle technology against conventional topical steroids in nail psoriasis treatment. Our findings demonstrate microneedle technology is as efficacious as topical therapy.

A clinico-pathological approach to management of atopic dermatitis

Recent research in atopic dermatitis (AD) has identified it to be a heterogeneous inflammatory skin disorder of different endotypes (immune polarisation of T-cell subsets and genetic mutations) underlying various phenotypes (age of onset, ethnicity, disease severity, etc.). The corresponding heterogeneity in underlying patho-mechanisms of the disease has resulted in an impetus towards an endotype-driven management of AD. We propose a practical approach that is based on classifying AD patients into intrinsic and extrinsic phenotypes and their corresponding underlying endotypes. This approach aims to provide a practical method that integrates recent understanding of AD pathogenesis for a targeted endotype-driven management of AD.

Causes and features of erythroderma

<p><b>INTRODUCTION</b>Erythroderma is a generalised inflammatory reaction of the skin secondary to a variety of causes. This retrospective study aims to characterise the features of erythroderma and identify the associated causes of this condition in our population.</p><p><b>MATERIALS AND METHODS</b>We reviewed the clinical, laboratory, histological and other disease-specific investigations of 225 inpatients and outpatients with erythroderma over a 7.5-year period between January 2005 and June 2012.</p><p><b>RESULTS</b>The most common causative factors were underlying dermatoses (68.9%), idiopathic causes (14.2%), drug reactions (10.7%), and malignancies (4.0%). When drugs and underlying dermatoses were excluded, malignancy-associated cases constituted 19.6% of the cases. Fifty-five percent of malignancies were solid-organ malignancies, which is much higher than those previously reported (0.0% to 25%). Endogenous eczema was the most common dermatoses (69.0%), while traditional medications (20.8%) and anti-tuberculous medications (16.7%) were commonly implicated drugs. In patients with cutaneous T-cell lymphoma (CTCL), skin biopsy was suggestive or diagnostic in all cases. A total of 52.4% of patients with drug-related erythroderma had eosinophilia on skin biopsy. Electrolyte abnormalities and renal impairment were seen in 26.2% and 16.9% of patients respectively. Relapse rate at 1-year was 17.8%, with no associated mortality.</p><p><b>CONCLUSION</b>Our study highlights the significant proportion of malignancy-related erythroderma in those whom common underlying causes such as dermatoses and drugs have been excluded. In cases of drug-related erythroderma, traditional medications and antituberculous medications are common causes in our population. Renal impairment and electrolyte abnormalities are commonly seen and should be monitored in patients with erythroderma.</p>

Exogenous ochronosis in a Chinese patient: use of dermoscopy aids early diagnosis and selection of biopsy site

The diagnosis of exogenous ochronosis is often challenging and requires a high index of suspicion. Herein, we report a case of exogenous ochronosis in a Chinese patient. The condition was caused by the use of bleaching agents, including creams containing hydroquinone. We demonstrate the use of dermoscopy as an invaluable tool for the early recognition of the condition, as well as in the selection of an appropriate site for a skin biopsy.