The Effectiveness of Local Surgical Technique in Treatment of Axillary Bromhidrosis.

BACKGROUND: Up to now, surgical excision of apocrine glands still has been a method that yields high treatment results and low rate of odour recurrent for patients, but many people worry about some serious complications that have been observed postoperatively, such as hematoma and skin necrosis. These prolong wound healing, leading to unsightly scars in the axillary fossae. AIM: We conducted this research to investigate the effects and complications of our surgical technique for axillary bromhidrosis. METHODS: Forty-three patients with axillary bromhidrosis were treated. An elliptical incision was made at a central portion of the area marked, with both tips of the ellipse along the axillary crease. The elliptical skin with the subcutaneous tissue was removed en lock. The adjacent skin was undermined to the periphery of the hair-bearing area with straight scissors. The undermined subcutaneous tissue was removed with curved scissors, and the skin was defatted to become a full-thickness skin flap. Any suspected hemorrhagic spots were immediately coagulated electrosurgically. Appropriate drains were placed, and the treated area was covered with thick gauze to each axilla. Arm movement was strictly controlled in the first 3 days post-operatively. RESULTS: Thirty-one patients have been followed up and evaluated for 6 months. 56 out of 62 axillae (90.3%) showed good to excellent results for malodor elimination. All patients reported a reduction in axillary sweating. There were two axillae of skin necrosis and three axillae of hematoma, with one patient receiving an anticoagulant from a cardiologist after the first day of surgery, to treat heart valve disease. The Dermatology Life Quality Index (DLQI) score decreased significantly, and the quality of life improved after the operation. CONCLUSION: Our technique is a simple surgical procedure and easy to perform helping to achieve results for high malodor elimination, with almost no serious complications. Patient's life quality improved significantly after the operation.

Improving Treatment Outcome of Pemphigus Vulgaris on Vietnamese Patients by Using Desmoglein Elisa Test.

BACKGROUND: Pemphigus Vulgaris (PV) is a chronic disease, is characterized by the presence of flacid bullous in skin and mucosa. There are 2 main autoantibodies against desmoglein3 (Dsg3) and desmoglein1 (Dsg1). AIM: The aims of this study were to evaluate the before and after treatment outcome with corticosteroid, using Desmoglein ELISA test. METHOD: Forty patients with Pemphigus include 36 PV and 4 PF (28 women, 12 women) were enrolled. The titers of Dsg in pemphigus patients by using ELISA test were done before and 1-month treatment. RESULTS: Both anti-Dsg1 and anti-Dsg3 levels were significantly reduced after treatment (P < 0.05). The severity of skin lesions was correlated with anti-Dsg1 antibody level and the severity of oral lesions was significantly correlated with anti-Dsg 3 antibody levels (p < 0.05). CONCLUSION: It is recommended that we can predict and improve the outcome of treatment by using Desmoglein ELISA test.

Clinical Aspects and Treatment of Pityriasis Lichenoides Et Varioliformis Acuta: A Retrospective Vietnamese Study.

BACKGROUND: Pityriasis lichenoides et varioliformis acuta (PLEVA) is an uncommon condition which presents acutely with papulo-vesicles that may develop necrotic, ulcerative, or hemorrhagic changes. AIM: We studied clinical, and treatment characteristics of PLEVA hospitalised patients at our hospital from September 2009 to December 2014. METHODS: The records of 15 PLEVA patients were retrospectively reviewed. RESULTS: The median age of onset was 21.8 ± 18.81 (from 1 to 68), male to female ratio was 2/1. The common area of onset was trunk (60.0%) and extremities (33.3%). Clinical features were purpuric papules (100%), hemorrhagic crusted papules (46.7%), pustular purpuric papules (40%), and necrotic ulcerating lesions (13.3%). CONCLUSION: All patients were received systemic antibiotics (macrolides: 53.3%, others: 46.7%), 2 patients were added immunosuppressive drugs. A 1-year-old patient died, others had a good response.

Efficacy and Safety of Methotrexate in Combination with Mini Pulse Doses of Methylprednisolone in Severe Alopecia Areata. The Vietnamese Experience.

BACKGROUND: Treatment of severe alopecia areata remains very difficult, especially in alopecia areata totalis and alopecia areata universalis. Methotrexate is known to be effective in the treatment of severe and chronic autoimmune disorders. OBJECTIVE: To assess the effectiveness and safety of MTX in combination with mini pulse dose of methylprednisolone in the treatment of severe alopecia areata. PATIENTS AND METHODS: The open, uncontrolled study compared pre-treatment and after-treatment. Thirty-eight patients (age 16-64) with severity AA (SALT score > 50 %) visiting National hospital of Dermatology and Venereology from April-2004 to September-2015 were enrolled. All patients received oral methylprednisolone 24mg/day for 3 consecutive days of a week in combination with oral MTX 7,5 mg weekly. This regimen is maintained up to 12 weeks and follow-up until to 6 months. RESULTS: After 6 months, 60.5% of patients show complete hair growth (good response) and 18.4% shows the medium response. There is a significant SALT score reduction: mean baseline SALT score 84.39 ± 17.03 compared to mean post-treatment SALT score 24.19 ± 29.42. Good clinical improvement noted in after 3 months. We do not observe any side- effects related to oral MTX and oral methylprednisolone, and no patients had to withdrawal treatment due to side- effects. CONCLUSION: Combination Methotrexate and mini pulse dose of methylprednisolone are effective and safe in treatment severity alopecia areata.

Using Patch Testing to Improve Therapeutic Outcome in the Treatment of Hand Eczema in Vietnamese Patients.

BACKGROUND: Hand eczema is a common chronic and relapsing skin disease with various clinical features. Hand eczema aetiology can be allergic contact dermatitis (ACD), irritant contact dermatitis (ICD), atopic dermatitis (AD) and unknown or combination causes. If the causative agents are not detected treatment of hand eczema will be a failure. A patch test can be useful to detect causative agents in suspected allergic contact hand eczema. Then patients will avoid contacting them. This results in the improvement of hand eczema. In Vietnam, patch test has not been used before, so we conduct this study. AIM: To identify causative allergens by using patch test with 28 standard allergens in consecutive patients. METHODS: A group of 300 HE patients from the National Hospital of Dermatology and Venereology (NHDV) in Vietnam were enrolled in this study. They were divided into 4 groups-ACD, ICD, AD and unknown aetiology. The patient was patch tested with 28 standard allergens to identify the causative agents. RESULTS: Among the 300 HE enrolled patients, ACD accounted for 72.7%, AD and ICD had the same rate of 12.7%. 39.3% of the patients had a positive patch test. Reaction to nickel sulfate was the most common (10.3%), followed by potassium dichromate (9.7%), cobalt (4%) and fragrance mix (3.1%). About one-third of the cases had relevant clinical reactions correlated with the contact agents and clinical history. Males reacted to cement, thiuram mix and formaldehyde more than females, while females reacted to a nickel more than males. CONCLUSIONS: Hand eczema has variable clinical features and diverse aetiology. ACD is an important cause of hand eczema that can be managed with a patch test to detect causative allergens. Nearly 40% of HE cases had positive patch test. Relevant patch test reactions were seen in one-third of the patients. We propose using patch test detect causative agents in suspected allergic contact hand eczema. Then patients will avoid contacting them. This results in the improvement of hand eczema.

Efficacy of Surgical Excision for Nevus Sebaceous - Vietnamese Experience.

BACKGROUND: Nevus Sebaceous (NS) is hamartoma predominantly composed of sebaceous glands and is classified as a type of epidermal nevus. In most case, clinical manifestation of NS is typical, so histopathology examination is important only in atypical lesions for its risk of malignancy. Clinical symptoms are plaques or papules (100%), appearing in the head area (100%) with smooth surface (65.8%), usually with hair loss (60.7%). The histopathology is mostly characterized by the image of sebaceous gland hyperplasia (100%), no hair follicles (60.7%) or immature follicles (14.3%). AIM: The aim of our study is describing clinical and histopathological manifestation, make diagnosis and evaluate the best therapy. METHODS: Our study recruited 38 patients with NS, 3 patients (7.9%) with atypical aspects. All patients were treated by surgical excision. RESULTS: Complications as hair loss and infections were reported in 36.8% patients. No patients had recurrence after one year of treatment. CONCLUSION: Based upon our experience, surgery is cheap, simple, associated with high aesthetics effectiveness and low recurrence rate, proposing as the first choice for treatment of NS.

Efficacy of Oral Isotretinoin in Combination with Desloratadine in the Treatment of Common Vulgaris Acne in Vietnamese Patients.

AIM: To evaluate the efficacy of oral isotretinoin used alone and in combination with desloratadine in the treatment of moderate acne vulgaris. METHODS: A comparative clinical trial was undertaken to evaluate the efficacy of oral isotretinoin alone and in combination with desloratadine in the treatment of 62 moderate acne vulgaris patients. Patients were randomised into two groups with 31 patients in each group. Each studied group's patient took 20 mg isotretinoin and 5 mg desloratadine per day. In the control group, patients took only 20 mg isotretinoin per day. The treatment time was 16 weeks. The evaluation and follow-up were done at week 2, 4, 8, 12 and 16 of the treatment. RESULTS: The studied group had a better curative rate than the control group (45.2% versus 22.6%). The average number of inflammatory lesions in the studied group was significantly lower than the control group (0.19 versus 0.94). The mean GAGS score of the studied group was significantly lower than the control group (3.71 versus 6.52). Acne outbreaks rate of the studied group was lower than the control group (in week 2: 22.6% versus 45.2% and in week 4: 16.1% versus 38.7%, respectively). The rate of itchy was lower in the studied group. CONCLUSION: In the treatment of moderate acne vulgaris, oral isotretinoin in combination with desloratadine is more effective and has fewer side effects than using isotretinoin alone.

The Effectiveness of Narrow Band Uvb (Nb-Uvb) In the Treatment of Pityriasis Lichenoides Chronica (PLC) In Vietnam.

AIM: This prospective clinical study presents the experiences with NB-UVB monotherapy in the treatment of PLC on Vietnamese patients. METHODS: We enrolled at National Hospital of Dermatology and Venereology (NHDV), Vietnam, 29 PLC patients with generalised disease involving at least 60% of the total body surface (based on Nine's Rule) and/or failed to respond to other modalities of treatment. Patients were treated with NB-UVB followed the guideline of the psoriatic treatment of AAD-2010, three times weekly. RESULTS: A complete response (CR) was seen in 24 out of 29 PLC patients (82.8%) with a mean cumulative dose of 9760.5 mJ/cm2 after a mean treatment period of 4.6 weeks (13.8 ± 7.4 exposures). Mild side effects were observed: 69% erythema minimum, 55.2% irritation related to dry skin. No severe side effects were seen during the study. No relapses occurred in 24 CR patients within a mean period of 3 months after the last treatment. CONCLUSION: NB-UVB therapy is an effective and safe option for the treatment and management of PLC.

Efficacy of Narrow - Band UVB Phototherapy versus PUVA Chemophototherapy for Psoriasis in Vietnamese Patients.

BACKGROUND: Psoralen UVA (PUVA) and narrow-band UVB (NBUVB) chemophototherapy are treatment options for psoriasis. AIM: To compare the effectiveness of NBUVB with PUVA in Vietnamese psoriasis patients. METHODS: We conducted a non-randomized trial on 60 patients with plaque-type psoriasis (30 NBUVB, 30 PUVA). Both regimens were thrice-weekly. The extent of lesion was assessed by the Psoriasis Area Severity Index (PASI). Clearance was defined as a ≥ 75% reduction in a follow-up PASI score from baseline. Patients with clearance were followed-up until 6 months after stopping treatment. Relapse was defined as 50% or more of the original extent. RESULTS: The proportion of patients achieving PASI75 was comparable (76.7% in NBUVB versus 80% in PUVA; p > 0.05). Patients in both groups had a similar number of sessions to achieve clearance but patients in the PUVA group exposed to a significantly higher cumulative UV dose. After six months, the relapse rate was higher in the NBUVB group compared with in the PUVA group (p > 0.05). CONCLUSION: Thrice weekly NBUVB is as effective as thrice weekly PUVA in treating psoriasis for Vietnamese patients.

Efficacy of Oral Itraconazole in the Treatment of Seborrheic Dermatitis in Vietnamese Adults Patients.

AIM: This longitudinal study aims to evaluate the efficacy of oral itraconazole in the treatment of seborrheic dermatitis in Vietnamese patients. METHODS: Thirty patients were enrolled at National Hospital of Dermatology and Venereology, Hanoi, Vietnam and were treated with oral itraconazole (200 mg daily in 14 days followed by 200 mg weekly in 4 weeks). The clinical severity was assessed by a four-parameter scoring system. All patients completed the six-week regimen with good adherence. RESULTS: At the week 2nd, 70% of the patients had moderate to severe diseases. At the week 6th, 63.4% of the patients achieve clearance of the lesions, and none had severe disease. No side effects were reported. CONCLUSION: Oral itraconazole can be an option for seborrheic dermatitis because of good efficacy, safety profile and adherence.

Effectiveness, Safety and Tolerance of Methotrexate in Vietnamese Psoriatic Arthritis Patients.

AIM: To access the effectiveness, safety and tolerance of methotrexate (MTX) in psoriatic arthritis (PsA) treatment. METHODS: We recruit 37 patients, admitted at HCMC Hospital of Dermato-Venereology from 1/2016 to 3/2017, with MTX dosage ranging from 10 mg to 15 mg per week. RESULTS: Skin lesion response after 12 weeks improved PASI 50: 40.5%, PASI 75: 24.3%. Disease activity score decreased after 12 weeks with ∆DAS28 = -1.43 + 0.79, 37.8% PsA achieved complete remission. Nausea and vomiting were 8.1%. These symptoms were mild and transient. We did not stop MTX usage. The rate of elevating SGPT 2-3 times as much as the upper limit of the normal range was 2.7%. CONCLUSION: We finally demonstrated that the rate of treatment response in Vietnam is the same as demonstrated by foreign authors in other countries.

The Efficacy of a Two-Fold Increase of H1-Antihistamine in the Treatment of Chronic Urticaria - the Vietnamese Experience.

BACKGROUND: Chronic urticaria, a mast cell-driven condition, is common, debilitating and hard to treat. H1-antihistamines are the first line treatment of chronic urticaria, but often patients do not get satisfactory relief with the recommended dose. European guidelines recommend increased antihistamine doses up to four-fold. AIM: We conducted this study to evaluate the efficacy of increased H1-antihistamine doses up to two-fold in Vietnamese chronic urticaria patients. METHODS: One hundred and two patients with chronic urticaria were recruited for treatment with levocetirizine (n = 52) or fexofenadine (n = 50). Treatment started at the conventional daily dose of 5 mg levocetirizine or 180 mg fexofenadine for 2 weeks and then increased to 10 mg levocetirizine or 360 mg fexofenadine for 2 weeks if patients did not have an improvement in symptoms. At week 0, week 2 and week 4 wheal, pruritus, size of the wheal, total symptom scores, and associated side-effects were assessed. RESULTS: With the conventional dose, the total symptom scores after week 2 decreased significantly in both groups compared to baseline figures, i.e. 7.4 vs 2.3 for levocetirizine group and 8.0 vs 2.6 for fexofenadine group (p < 0.05). However, there were still 26 patients in each group who did not have improvements. Of these 26 patients, after having a two-fold increase of the conventional dose, 11.5% and 38.5% became symptom-free at week 4 in levocetirizine group and fexofenadine group, respectively. At week 4 in both groups, the total symptom scores had significantly decreased when compared with those at week 2 (2.8 ± 1.5 versus 4.7 ± 1.6 in levocetirizine group; 2.1 ± 1.9 versus 5.1 ± 1.4 in fexofenadine group). In both groups, there was no difference in the rate of negative side effects between the conventional dose and the double dose. CONCLUSION: This study showed that increasing the dosages of levocetirizine and fexofenadine by two-fold improved chronic urticaria symptoms without increasing the rate of negative side effects.

Efficacy of 10% Potassium Hydroxide Solution Versus 10% Salicylic Acid Ointment in Treatment of Molluscum Contagiosum - the Low - Cost Dermatologic Therapy in Vietnam.

BACKGROUND: Molluscum contagiosum is a common viral disease primarily affecting children. AIM: The objective is to compare the efficacy of 10% potassium hydroxide (KOH) solution versus 10% salicylic pomade in the treatment of molluscum contagiosum. METHODS: Clinical trials on 70 patients were randomised into 2 groups: 39 patients treated with 10% KOH solution and 31 patients treated with 10% salicylic pomade. The evaluation was based on the complete clearance of lesions, side effects and complications of the drug. RESULTS: The clearance of all lesions after 2, 4, 6, 8 weeks of treatment in both groups were 7.7%; 23.1%; 53.8%; 79.5% and 0%; 3.2%, 9.7% 22.6%, respectively (p < 0.05). Side effects were seen in both groups include burning (76.9% versus 19.4%; p < 0.05); redness (59% versus 14%; p < 0.01); desquamation (12.8% versus 19.3%; p < 0.05). CONCLUSION: The efficacy of KOH solution in the treatment of MC was better than that of salicylic pomade and both products are safe, effective, and easy to apply at home.

Efficacy of BAFF in Monitoring Treatment Response in Early Vietnamese Systemic Sclerosis Patients.

BACKGROUND: B-cell activating factor (BAFF) is considered to have a role in the pathogenesis of systemic sclerosis (SSc). AIM: We conducted a longitudinal study on early SSc patients to determine the change in BAFF serum level after treatment and its association with organ involvements. METHODS: A total of 46 patients (32 diffuse, 14 limited) were recruited, among which 35 patients (24 diffuse, 11 limited) completed 12-month follow-up. RESULTS: Higher pretreatment BAFF levels were observed in patients with positive anti-topoisomerase antibody (ATA) (2252.1 ± 899.7 pg/ml versus 1475.5 ± 697.6 pg/ml in ATA-negative patients; p = 0.01) and muscular involvement (2741.9 ± 1039.9 pg/ml versus 1897.2 ± 762.9 pg/ml in patients without muscular involvement; p = 0.005). Lower levels were observed in patients with interstitial lung disease (ILD) (1926.7 ± 757.9 pg/ml versus 2721.6 ± 1131.4 pg/ml in non-ILD patients; p = 0.01). After treatment, BAFF level reduced significantly in diffuse SSc patients (1652.2 ± 892.7 pg/ml versus 2147.6 ± 945.5 pg/ml before treatment; p = 0.03). CONCLUSION: Patients with worsening outcome had the highest pretreatment BAFF level and was associated with increased BAFF level after treatment. BAFF can be used to predict and monitor patients' response to therapy.

Successful Treatment of Intralesional Triamcilonon Acetonide Injection in Keloid Patients.

AIM: Evaluation the effect of intralesional corticosteroid injection on keloid, at the National Hospital of Dermatology and Venereology from 1/2009 to 12/2009. METHODS: A group of 65 patients with keloid were randomly assigned into three groups. In the studied group, 33 patients were intralesionally injected 7.5 mg/1 cm2 of TCA. In the control group, TAC 32 patients were intralesionally injected 15 mg/1 cm2 of TCA. The result was evaluated basing on the criteria of Henderson (1998) and El-Tonsy (1996). RESULTS: In comparison between 2 groups, good to excellent improvement in the studied group was statistically higher than the control group (90.7% versus 68.7%; p < 0.05). After each injection, the thickness of the scar was reduced 1.24 ± 0.53 mm in the studied group and 0.81 ± 0.39 mm in the control group. The disappearance of pain and itching after treatment were 86.6% and 95.5% in the studied group and 78.1% and 80% in the control group (p > 0.05). Ulceration, acne and troublesome with menstrual cycles were sometimes were noted more frequently in the control group than in the studied group. CONCLUSION: Intralesional triamcinolone acetonide injection had a good result, and 7.5 mg/1 cm2 scar is the best dose for treatment of keloid.

Successful Treatment of Vitiligo Vietnamese Patients with Vitilinex® Herbal Bio-Actives in Combination with Phototherapy.

BACKGROUND: Vitiligo is an acquired pigmentary disease, that causes progressive loss of melanocytes, resulting in hypopigmented skin patches. Current treatments aim at stopping the disease progression and achieving repigmentation of the amelanotic areas. Corticosteroids, surgery, topical immunomodulators, total depigmentation of normal pigmented skin and phototherapy are current treatment options for vitiligo although phototherapy remains the treatment of choice. There is no documented evidence that herbal bio-active products may also be effective treatment options for vitiligo. AIM: This study aimed to investigate the efficacy and safety of Vitilinex® (herbal bio- actives) alone and in combination with UVB narrowband (311 nm) phototherapy, in the treatment of localised stable or active forms of vitiligo. MATERIAL AND METHODS: Sixty two subjects with mean age 34.5 years (range: 18-58 years) with mild to moderate vitiligo, consisting of 36 females and 26 males were randomly divided into three treatment groups - Group A (13 females, 10 males) treated with Vitilinex® alone; Group B (12 females, 11 males) were treated with Vitilinex® in combination with narrowband UVB (311 nm) phototherapy for 15 seconds, using a handheld lamp and Group C (8 females, 8 males) were treated with nbUVB (311 nm) phototherapy alone, for 15 seconds over a 12-week period. RESULTS: In Group A, 9 patients (39%) achieved outstanding improvement with a re-pigmentation rate higher than 75%, with 2 patients experiencing total repigmentation. 6 patients (26%) had marked improvement with a repigmentation rate between 50-75% while 5 patients (22%) showed a moderate response between 25-50% re-pigmentation rate. 3 patients (13%) had minimal or no improvement. In Group B, 16 patients (69.5%) achieved outstanding improvement with a re-pigmentation rate higher than 75%, with 12 patients experiencing total re-pigmentation. 4 patients (17.5 %) achieved a marked improvement with a re-pigmentation rate between 50-75%; 2 patients (8.7%) showed a moderate response with a re-pigmentation rate between 25-50%. 1 (4.3%) patient had minimal or no improvement. In Group C, 6 patients (37.5%) achieved a re-pigmentation rate higher than 75%, with 2 patients experiencing total re-pigmentation. 4 patients (25%) achieved marked improvement with a re-pigmentation rate between 50-75% while 3 patients (18.75%) had a re-pigmentation rate between 25-50%. 3 patients (18.75%) had minimal or no improvement. CONCLUSION: Vitilinex® herbal bio-actives in combination with nbUVB is a more effective treatment option for vitiligo with 87% of the patients achieving a re-pigmentation rate higher than 50%, compared to Vitilinex® alone (65%) or nbUVB alone (62.5%).

The Effectiveness of Oral Mini-Pulse Methylprednisolonein - the Treatment of Alopecia Areata in Vietnam.

BACKGROUND: Systemic corticosteroid is used to treat alopecia areata, but it is associated with side effects. Mini-pulse therapy is thought to be effective but able to reduce side effects. AIM: The study aimed to evaluate the effectiveness of oral mini-pulse methylprednisolone in the treatment of alopecia areata. METHODS: Patients received methylprednisolone 16 mg orally for 2 consecutive days every week. RESULTS: After 3 months, among patients, 40% recovered well, and 55.6% recovered fairly. After 6 months, 82.2% recovered well, 17.8% recovered fairly. No adverse events were detected, and the recurrence rate was low (2.2%). CONCLUSION: Oral mini-pulse methylprednisolone therapy is an effective and safe therapeutic option for alopecia areata without side effects, and the time of the treatment is short.

Successful Treatment of Intralesional Bleomycin in Keloids of Vietnamese Population.

BACKGROUND: Keloid is an overactive condition of the skin tissue to early lesions characterised by proliferation of fibroblasts, excessive collagen production in the lesion. Treatment of keloids is a big challenge because of the poor response rate and high risk of recurrence after treatment. We found that bleomycin offers promise in the treatment of keloids. AIM: To evaluate the efficacy of bleomycin injected in the injury for keloids treatment. METHODS: The treatment was carried out in 55 patients having 120 keloids of different sizes and locations. Average treatments were 4 times. RESULTS: Complete flattening was 70.8%, highly significant flattening was 8.3%, no patient of minimal flattening. Systemic side-effects of bleomycin were not evaluated, but local side-effects were mainly pains (100%), blisters (78.3%), ulceration (5.8%), and hyperpigmentation (56.7%). CONCLUSION: The percentage of patients recurring 6, 12, 15, 18 months after the last treatment were 3.8, 15.4, 45.5, 50%, respectively.