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Objective: This study aimed to assess the effects of AFA and its associated factors, especially those coexisting with hyperandrogenism or PCOS, on QoL using the Dermatology Life Quality Index (DLQI). Materials and Methods: A retrospective cross-sectional study was conducted on AFA patients who had been treated between May 2018 and January 2020. Dermatologists had performed history taking and determined the clinical severity of the acne, and gynecologists had identified PCOS. Aggravating factors and DLQI were self-reported by the patients. Results: A total of 208 AFA patients, aged 31.8±7.1 years on average, were included. The mean DLQI score was 8.0±5.4 (range: 0-23). Patients with moderate to severe acne had significantly higher total DLQI scores compared to those with almost clear to mild acne (P=0.043). Similarly, patients who reported acne aggravated by diet, androgenetic alopecia, or perioral and chin lesions had significantly higher total DLQI scores (P=0.025, P=0.049, and P=0.014, respectively). However, PCOS and hirsutism did not significantly impact QoL. The aspect most affected was feeling embarrassed and self-conscious, with significantly greater impacts observed in patients with moderate to severe acne compared to mild acne. The daily activities of patients with androgenetic alopecia were significantly impacted in terms of their choice of clothes and sexual difficulties. Conclusion: AFA mostly had a moderate to extremely large effect on patients’ QoL. Knowing the factors influencing QoL, such as acne severity, dietary aggravation of acne, and androgenetic alopecia, may enable physicians to improve the QoL of patients.

Objective: To evaluated the health-utility values and risk factors for cumulative life course impairment (CLCI) using Patient Acceptable Symptom State (PASS) and European Quality of Life 5 Dimensions (EQ-5D). Materials and Methods: This cross-sectional investigation enrolled patients with psoriasis. Patients were asked PASS questions about their overall self-perceived health state, adaptation, and expectations for current, future, and lifelong conditions. The patients also completed EQ-5D. Results: The mean age of 139 enrolled patients was 45.8 ± 14.4 years, and 57.6% were women. Most cases had chronic plaque psoriasis 121 (87.1%). For current PASS, satisfaction was significantly associated with older age, being married, and lower disease severity. The mean health-utility value and visual analog scale of the 139 patients were 0.89 ± 0.12 and 77.0 ± 17.4, respectively. Patients would not accept their disease if they had moderate to extreme problems in usual activities and depression/anxiety for the future and lifelong. Univariate analysis revealed that depression and usual activities were significantly associated with satisfaction for current PASS, future PASS, and lifelong PASS. Conclusion: Disease severity, age, marital status, problems with usual activities, and depression/anxiety were significantly related to CLCI. These findings may allow physicians to identify psychosocial and psychological aspects of psoriatic patients at high risk for developing CLCI. Early and adequate treatment, good coping strategies, and good social support can prevent a negative impact on CLCI and major life-changing decisions.

Objective: This study aimed to investigate the validity and reliability of the Thai version of FDLQI. Materials and Methods: Patients and their accompanying family members attending the Dermatology Outpatient Clinic at Siriraj Hospital were asked to complete the Dermatology Life Quality Index (DLQI), FDLQI, and the global question of their QoL (GQoL). The severity of the disease was assessed by physicians, the patients and the family members of the patients. Results: One hundred family members accompanying 92 patients with dermatological diseases (63% with inflammatory skin diseases and 37% with non-inflammatory skin diseases) were included. The mean age of the family members was 43.5±12.1 years and 70% were women. They had been mostly employed (74%) and graduated from universities (65%). Validity was demonstrated by a positive correlation between FDLQI and GQoL scores (rs=0.695, P

Cutaneous manifestations of lupus erythematosus (LE) have a variety of clinical phenotypes and require proper investigation for diagnosis. Knowledge of the direct immunofluorescence (DIF) technique has improved and played an important role in the diagnosis of cutaneous LE. This review explores and summarizes reported DIF findings of each cutaneous LE variant. Historically, DIF findings of cutaneous LE have revealed deposits of multiple immunoreactants at the dermo-epidermal junction with either linear or granular patterns. Immunoglobulin M is the most common immunoreactant and DIF findings of cutaneous LE variants overlap. Therefore, diagnosis of cutaneous LE requires a combination of monitoring patient history, physical examinations and laboratory studies. This review helps interpret and better understand the application of DIF studies in cutaneous LE.

Objective: To evaluate the characteristics of post-adolescent male patients with acne in terms of the onset of the condition, its clinical course and severity, and the behaviors associated with its severity. Materials and Methods: A prospective, cross-sectional study was conducted on adult males with acne who visited Siriraj Hospital, Thailand. All male acne patients aged 21 years and older were enrolled. Diagnoses and physical examinations were performed by dermatologists. Results: Seventy-two patients (mean age, 26.9 [± 4.3] years) were included. Persistent acne, relapse acne, and late-onset acne (onset at age ≥ 21 years) were reported in 62.5%, 33.3%, and 4.2% cases, respectively. Persistent acne tended to subside at 26 years of age, whereas late-onset acne tended to start at 28 years of age. The acne severity was mild in most cases. Pimple-picking, followed by frequent face washing, were common habits among male acne patients. Shaving influenced the severity in some adult male with acne. Conclusion: Adult male acne commonly presented as inflammatory lesions and comedones on the cheeks. They commonly had an onset earlier than 21 years old and continued into adulthood, but the post-adolescent severity tended to be mild. While several factors have been reported elsewhere to be involved in the severity of acne, this study found that only shaving influenced severity.

Objective: To determine the proportion of patients with psoriasis prepared to pay for TD. Attitudes and factors influencing their willingness to pay (WTP) were evaluated. Materials and Methods: This cross-sectional study was conducted from July 2020 to October 2021. Adult patients with psoriasis completed a 2-page self-administered questionnaire. Results: Of 200 patients, 133 (66.5%) were unfamiliar with TD. However, 144 (72%) were prepared to pay for TD if it were introduced. The majority of patients answered that 300 Bath was the maximum price that they were willing to pay for TD service. Compared with traditional in-person visits, the significant positive influencing factors on WTP were TD’s quicker delivery of treatment, lower costs, and non-inferiority to usual care. Multivariate analysis showed that the independent factors for WTP were higher educational levels, elimination of out-of-pocket, in-hospital visit expenses, owning a business, TD options suited to psoriasis, and no adverse effects on the patient-doctor relationship. Conclusion: Knowing patients’ attitudes toward TD and the factors influencing their WTP is essential for developing efficient services. Data from this study can be used to develop successful TD services for patients with psoriasis.

Objective: To assess the clinical utility of the Psoriasis Epidemiology Screening Tool (PEST), the Early Arthritis for Psoriatic Patients (EARP) questionnaire, and the Siriraj Psoriatic Arthritis Screening Tool (SiPAT) as screening tools for psoriatic arthritis (PsA), and to identify factors significantly associated with PsA. Methods: This cross-sectional study included adult psoriasis patients who attended the outpatient clinic at Siriraj Hospital and had not been diagnosed with PsA during 1 March 2017 to 28 February 2018. Participants completed the EARP, PEST, and SiPAT, after which musculoskeletal history was taken, and examination and radiography were performed. Diagnosis of PsA was based on Classification Criteria for Psoriatic Arthritis. Receiver operator characteristic (ROC) curves, sensitivity, and specificity were used to determine assessment tool performance. Logistic regression analysis was used to identify factors associated with PsA. Results: Eighty-seven patients with a mean age of 45.90±14.75 years were enrolled. Twenty-six (29.88%) patients were diagnosed as PsA. According to ROC values, EARP had the best discriminative power (0.83) for distinguishing between psoriatic patients with and without PsA (SiPAT: 0.78, PEST: 0.77). SiPAT had the highest sensitivity (92.3%), followed by EARP (84.6%) and PEST (50.0%); whereas, PEST had the highest specificity (82.0%), followed by EARP (62.3%) and SiPAT (54.1%) for detecting PsA. Multivariate analysis revealed body surface area involvement >10% to be the only independent predictor of PsA (OR: 2.99, 95% CI: 1.09-8.21). Conclusion: SiPAT is an effective and simple to use tool for screening PsA in psoriasis patients. Body surface area involvement >10% is a significant predictor of PsA.

Objective: To systemically summarize and meta-analyze the risk of dementia in psoriasis patients. Methods: A systematic review was performed in two databases (EMBASE and MEDLINE). The eligible studies had to be a cohort study or a cross-sectional study that compared either the prevalence or incidence of dementia in patients with psoriasis, versus individuals without psoriasis. Results: Of 791 retrieved articles, seven studies met the inclusion criteria and were included into the meta-analysis. The risk of incident and prevalent dementia were significantly higher in patients with psoriasis, with a pooled risk ratio of 1.16 (95% CI: 1.02-1.33; I2 96%) and 1.36 (95% CI: 1.07-1.72; I2 10%), respectively. Conclusions: This study revealed a slight increase in both the incidence and prevalence of dementia in psoriasis patients. However, dermatologists should carefully observe and periodically screen psoriasis patients for this comorbidity, especially among those who have symptoms and signs of cognitive impairment. This article was retracted on 10 May 2021

Objective: To compare the efficacy and safety of a generic desoximetasone cream (Topoxy) with the reference form, Topicorte, for the treatment of scalp psoriasis. Methods: A randomised, double-blind, controlled study was conducted. Altogether, 105 patients with psoriasis lesions covering more than 10% of the scalp were randomised into three groups. The first, second and third groups received a placebo, Topoxy and Topicorte, respectively. The scalp psoriasis severities were assessed at weeks 0, 2, 4 and 8, using the Investigator Global Assessment (IGA) scale and Total Sign Score (TSS). The safety profiles of the products were assessed by the patients and physicians. Results: Topoxy and Topicorte were significantly more effective than the placebo in achieving at least a two-grade improvement in the IGA score from baseline at weeks 2, 4 and 8, and there were no significant differences between Topoxy and Topicorte. The TSS of both creams were significantly lower than that of the placebo at weeks 2, 4 and 8. All patients tolerated well to the therapy. Conclusion: Topoxy and Topicorte had comparable efficacies for scalp psoriasis., The medications were superior to the placebo in all parameters, and had a good safety profile.

Objective: To report a case of paraneoplastic pemphigus (PNP), a rare disease, associated with follicular B-cell lymphoma. Treatment outcomes of PNP associated with follicular B-cell lymphoma following rituximab treatment were also reviewed in this article. Case presentation: We reported a PNP patient presenting with intractable stomatitis and erythema multiforme-like lesions. Skin biopsy from erythema multiforme-liked lesion revealed interface dermatitis and necrotic keratinocytes. Direct immunofluorescence demonstrated immunoglobulin G deposition at intercellular space, as well as complement deposition at dermo-epidermal junction. Indirect immunofluorescence using rat bladder substrate was helpful in confirming the diagnosis of PNP. Further investigations revealed an underlying disease of follicular B-cell lymphoma. He was treated with rituximab and systemic corticosteroids. Improvement of mucocutaneous lesions and lymphoma were noted. Nevertheless, he developed hospital-acquired pneumonia and died from septic shock shortly after receiving conventional chemotherapy. His survival duration was approximately 8 months after diagnosis of PNP. Conclusion: It seemed that rituximab might provide promising benefits for mucocutaneous lesions in PNP patients associated with follicular B-cell lymphoma.

Objective: To assess the clinical utility of the Psoriasis Epidemiology Screening Tool (PEST), the Early Arthritis for Psoriatic Patients (EARP) questionnaire, and the Siriraj Psoriatic Arthritis Screening Tool (SiPAT) as screening tools for psoriatic arthritis (PsA), and to identify factors significantly associated with PsA. Methods: This cross-sectional study included adult psoriasis patients who attended the outpatient clinic at Siriraj Hospital and had not been diagnosed with PsA during 1 March 2017 to 28 February 2018. Participants completed the EARP, PEST, and SiPAT, after which musculoskeletal history was taken, and examination and radiography were performed. Diagnosis of PsA was based on Classification Criteria for Psoriatic Arthritis. Receiver operator characteristic (ROC) curves, sensitivity, and specificity were used to determine assessment tool performance. Logistic regression analysis was used to identify factors associated with PsA. Results: Eighty-seven patients with a mean age of 45.90±14.75 years were enrolled. Twenty-six (29.88%) patients were diagnosed as PsA. According to ROC values, EARP had the best discriminative power (0.83) for distinguishing between psoriatic patients with and without PsA (SiPAT: 0.78, PEST: 0.77). SiPAT had the highest sensitivity (92.3%), followed by EARP (84.6%) and PEST (50.0%); whereas, PEST had the highest specificity (82.0%), followed by EARP (62.3%) and SiPAT (54.1%) for detecting PsA. Multivariate analysis revealed body surface area involvement >10% to be the only independent predictor of PsA (OR: 2.99, 95% CI: 1.09-8.21). Conclusion: SiPAT is an effective and simple to use tool for screening PsA in psoriasis patients. Body surface area involvement >10% is a significant predictor of PsA.

Necrolytic migratory erythema (NME) is a rare skin condition, which is the first presenting manifestation in almost 70% of the patients with glucagonoma. It is characterized by well-defined scaly erythematous patches with crusted erosion in annular appearance. The predominant areas are genital area, intertrigenous sites and lower extremities. This article has presented the case who had a 5-month history of progressive erythematous scaling patches with crusted erosion on acral, trunk and intertriginous areas. He had been treated for several months at another hospital without definite diagnosis. Our investigations revealed diabetes mellitus and a 6.5x5.7x6.0 cm mass at pancreatic head without liver metastasis. Percutaneous biopsy revealed monomorphic round cells with pleomorphic nuclei which immunohistochemical staining revealed strongly positive for neuroendocrine tumor. The diagnosis of probable glucagonoma associated with NME was established. Zinc supplement was initiated resulting in marked improvement of his rash. He went to Fuda Hospital in China to receive cryosurgery for his pancreatic tumor. Up until now, there has been no recurrence of his rash and his general condition remains stable for 3 years. However, CT scan at 3 years after cryosurgery showed slight increase in size of pancreatic mass and increased degree of diffuse dilatation of main pancreatic duct and side-branch. Thus, long term follow-up is mandatory to conclude the outcome of cryosurgery for pancreatic cancer.

Objective: To report a case of paraneoplastic pemphigus (PNP), a rare disease, associated with follicular B-cell lymphoma. Treatment outcomes of PNP associated with follicular B-cell lymphoma following rituximab treatment were also reviewed in this article. Case presentation: We reported a PNP patient presenting with intractable stomatitis and erythema multiforme-like lesions. Skin biopsy from erythema multiforme-liked lesion revealed interface dermatitis and necrotic keratinocytes. Direct immunofluorescence demonstrated immunoglobulin G deposition at intercellular space, as well as complement deposition at dermo-epidermal junction. Indirect immunofluorescence using rat bladder substrate was helpful in confirming the diagnosis of PNP. Further investigations revealed an underlying disease of follicular B-cell lymphoma. He was treated with rituximab and systemic corticosteroids. Improvement of mucocutaneous lesions and lymphoma were noted. Nevertheless, he developed hospital-acquired pneumonia and died from septic shock shortly after receiving conventional chemotherapy. His survival duration was approximately 8 months after diagnosis of PNP. Conclusion: It seemed that rituximab might provide promising benefits for mucocutaneous lesions in PNP patients associated with follicular B-cell lymphoma.

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are over-the-counter drugs which are widely used. In Thailand, cutaneous reactions to nonsteroidal anti-inflammatory drugs were frequently angioedema and urticaria. However, there are many limitations of the diagnostic investigations, so the diagnosis is still based on history and clinical manifestation. In 2007, there was a study in Italy, which reported that an autologous plasma skin test (APST) could detect autoreactive state in patients with multiple intolerances to NSAIDs. Objective: We aimed to investigate whether APST is positive in single and multiple NSAID reactors in the Thai population or not. Methods: The patients with recent history of urticaria and/or angioedema following the administration of NSAIDs were prospectively recruited. Individuals were classified into two groups (single or multiple NSAID reactors) based on history, clinical manifestation and/or laboratory investigation and then APST was done after at least a month free of symptoms. Results: Of all sixty-eight patients, thirteen (19.1%) were men and fifty-five (80.9%) were women. The mean age was 42.7 ± 15.0 years (range 17-77 years). In our study, single NSAID reactors (69.1%) were more common than multiple NSAID reactors (30.9%). Multiple NSAID reactors tended to have a personal and family history of atopy (p = 0.030 and 0.012, respectively) than single reactors. APST was positive 19.0% and 10.6% in multiple and single NSAID reactors, respectively. However, there was no statistically significant relationship between positive APST and multiple NSAID reactivity (p = 0.442). Conclusion: This study showed no statistically significant association between APST positivity and multiple NSAID reactors in Thai patients. However, our study revealed significantly higher proportions of personal and family history of atopic diathesis in multiple NSAID reactors. Keywords: Urticaria, angioedema, autologous plasma skin testing, multiple NSAID reactor, single NSAID reactor Siriraj Med J 2014;66:11-14