ABSTRACT
Neonatal lupus erythematosus (NLE) is an autoimmune disease affecting the fetus as a result of transplacental transfer of anti-Ro autoantibodies. Typically, it presents in the first few months of life with an annular form of subacute cutaneous lupus erythematosus. We report an infant of NLE presenting at birth with multiple annular erythematous plaques with skin atrophy involving the face, head, and upper trunk. Histopathology of skin biopsy was consistent with subacute cutaneous lupus. The mother was clinically free of disease and had no family history of autoimmune disease. Serology (extranuclear antigens) was positive in both the baby and the mother. This is a rare presentation of a rare disease.
ABSTRACT
Haemangiomas usually develop within the first few weeks of life, most regressing spontaneously before the age of 7 to 10 years. Some may ulcerate or compromise a vital function, in which case systemic corticosteroids, surgery or radiotherapy may be helpful. All of these treatment modalities are associated with significant morbidity. Treatment with 585nm flashlamp pulsed dye laser is safe and effective in the management of ulcerated and superficial proliferating haemangiomas. We report a retrospective review of 33 children under the age 12 months, who were treated at our centre with 585nm pulsed dye laser over a period of 4 years. Forty eight percent of these children presented with rapidly proliferating haemangiomas causing functional impairment, 40% with ulcerated haemangiomas and others for re-growth after stopping oral treatment. Patients were treated with the 585nm pulsed dye laser (fluence: 5.5-7J/cm2; spot size: 7mm and duration: 0.45s). Patients received treatment until the lesion was almost clear or until lesion failed to respond. All lesions ulcerated haemangiomas healed after an average 3 treatment. Both the physician and parental perception of improvement were analysed based on three parameters, which include reduction in redness, thickness and size. All the haemangiomas showed significant reduction in size, thickness and colour. Less than 1% of patients had atrophic scaring. We conclude that the flashlamp-pulsed dye laser may successfully prevent enlargement and promote involution of superficial haemangiomas with minimal adverse effect. Therapy is most appropriate for patients with ulcerated haemangiomas and haemangiomas at sites of potential functional impairment.
ABSTRACT
Objectives To evaluate the efficacy and safety of tacrolimus ointment 0.1% in adult and 0.03% in pediatric patients with moderate to severe atopic dermatitis in Malaysia. Methods This is an open-labeled and single arm multi-center study. 36 adult and 37 pediatric patients were enrolled. Tacrolimus ointment is applied twice daily for four weeks. The primary efficacy outcome is based on the Physician’s Global Evaluation of Clinical Response (PG) at Week 4. The secondary efficacy outcomes are Eczema Area and Severity Index (EASI) score, changes from baseline in individual scores of signs and symptoms and body surface area affected and Patients Assessment of Treatment Effects. Results Overall success rate were 97.1% and 91.2% in the adult and pediatric groups respectively. The decline in EASI, percentage of total BSA affected and patient’s assessment of pruritus were significant (P<0.001). Of adults and pediatric patients, 97.2% and 75.7% respectively reported adverse effect. The most common adverse effect reported was skin burning sensation in 91.7% adult patients and pruritus in 67.6% pediatric patients. Conclusion Tacrolimus ointment 0.1% in adult and 0.03% in pediatric patients is effective for the treatment of moderate to severe atopic dermatitis in Malaysia.
ABSTRACT
Atopic dermatitis is the commonest skin disease in children, causing psychological, social and functional disability to them and their families. This study assessed the family impact and quality of life using the translated Malay version of The Dermatology Family Impact (DFI) and The Children's Dermatology Life Quality Index (CDLQI) questionnaires. Seventy-two children, aged between 6 months and 16 years attending the Paediatric Dermatology Clinic at the Paediatric Institute and the Dermatology Department, Hospital Kuala Lumpur participated in this study. Thirty-nine patients (54.2%) were males and 33 patients (45.8%) were females. The median age of the patients was 74 months (Q1 6, Q3 104 months). The median age of diagnosis was 22 months (Q1 1, Q3 36 months). The median disease duration was 44 months (Q1 3, Q3 65). The severity of eczema was assessed using the SCORAD severity index (maximum score = 83). The median SCORAD (European Task Force On Atopic Dermatitis) score was 36 (n = 72, SD = 16.2). The majority of patients in this study suffered from moderately severe eczema (n = 40, mean, SCORAD = 29.3) followed by severe eczema (n = 27, mean SCORAD = 54.3). The mildly affected patients formed the minority group (n = 5, mean SCORAD = 9.0). The family impact was shown to be greater in severe atopic dermatitis compared to moderate atopic dermatitis (Anova, p = 0.02). The children's quality of life impairment was also greater in severe atopic dermatitis compared to moderate atopic dermatitis (Anova p = 0.08). This study confirms that quality of life and family impact are related to the severity of atopic dermatitis.
