Prevalence of depression and anxiety among adults with vitiligo in a Malaysian tertiary hospital.

INTRODUCTION: Vitiligo is a chronic disorder resulting in skin depigmentation with reported global prevalence of 1-2%. This disease is often accompanied by psychosocial distress owing to the cosmetic disfigurement associated with it. The primary objective of this study was to determine the prevalence of depression and anxiety among adults with vitiligo in a local tertiary hospital. In addition, this study also evaluated the association of depression and anxiety with patients' characteristics. MATERIALS AND METHODS: This cross-sectional study was conducted among vitiligo patients aged 18 years and older in Hospital Klang, Selangor between October 2021 and June 2022. Assessment instruments used were Vitiligo Area Scoring Index (VASI) and Hospital Anxiety and Depression Scale (HADS). Demographic data and clinical characteristics of vitiligo patients were recorded. RESULTS: Of the 100 participants, 12 (12%) and 21 (21%) had depression and anxiety, respectively. The mean depression score (HADS-depression component) was 3.4 (SD 3.4) and mean anxiety score (HADS-anxiety component) was 4.7 (SD 3.9). There were significantly higher number of patients with abnormal HADS-D score in the age group of 35-51 years (p=0.029), single status (p=0.001), with employment (p=0.014) and disease duration <2 years (p=0.004). Patients in the divorced/widowed group had a significant association with anxiety (p=0.011). CONCLUSION: The prevalence of depression was 12% while anxiety was 21% in our cohort. Vitiligo has a significant psychosocial impact, thus clinicians should actively evaluate the mental health of these patients with the use of screening tools such as HADS and provide appropriate referrals and management.

Subcutaneous panniculitic T-cell lymphoma-review of five cases.

Subcutaneous panniculitic T-cell lymphoma (SPTL) is a rare variant of cutaneous T-cell lymphoma where lymphoma cells infiltrate preferentially into subcutaneous tissue. Five cases of SPTL were seen during the period from 2001-2004 at the Department of Dermatology, Hospital Kuala Lumpur. All five presented with multiple subcutaneous nodules on the face, trunk and limbs of one week to six months duration with associated fever and loss of weight. Physical examination showed multiple tender, erythematous indurated plaques and subcutaneous nodules on their face, trunk and limbs. One patient also presented with unhealing ulcerated nodules. Two patients had hepatosplenomegaly and one hepatomegaly. Two patients had pancytopaenia while the other three had leucopaenia. One patient had deranged liver function. Out of the five patients, three had bone marrow examination with haemophaegocytosis in two and one hypocellular marrow. Skin biopsy of all patients showed infiltration with atypical lymphoid cells in the upper dermis and subcutaneous fat. These neoplastic cells showed positivity for CD3 and CD30 in three patients with CD8, TIA-1 and LCA (Leucocyte common antigen) being positive in one patient. One patient treated with prednisolone and subcutaneous Roferon 3Mu three times a week since 2001 was in remission. Two patients who were planned for chemotherapy had deteriorated rapidly and succumbed to septicaemia from pancytopaenia. Subcutaneous panniculitic T-cell lymphoma has been reported to show two distinct clinical presentations. The first is characterized by an indolent course with good prognosis and the second with rapid clinical deterioration, haemophaegocytosis and death. Both presentations were seen in our five patients seem to demonstrate these two subtypes of SPTL.