Pustular psoriasis in Malaysia: A review of the Malaysian Psoriasis Registry 2007-2018.

Pustular psoriasis (PP) is an uncommon subtype of psoriasis with distinct genetic features and clinical phenotypes. Patients with PP tend to experience frequent flares and significant morbidity. This study aims to determine the clinical characteristics, co-morbidities and treatment of PP patients in Malaysia. This was a cross-sectional study of patients with PP notified to the Malaysian Psoriasis Registry (MPR) between January 2007 and December 2018. Of 21 735 psoriasis patients, 148 (0.7%) had pustular psoriasis. Of these, 93 (62.8%) were diagnosed with generalized pustular psoriasis (GPP) and 55 (37.2%) with localized PP (LPP). The mean age for pustular psoriasis onset was 31.71 ± 18.33 years with a male to female ratio of 1:2.1. Patients with PP were more likely to have dyslipidaemia (23.6% vs. 16.5%, p = 0.022), severe disease (Body surface area >10 and/or Dermatology Life Quality Index [DLQI] >10) (64.8% vs. 50%, p = 0.003) and require systemic therapy (51.4% vs. 13.9%, p < 0.001) compared to non-PP patients. Patients with PP also suffered greater impairment to their quality of life (DLQI >10, 48.9% vs. 40.3%, p = 0.046), had more days off school/work (2.06 ± 6.09 vs. 0.5 ± 4.91, p = 0.004) and a higher mean number of hospitalizations (0.31 ± 0.95 vs. 0.05 ± 1.22, p = 0.001) in 6 months compared to non-PP patients. Overall, 0.7% of psoriasis patients in the MPR had pustular psoriasis. Patients with PP had a higher rate of dyslipidaemia, severe disease, greater impairment of quality of life and systemic therapy usage compared to other psoriasis subtypes.

Psoriasis Patients with Human Immunodeficiency Virus Infection: Data from the Malaysian Psoriasis Registry

Background@#Psoriasis can be a presenting feature of human immunodeficiency virus (HIV) infection. Our objective was to determine the frequency of HIV infection among patients with psoriasis and to describe the clinical features, treatment and quality of life in this population.@*Methods@#This is a multi-centre retrospective cross-sectional study of psoriasis patients who were registered to the Malaysian Psoriasis Registry (MPR) from January 2007 to December 2018.@*Results@#Of a total of 21,735 patients registered, 105 (0.5%) had HIV infection. Among these patients, 90 (85.0%) were male, mean age was 40.90 ± 10.85 years, and plaque psoriasis was the most frequently encountered presentation (85.7%). Significantly more patients with HIV had severe psoriasis (61.3% vs 49.9%, p=0.043), face and neck (62.7% vs 51.4%, p=0.022) involvement, and nail disease (69.9% vs 56.2%, p=0.005) compared to those without HIV. Only n patients (8.7%) had psoriatic arthropathy, and only 9 (8.8%) received systemic therapy, namely acitretin and methotrexate. None received a biologic, and only one patient was treated with narrowband ultraviolet-B therapy. The mean Dermatology Life Quality Index (DLQI) score at enrolment was 10.98 ± 7.07 for the HIV cohort compared to 8.68 ± 6.60 for the non-HIV cohort (t=2.190, p=0.029). More patients with HIV reported a DLQI score >10 compared to those without HIV (51.5% vs 40.2%, p=0.021).@*Conclusion@#The frequency of HIV infection among patients with psoriasis in the MPR was 0.5%. Patients with HIV had more severe disease, more nail, face and neck involvement, and greater impairment of quality of life. Treatment of HIV patients with psoriasis remains conservative in Malaysia.

The Utilization of Cutaneous Laser Therapy at the Department of Dermatology, Hospital Kuala Lumpur: A 5-year review

Introduction:The Department of Dermatology, Hospital Kuala Lumpur has been providing cutaneous laser therapyservices for over 20 years. We aim to describe the utilization of cutaneous laser therapy at the Departmentof Dermatology, Hospital Kuala Lumpur and the post treatment complications.Methods:We reviewed all patients who received cutaneous laser therapy at the Department of Dermatology, HospitalKuala Lumpur from January 2012 till December 2016. Complications were defined as dyspigmentation,infection, scarring, blisters, ulcerations, skin textural changes or contact dermatitis secondary to post/ pre-lasertopical therapy.Results:A total of 1190 patients with a male to female ratio of 1:2.21 and a mean age of 35.8 years received single,repeated or combination cutaneous laser therapy from 2012 till 2016 for 48 different skin conditions. Annually,an average of 1314 laser sessions were performed. Indications included seborrhoeic keratosis (249, 20.9%),port wine stain (162, 13.6%), solar lentigines (144, 12.1%), syringoma (105, 8.8%), viral warts (88, 7.4%),and Naevus of Ota (82, 6.9%) among others. Majority underwent Q-switched Nd:YAG laser (36.5%) followedby pulsed dye laser (33.6%), ablative conventional carbon dioxide laser (29.2%) and fractional carbon dioxidelaser (0.7%). Over the past 5 years, 3 patients developed severe complication post laser therapy which wasblisters. Pain was tolerable with application of topical 5% EMLA? (lidocaine 2.5% and prilocaine 2.5%) creampre-laser treatment.Conclusion:Q-switched Nd:YAG laser therapy was the most frequently employed laser in the Department ofDermatology, Hospital Kuala Lumpur. Our centre has a high volume of cases with a low rate of posttreatment complication.