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The article discusses the results of an international survey on sun exposure behaviors and knowledge among outdoor workers in 17 countries. The study reveals that outdoor workers are at a higher risk of skin health issues due to sun exposure, with a significant disparity between their risk level and actual sun protection practices. Factors influencing sun protection measures among outdoor workers include awareness, attitudes, workplace policies, and access to resources. The findings emphasize the importance of public health measures and workplace policies to address UV-related risks for outdoor workers. [Extracted from the article]

The article discusses a study on sun exposure behaviors and knowledge among at-risk populations, particularly those with a history of skin cancer or medication-induced sun sensitivity. The study, conducted internationally, found that individuals at increased risk of sunlight-related damage exhibited suboptimal adherence to photoprotection measures. While the at-risk population showed better protection measures than the general population, there were still misconceptions and gaps in knowledge about sunrays. The study highlights the importance of dermatologists and general practitioners in educating and guiding individuals with heightened vulnerability to sun-related skin damage. [Extracted from the article]

Background: While treatment is a definitive therapeutic component in the management of inflammatory skin conditions, adjunctive skin care comprising of appropriate cleansing, moisturization, and photoprotection are just as important. Cleansing, treatment, moisturization, and photoprotection (CTMP) constitute the four major components of holistic skincare routine for dermatological conditions. However, inadequate patient understanding of the condition, limited resources for physicians, and insufficient time for patient education during busy dermatological consultations are the main obstacles to establishing a holistic skincare routine in the real world. Aims: This study aimed to identify key challenges in the implementation of a holistic skincare routine, and offer practical guidance to physicians to improve adoption in the management of acne, atopic dermatitis, rosacea, and sensitive skin syndrome. Methods: An expert panel comprising of nine dermatologists from Australia, China, Hong Kong, Taiwan, India, Philippines, Singapore, South Korea, and Thailand convened to develop consensus statements to stimulate real‐world adoption of holistic skincare routine in acne, rosacea, atopic dermatitis, and sensitive skin syndrome using the Delphi approach. Results: Consensus was defined as ≥80% of panel rating statement as ≥8 or median rating of ≥8. The final statements were collated to develop consensus recommendations to encourage adoption of holistic skincare routine. Conclusion: Promoting patient education on the skin condition, training support staff in patient counseling, and offering physician training opportunities are the key strategies to encourage real‐world adoption of CTMP as a holistic skincare routine. The consensus recommendations presented here should be considered in all dermatology patients to accomplish the ultimate goals of improved treatment outcomes and patient satisfaction. [ABSTRACT FROM AUTHOR]

Background: In this article, we review and discuss the photoprotection behavior of Asians based on the literature, along with a subanalysis of an original online survey, and make recommendations to optimize photoprotection for Asian populations to prevent photoaging and pigmentary disorders. Methods: An international panel of eight dermatologists from Asia (China, Korea, Japan, Singapore, Indonesia, and Vietnam) met to discuss sunscreen photoprotection for Asian patients. Additionally, a subanalysis of an online survey by 3000 respondents from three Asian countries (China, Indonesia, and Japan) investigated general public awareness and attitudes to sun exposure. Results: A pre‐meeting survey of the eight experts from Asia showed key concerns of Asian patients consulting dermatologists are pigmentary disorders, especially actinic/senile lentigo, post‐inflammatory hyperpigmentation, melasma, vitiligo, and Hori's nevus. The survey subanalysis of participants from China, Indonesia, and Japan with predominantly Fitzpatrick skin types (FST) II to IV revealed that they are particularly concerned about sun exposure causing photoaging and pigmentary disorders. Most of the respondents indicated they have limited knowledge on sunlight radiation and appropriate sunscreen protection factors. Only 22%, 13%, and 3% for China, Indonesia, and Japan, respectively, systematically use multiple protective measures (using sunscreen, avoiding midday sun, staying in the shade, wearing a hat, protective clothing, and sunglasses) when exposed to the sun. Conclusions: Further education is needed for Asian populations on the importance of comprehensive daily photoprotection, including broad‐spectrum sunscreen, with high UVA and visible light protection, to reduce and prevent photoaging and pigmentary disorders. [ABSTRACT FROM AUTHOR]

Background: Behavioural interventions can improve attitudes towards sun protection but the impact remains inconsistent worldwide. Objective: To assess awareness of and attitudes towards the multiple facets of sun exposure and suggest ways to improve prevention from overexposure to the sun in all geographical zones and multiple skin types. Methods: Online survey was conducted from 28 September to 18 October 2021. Study population was selected from the Ipsos online Panel (3,540,000 panellists), aged ≥18 years, from 17 countries around the five continents. Demographics, sun‐exposure habits and practices, understanding of risks and information on phototypes were documented and analysed using descriptive statistics. Results: Eighty‐eight per cent of participants knew that sunlight can cause skin health problems (90% phototypes I‐II, 82% phototypes V‐VI, >90% in American and European countries, 72% in Asia and 85% in Africa). Eighty‐five per cent used some form of protection against sunlight, predominantly: Seeking shade (77%), avoiding the midday sun (66%), facial application of sunscreen (60%) and wearing protective clothing (44%). The perception of sunlight itself is positive ('it gives energy' for 82%; 'tanned skin looks attractive' for 72%), although less in Asian countries and among individuals with dark skin phototypes. Eighty‐three per cent reported having experienced sunburn, mainly in Australia, Canada, USA, Germany, France and Russia, and among individuals with dark skin phototypes. Only 12% systematically/often used all types of protection during exposure to the sun and 23% believed it is safe to go out in the sun with no protection when their skin is already tanned. From 13% (skin phototype I) to 26% (phototype VI) reported not using any form of protection against the sun. Knowledge and habits were significantly superior among people who are accustomed to seeing a dermatologist for a complete skin exam. Conclusions: Dermatologists could play a crucial role in relaying novel prevention messages, more finely tailored to specific risks, populations and areas of the world. [ABSTRACT FROM AUTHOR]

Background: Treatment, cleansing, moisturizing, and photoprotection are four major components of holistic skin care for dermatological conditions. While treatment (T) is recognized as a key component in the management of dermatological conditions, there is a lack of practical guidance on the adjunctive role of cleansing, moisturizing, and photoprotection ("CMP"). Limited patient knowledge, confusion over product selection, and lack of guidance on how to choose and use CMP skin care products (in conjunction with pharmacological therapy) are the main barriers to establishing a holistic skin care routine for dermatological conditions. Aims: This study aimed to review current clinical evidence, identify gaps, and provide practical guidance on conceptualization and implementation of CMP routine in the management of sensitive skin due to underlying acne, atopic dermatitis, or rosacea, including conditions with idiopathic causes referred to as idiopathic sensitive skin syndrome. Methods: An expert panel comprising of 10 dermatologists from Australia, China, Hong Kong, Taiwan, India, Indonesia, Philippines, Singapore, South Korea, and Thailand convened to develop consensus statements on holistic skin care in acne, rosacea, atopic dermatitis, and idiopathic sensitive skin syndrome using the Delphi approach. Results: Consensus was defined as ≥80% of panel rating statement as ≥8 or median rating of ≥8. The final statements were collated to develop consensus recommendations on holistic skin care. Conclusion: A dermatologist‐guided holistic skin care routine is essential to improve patient confidence and reduce confusion over product selection. The consensus recommendations presented here highlight the importance of cleansing, moisturization, and photoprotection in holistic skin care and how it can be utilized as a communication tool for physicians and patients to achieve overall better patient compliance, satisfaction, and treatment outcomes. [ABSTRACT FROM AUTHOR]

We report the formation of noise‐like pulse (NLP) with tungsten trioxide/polydimethylsiloxane‐clad microfiber saturable absorber integrated in a ring‐cavity erbium‐doped fiber laser. The NLP operation was confirmed by the presence of a coherence spike on top of a broad pedestal in the autocorrelation trace, with the measured pulse width value of 410 fs and 3.56 ps respectively. By increasing the pump power from the mode‐locking threshold of 280–3300 mW, the spectral bandwidth was stretched from 22.3 to 22.8 nm, while the output power increased from to 1.9 to 24.3 mW. The maximum pulse energy of 3.5 nJ was generated at a repetition rate of 7 MHz. The signal‐to‐noise ratio was measured to be 53.8 dB, which indicated a good stability of pulse laser. [ABSTRACT FROM AUTHOR]

Acne vulgaris is a common and chronic skin disorder that can have significant psychosocial effects, dyspigmentation, and permanent scarring. It is responsible for a large global burden of disease and disability. Despite its impacts, acne is often considered a cosmetic issue. The prevalence of post-adolescent acne is increasing, particularly among adults aged 20-29. To address the challenges of acne management, there is a need for increased knowledge and education, improved access to care, addressing healthcare disparities, and reducing prolonged antibiotic usage. By addressing these areas, the complications and prevalence of acne can be decreased globally. [Extracted from the article]

We analyzed the spontaneous adverse event database in Singapore to determine the types of cutaneous adverse drug reactions (CADRs) and causative drugs reported. We selected 10 CADRs-of- interest, and identified the suspected drugs and the characteristics of the at-risk population. ADR reports received from 2006 to 2015 of the system organ class "Skin and Appendages Disorders" were analyzed based on patient demographics, the types of CADRs, suspected drugs, outcome, and latency period. Of the 104 372 reports analyzed, 56.2% involved females and 72.5% involved Chinese patients. The mean age was 41.1 years old. The top CADRs reported were rash (including nonspecified rash, follicular rash, maculopapular rash, and vesicular rash) (67.2%) and angioedema (13.9%). The drugs frequently associated with the CADRs-of- interest include nonsteroidal antiinflammatory drugs and antibiotics with angioedema, iohexol with urticaria, and antiepileptics and allopurinol with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). A subgroup analysis based on age, sex, and race on the 10 CADRs-of- interest showed the following trends in reporting: Alopecia (reported more in females), drug hypersensitivity syndrome (more in males), angioedema (more in younger patients), and photosensitivity (more in older patients). In general, the racial distribution across each CADR-of- interest was consistent with that of Singapore's population, with slight deviations observed for SJS/TEN, photosensitivity and skin discoloration. We analyzed CADR reports from Singapore over 10 years, and identified the types of CADRs reported, and their associated drugs, latency periods and patient characteristics. Such information could add value to healthcare professionals as they assess CADR cases and evaluate suspected drugs. [ABSTRACT FROM AUTHOR]

Background: There are patients with recalcitrant psoriasiform plaques that do not fit into conventional categories of facial dermatoses. Our study aims to describe the clinicopathological characteristics of several patients with a unique presentation of persistent psoriasiform facial rashes. Methods: This retrospective cross‐sectional study analyzed clinical and histological data of known cases of recalcitrant psoriasiform dermatosis of the face diagnosed at National Skin Centre, Singapore, over 10 years. Results: There were 8 Chinese patients with mean age at onset of 29 years. Majority had pink to pink‐orange well‐defined plaques with dry scale (n = 6, 75%), distributed mostly on the cheeks (100%) and chin (n = 7, 88%). Hyperkeratosis, parakeratosis, preserved granular layer and psoriasiform hyperplasia were showed in all biopsies. Other common findings included subtle subcorneal acantholysis, “checkerboard” alternating ortho‐/parakeratosis, vacuolated keratinocytes and follicular plugging. All patients showed little treatment response. One patient eventually developed features of type II pityriasis rubra pilaris (PRP). Our study was limited by its small sample size and lack of a pre‐existing diagnostic code. Conclusions: This recalcitrant psoriasiform facial dermatosis seems to be a distinct entity, with consistent and reproducible clinical features and a PRP‐like histology, bearing some resemblance to the recently described condition—facial discoid dermatosis. [ABSTRACT FROM AUTHOR]

Abstract: Acne vulgaris is a common disease among people in Asia. International guidelines and treatment recommendations emphasize the central role of topical retinoids in the management of acne. However, topical retinoids remain underutilized in clinical practise, which may be in part due to fear of retinoid‐associated dermatitis/lack of experience, particularly in Asian patients. There is a perception that Asian skin has a greater tendency toward sensitivity compared with Caucasian skin. In our clinical experience, topical retinoid therapy can be used with excellent effect to treat Asians with acne. This article discusses available published work regarding the use of topical retinoids in Asian populations, and presents tips for utilizing these important agents in daily practise. Optimizing use of topical retinoids may improve adherence and, in turn, therapeutic outcomes and patient satisfaction. [ABSTRACT FROM AUTHOR]

Background Limonene and linalool are common fragrance terpenes. Both oxidized R -limonene and oxidized linalool have recently been patch tested in an international setting, showing contact allergy in 5.2% and 6.9% of dermatitis patients, respectively. Objective To investigate concomitant reactions between oxidized R-limonene and oxidized linalool in consecutive dermatitis patients. Methods Oxidized R-limonene 3.0% (containing limonene hydroperoxides 0.33%) and oxidized linalool 6% (linalool hydroperoxides 1%) in petrolatum were tested in 2900 consecutive dermatitis patients in Australia, Denmark, Singapore, Spain, Sweden, and the United Kingdom. Results A total of 281 patients reacted to either oxidized R-limonene or oxidized linalool. Of these, 25% had concomitant reactions to both compounds, whereas 29% reacted only to oxidized R-limonene and 46% only to oxidized linalool. Of the 152 patients reacting to oxidized R-limonene, 46% reacted to oxidized linalool, whereas 35% of the 200 patients reacting to oxidized linalool also reacted to oxidized R-limonene. Conclusions The majority of the patients (75%) reacted to only one of the oxidation mixtures, thus supporting the specificity of the reactions. The concomitant reactions to the two fragrance allergens suggest multiple sensitizations, which most likely reflect the exposure to the different fragrance materials in various types of consumer products. This is in accordance with what is generally seen for patch test reactions to fragrance materials. [ABSTRACT FROM AUTHOR]

The management of acne in South-East Asia is unique, as Asian skin and local variables require a clinical approach unlike that utilized in other parts of the world. There are different treatment guidelines per country in the region, and a group of leading dermatologists from these countries convened to review these guidelines, discuss current practices and recent advances, and formulate consensus guidelines to harmonize the management of acne vulgaris in the region. Emphasis has been placed on formulating recommendations to impede the development of antibiotic resistance in Propionibacterium acnes. The group adopted the Acne Consensus Conference system for grading acne severity. The group recommends that patients may be treated with topical medications including retinoids, benzoyl peroxide ( BPO), salicylic acid, a combination of retinoid and BPO, or a combination of retinoids and BPO with or without antibiotics for mild acne; topical retinoid with topical BPO and a oral antibiotic for moderate acne; and oral isotretinoin if the patient fails first-line treatment (a 6- or 8-week trial of combined oral antibiotics and topical retinoids with BPO) for severe acne. Maintenance acne treatment using topical retinoids with or without BPO is recommended. To prevent the development of antibiotic resistance, topical antibiotics should not be used as monotherapy or used simultaneously with oral antibiotics. Skin care, comprised of cleansing, moisturizing and sun protection, is likewise recommended. Patient education and good communication is recommended to improve adherence, and advice should be given about the characteristics of the skin care products patients should use. [ABSTRACT FROM AUTHOR]

Background R-Limonene is a common fragrance terpene found in domestic and industrial products. R- Limonene autoxidizes on air exposure, and the oxidation products can cause contact allergy. In a recent multicentre study, 5.2% (range 2.3-12.1%) of 2900 patients showed a positive patch test reaction to oxidized R-limonene. Objective To study the exposure to limonene among consecutive dermatitis patients reacting to oxidized R-limonene in an international setting, and to assess the relevance of the exposure for the patients' dermatitis. Methods Oxidized R-limonene 3.0% (containing limonene hydroperoxides at 0.33%) in petrolatum was tested in 2900 consecutive dermatitis patients in Australia, Denmark, the United Kingdom, Singapore, Spain, and Sweden. A questionnaire assessing exposure to limonene-containing products was completed. Results Overall, exposure to products containing limonene was found and assessed as being probably relevant for the patients' dermatitis in 36% of the limonene-allergic patients. In Barcelona and Copenhagen, > 70% of the patients were judged to have had an exposure to limonene assessed as relevant. Conclusions Oxidized R-limonene is a common fragrance allergen, and limonene was frequently found in the labelling on the patients' products, and assessed as relevant for the patients' dermatitis. A large number of domestic and occupational sources for contact with R-limonene were identified. [ABSTRACT FROM AUTHOR]

Lichen planus pigmentosus is a rare variant of lichen planus for which no effective treatment is currently available. Patients usually present with hyperpigmented, dark brown macules on sun-exposed areas or flexural folds. Here we describe a 50-year-old Chinese woman who had biopsy-confirmed lichen planus pigmentosus that was recalcitrant to a variety of topical treatments, but responded to treatment with a pigment laser. [ABSTRACT FROM AUTHOR]

What's known on the subject? and What does the study add? Family history ( FH) is a major risk factor for the development of prostate cancer. The search for genetic variants has led to genome-wide association studies ( GWAS), which have so far reported 47 susceptibility loci that predispose men to prostate cancer. However, the use of genetics or FH status in predicting clinical outcomes after prostate cancer diagnosis remains uncertain. Guidelines currently exist for clinicians and patients summarising evidence relating to the best outcomes of different prostate cancer treatment methods. Genetics and FH could potentially add to this stratification., Our study aimed to ascertain the potential prognostic roles of FH or genetic risk scores in patients managed by active surveillance., Objectives To explore the potential prognostic role of family history ( FH) of prostate cancer and prostate cancer risk single nucleotide polymorphisms ( SNPs) in patients undergoing active surveillance ( AS) for prostate cancer., This is the first study to date, which has investigated the potential prognostic role of SNP profiles in an AS cohort, Patients and Methods FH data were collected from patients in the Royal Marsden Hospital AS study., In all, 39 prostate cancer-risk SNPs identified from published genome wide association studies ( GWAS) were genotyped using the Sequenom Platform and TaqMan™ assays from available DNA., The cumulative genetic-risk scores for each patient were then calculated using the weighted effect estimated from previous GWAS (log-additive model)., FH status and the genetic-risk scores were assessed against adverse outcomes in AS, time to treatment and adverse histology on repeat biopsy, using univariable and multivariable Cox regression models to address time to treatment; and binary logistic regression to address biopsy upgrade., Results Of 471 patients, 55 (13.6%) had adverse histology on repeat biopsies and 145 (30.8%) had deferred treatment., On univariate analysis, there was no significant relationship between FH of prostate cancer in any degree of relation, and adverse histology or time to treatment., For risk score analyses, 386 patients' DNA was studied; and there was also no relationship found between the calculated genetic risk scores and adverse histology or time to treatment ( P = 0.573 and P = 0.965, respectively)., The retrospective study design and the few events were the main limitation of the study., Conclusions There is currently insufficient data to support the use of FH status or prostate cancer SNP profile risk scores as prognostic factors in AS and these should not be used to influence management decisions., As more genetic variants are discovered this may change and should be reassessed in multicentre AS cohorts. [ABSTRACT FROM AUTHOR]

The article describes the case of a six-year-old girl diagnosed with extensive congenital plaque-type glomuvenous malformation (GVM), a relatively rare vascular anomaly. Information is presented on the histopathology of GVMs and the two main differential diagnoses of GVMs. Some of the therapies for GVMs include sclerotherapy, carbon dioxide, argon, pulsed-dye or neodymium-doped yttrium aluminum garnet (Nd-YAG) laser.

What's known on the subject? and What does the study add? The link between inflammation and cancer has long been reported and inflammation is thought to play a role in the pathogenesis of many cancers, including prostate cancer ( PrCa). Over the last 5 years, genome-wide association studies ( GWAS) have reported numerous susceptibility loci that predispose individuals to many different traits., The present study aims to ascertain if there are common genetic risk profiles that might predispose individuals to both PrCa and the autoimmune inflammatory condition, rheumatoid arthritis. These results could have potential public heath impact in terms of screening and chemoprevention., Objectives To investigate if potential common pathways exist for the pathogenesis of autoimmune disease and prostate cancer ( PrCa)., To ascertain if the single nucleotide polymorphisms (SNPs) reported by genome-wide association studies ( GWAS) as being associated with susceptibility to PrCa are also associated with susceptibility to the autoimmune disease rheumatoid arthritis ( RA)., Materials and Methods The original Wellcome Trust Case Control Consortium ( WTCCC) UK RA GWAS study was expanded to include a total of 3221 cases and 5272 controls., In all, 37 germline autosomal SNPs at genome-wide significance associated with PrCa risk were identified from a UK/Australian PrCa GWAS., Allele frequencies were compared for these 37 SNPs between RA cases and controls using a chi-squared trend test and corrected for multiple testing ( Bonferroni)., Results In all, 33 SNPs were able to be analysed in the RA dataset. Proxies could not be located for the SNPs in 3q26, 5p15 and for two SNPs in 17q12., After applying a Bonferroni correction for the number of SNPs tested, the SNP mapping to CCHCR1 (rs130067) retained statistically significant evidence for association ( P = 6 × 10-4; odds ratio [ OR] = 1.15, 95% CI: 1.06-1.24); this has also been associated with psoriasis., However, further analyses showed that the association of this allele was due to confounding by RA-associated HLA-DRB1 alleles., Conclusions There is currently no evidence that SNPs associated with PrCa at genome-wide significance are associated with the development of RA., Studies like this are important in determining if common genetic risk profiles might predispose individuals to many diseases, which could have implications for public health in terms of screening and chemoprevention. [ABSTRACT FROM AUTHOR]

Background. Limonene is a common fragrance terpene that, in its pure form, is not allergenic or is a very weak allergen. However, limonene autoxidizes on air exposure, and the oxidation products can cause contact allergy. Oxidized R-limonene has previously been patch tested in multicentre studies, giving 2-3% positive patch test reactions in consecutive patients. Objectives. To investigate whether oxidized R-limonene 3.0% in petrolatum, with a stable concentration of the main haptens, limonene hydroperoxides (Lim-OOHs), could be a useful tool for the detection of contact allergy in an international setting. Methods. Oxidized R-limonene 3.0% (Lim-OOHs 0.33%) pet. was tested in 2900 consecutive dermatitis patients in Denmark, the United Kingdom, Singapore, Spain, Sweden, and Australia. Results. Overall, 5.2% (range 2.3-12.1%) of the patients showed a positive patch test reaction to oxidized R-limonene. Doubtful reactions were found in 7.0% of the patients (range 0-24%). Few irritant reactions were seen. Conclusions. Oxidized R-limonene at 3.0% pet. with a specified content of Lim-OOHs 0.33% is a standardized and useful tool for the detection of contact allergy in dermatitis patients. Many patients showing positive patch test reactions to oxidized R-limonene would not be informed of their fragrance allergy if this specific test had not been performed. [ABSTRACT FROM AUTHOR]

Background. Linalool is a common fragrance terpene that, in pure form, is not allergenic or is a very weak allergen. However, linalool autoxidizes on air exposure, and the oxidation products can cause contact allergy. In a Swedish study, oxidized linalool 6.0% in petrolatum (pet.) gave 5% positive patch test reactions in 2500 dermatitis patients. Objectives. To investigate whether oxidized linalool 6%, with a stable concentration of the main haptens, the linalool hydroperoxides (Lin-OOHs) in pet., could be a useful tool for the detection of contact allergy in an international setting. Methods. Oxidized linalool 6.0% (Lin-OOHs 1%) pet. was tested in 2900 consecutive dermatitis patients in Denmark, the United Kingdom, Singapore, Spain, Sweden, and Australia. Results. Overall, 6.9% (range 3-13%) of the patients showed positive patch test reactions to oxidized linalool. Doubtful reactions were found in 9.2% of the patients (range 0-36%). Few irritant reactions were seen. Conclusions. In an international setting, oxidized linalool has been shown to be a common allergen. Oxidized linalool 6.0% (Lin-OOHs 1%) pet. is a useful, standardized and stable tool for the detection of contact allergy in dermatitis patients. Many patients showing positive patch test reactions to oxidized linalool would not have been informed of their fragrance allergy if this specific test had not been performed. [ABSTRACT FROM AUTHOR]

Background. Although acrylate/methacrylate allergy has been frequently reported, until now patch testing with this group of allergens has been unwieldy, requiring the application of large supplementary series in most centres. Objectives. To formulate and evaluate two mixes of acrylate/methacrylate allergens in three centres (Malmö, Singapore, and Leuven). Patients/materials/methods. All patients tested with the baseline series during the study period were also patch tested with the mixes. Mix 1 consisted of: triethyleneglycol diacrylate (TREGDA) 0.1% wt/wt, 2-hydroxyethyl methacrylate (2-HEMA) 1.0% wt/wt and ethyleneglycol dimethacrylate 1.0% wt/wt in petrolatum. Mix 2 consisted of: TREGDA 0.1% wt/wt and 2-HEMA 2.0% wt/wt in pet. The separate components of the two mixes were also tested simultaneously. Results. There were 25 (5 males; 20 females) positive reactions to mix 1 with 16 in Malmö, 8 in Singapore, and 1 in Leuven. Positive reactions to mix 2 were seen only in Malmö, in 8 female patients. Thus, the positive reaction rate for mix 1 was 8.3% overall (Malmö 7.7%, Singapore 18.6%, and Leuven 2.1%), and that for mix 2 was 2.7% overall (Malmö 3.8%, Singapore 0%, and Leuven 0%). Of the 16 positive reactions to mix 1 in Malmö, only 4 were considered to be true allergic reactions, as the component allergen testing gave totally negative results in 12/16. For mix 2, only 3/8 positive reactions were considered to be true allergic reactions, as the component testing was negative in 5/8. Many doubtful (10-20%) and positive but non-allergic reactions were recorded, leading to early termination of the study. Conclusions. Although this was an unsuccessful attempt to formulate an acrylate/methacrylate mix, our experience will be useful for those embarking on future attempts to do this. [ABSTRACT FROM AUTHOR]

Acne vulgaris is common throughout the world and often perceived by both patients and clinicians as an inconsequential disease of adolescence. In reality, however, acne is a chronic medical disease that lasts for years and causes a considerable impact on quality of life. Many patients with acne experience emotional problems due to their disease, which can lead to reduced social interactions and even a lower likelihood of employment. Little has been written specifically about acne in Asian patients in the English-language medical published work, perhaps due to an assumption that the management of acne is the same in all populations. A group of acne experts from nine Asian countries and the USA met to review and discuss acne care within the Asia-Pacific region, focusing on evidence-based medicine. This group developed a care algorithm using results of clinical trials as well as knowledge of practice patterns. [ABSTRACT FROM AUTHOR]

Primary localized cutaneous amyloidosis (PLCA) commonly presents as macular and lichen variants. We present a case of a 27-year-old Chinese woman with cutaneous features of the rarely reported poikiloderma-like, dyschromic and bullous forms of PLCA, and the commoner lichen variant. There were no syndromic associations or systemic involvement, and the various morphological subtypes occurred in isolation from one another. We review the clinical spectrum of PLCA, highlight its protean clinical manifestations in this patient, and discuss its postulated pathogenesis in relation to its histopathological features. [ABSTRACT FROM AUTHOR]

In patients with darker skin types (Fitzpatrick phototypes III- VI), acne is often accompanied by post-inflammatory hyperpigmentation ( PIH). Further, acne-related pigmentation can pose a greater concern for the patient than the acne lesions. There has been little formal study of this acne-related PIH. Recently, the Asian Acne Board - an international group of dermatologists with interest in acne research - made a preliminary evaluation of the frequency and characteristics of PIH in seven Asian countries. A total of 324 sequential acne subjects were evaluated for the presence of PIH. The majority (80.2%) of subjects had mild to moderate acne and there were more females than males (63.0% vs 37.0%). In this population of patients consulting a dermatologist for acne, 58.2% (188/324) had PIH. The results also showed that pigmentation problems are often long lasting: at least 1 year for more than half of subjects and 5 years or longer in 22.3%. In accordance with our clinical experience, patients reported that PIH is quite bothersome, often as bothersome or more so than the acne itself and sometimes more problematic. Excoriation was commonly reported by patients, and may represent a modifiable risk factor that could potentially be improved by patient education. [ABSTRACT FROM AUTHOR]

The authors propose third-generation small and high-speed saturable absorbers to replace semiconductor-based saturable absorbers and optical-fiber-based nonlinear devices. The device is based on the carbon nanotube (CNT). This paper discusses the characteristics of CNT-based saturable absorbers. The present status of research on passively mode-locked fiber lasers using CNT-based saturable absorbers is reported. © 2007 Wiley Periodicals, Inc. Electron Comm Jpn Pt 2, 90(2): 17– 24, 2007; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/ecjb.20272 [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome (SARS) was first recognized in February 2003. It is the first severe and readily transmissible new disease to emerge in the 21st century. Healthcare workers in affected countries were exposed to the regular use of personal protective equipment (PPE) such as the N95 mask, gloves, and gowns. Our aim was to study the prevalence of adverse skin reactions to PPE among healthcare workers in Singapore during the SARS outbreak. Healthcare staff in the National Skin Centre and Tan Tock Seng Hospital were surveyed using questionnaires. Of those asked to participate, 322 (94.7%) agreed. 14.3% of the respondents were doctors, 73.0% nurses, and 12.7% other ancillary staff. Mean age of respondents was 32.4 years, with the majority being women (85.7%) and Chinese (53.7%). 109 (35.5%) of the 307 staff who used masks regularly reported acne (59.6%), facial itch (51.4%), and rash (35.8%) from N95 mask use. 64 (21.4%) of the 299 who used gloves regularly reported dry skin (73.4%), itch (56.3%), and rash (37.5%). The use of PPE is associated with high rates of adverse skin reactions. There is a need to find suitable alternatives for affected staff and to encourage awareness among staff of the role of dermatologists in their care. [ABSTRACT FROM AUTHOR]

Contact allergy to dental allergens is a well-studied subject, more so among dental professionals than dental patients. 1632 subjects had been patch tested to either the dental patient series or dental personnel series at the department of Occupational and Environmental Dermatology, Malmö, Sweden. Positive patch tests to (meth)acrylate allergens were seen in 2.3% (30/1322) of the dental patients and 5.8% (18/310) of the dental personnel. The most common allergen for both groups was 2-hydroxyethyl methacrylate (2-HEMA), followed by ethyleneglycol dimethacrylate (EGDMA), triethyleneglycol dimethacrylate, and methyl methacrylate. 47 (29 dental patients and 18 dental personnel) out of these 48 had positive patch tests to 2-HEMA. All 30 subjects who had a positive reaction to EGDMA had a simultaneous positive reaction to 2-HEMA. One dental patient reacted only to 2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy) phenyl]propane (bis-GMA). From our data, screening for (meth)acrylate contact allergy with 2-HEMA alone would have picked up 96.7% (29/30) of our (meth)acrylate-allergic dental patients and 100% (18/18) of our (meth)acrylate-allergic dental personnel. The addition of bis-GMA in dental patients would increase the pick-up rate to 100%. [ABSTRACT FROM AUTHOR]

Background Much controversy has existed with regard to the relationship between Kimura's disease and angiolymphoid hyperplasia with eosinophilia. They were initially thought to represent the same disease spectrum, but it has now been widely accepted that they are two separate disease entities. To our knowledge, there have been no reports to date describing a case of both Kimura's disease and angiolymphoid hyperplasia with eosinophilia coexisting in the same patient. Methods We describe a patient presenting initially with a right postauricular subcutaneous swelling and subsequently developing multiple erythematous facial papules and nodules. The medical literature is reviewed. Results Clinical features of the right postauricular subcutaneous swelling and multiple erythematous facial papules/nodules suggest Kimura's disease in the former and angiolymphoid hyperplasia with eosinophilia in the latter. Histopathological examinations of these lesions helped to confirm the diagnosis of Kimura's disease and angiolymphoid hyperplasia with eosinophilia, respectively. Conclusions Kimura's disease and angiolymphoid hyperplasia with eosinophilia can coexist in the same patient. Coexistence of the two types of lesions in one patient may also be considered evidence that Kimura's disease and angiolymphoid hyperplasia with eosinophilia form a spectrum in one disease. [ABSTRACT FROM AUTHOR]

Objectives To provide a description of medical and psychological aspects of Chinese psoriasis patients, and to examine the specific contribution of demographic, medical and psychological variables to the Psoriasis Disability Index. Methods Ninety-three Chinese psoriasis patients underwent a clinical assessment using the Psoriasis Area and Severity Index (PASI) and completed a questionnaire that included questions on demographic and medical data, the Hospital Anxiety and Depression Scale (HADS) and the Psoriasis Disability Index (PDI). Results Psoriasis patients with cosmetic involvement had higher levels of anxiety and depression and higher disability scores than those without cosmetic involvement. Thirty-four per cent of the patients reported a significant level of anxiety (HADS-anx. > 11). The clinical severity of psoriasis was not associated with psychological and PDI scores. Multiple regression analysis indicated that psychological variables were associated with PDI scores, and explained 30% of the variance. However, demographic and psoriasis severity variables explained only 6% of the variance. Conclusion Psoriasis patients suffer from anxiety and depression. Psychological factors are much stronger determinants of the PDI than demographic, disease related variables. Clinical management of the disease should consider both clinical and psychological factors. [ABSTRACT FROM AUTHOR]

Abstract Background Alopecia areata is believed to be an autoimmune condition with a worldwide occurrence. It usually presents as patchy, nonscarring hair loss. There is a paucity of clinical data in Asians. Objective To study the epidemiology, clinical aspects, associations, and treatment of alopecia areata in an Asian population over a 1-year period. Methods Records of all newly diagnosed alopecia areata cases seen from May 1998 to April 1999 at the National Skin Center were collated with regard to the epidemiology, pattern of alopecia, and associations according to the investigational guidelines published by Oslen et al . The treatment and psychologic impact of alopecia areata were also assessed. Results Two hundred and nineteen new case referrals of alopecia areata were seen from May 1998 to April 1999. The incidence of alopecia areata was 3.8%. There were 173 Chinese (79%), 35 Indians (16%), and 11 Malays (5.0%). The male to female ratio was 1 : 1.3. The median age at presentation was 25.2 years. The majority of patients (85.5%) had their first episode of alopecia areata before the age of 40 years. Of the patients with onset of alopecia areata before the age of 40 years, 36.5% presented with extensive alopecia, compared with 5.5% above the age of 40 years (P < 0.05). Nail changes, consisting of pitting, trachyonychia, and longitudinal ridging, were reported in 23 patients (10.5%). A significant percentage of patients had an associated personal and family history of atopy (60.7%). There was no significant association between a personal history of atopy and the extent of alopecia areata. The frequencies reported for the following associated diseases were: thyroid disease, 2.3%; vitiligo, 4.1%; diabetes mellitus, 3.2%; Down's syndrome, 1.4%; and rheumatic arthritis, 0.9%. A family history of alopecia areata was reported in 4.6%. Intralesional triamcinolone acetonide was the first-line treatment for limited alopecia areata, while squaric acid dibutyl ester was... [ABSTRACT FROM AUTHOR]

406 patients were patch tested over an 18-month period (January 1998 to June 1999) at a dermatology referral centre. 33 patients (8.1%) had a positive reaction to para-phenylenediamine (PPD). 20 patients were experiencing PPD hair dye dermatitis (present relevance, 61%), 2 were using PPD hair dyes without developing dermatitis (clinical tolerance, 6%), 4 had previously used PPD hair dyes with dermatitis in the past (past relevance, 12%), 3 had previously used PPD hair dyes without dermatitis (past exposure, 9%) and 4 had no known exposure to PPD (unknown relevance, 12%). Of the 20 patients whose test results were of present relevance, 17 avoided PPD hair dyes, resulting in total clearance of the dermatitis in all except 3, who had concurrent endogenous eczema. 3 continued using PPD hair dyes: 2 had recurrent contact dermatitis and 1 avoided dermatitis with meticulous technique. The 2 patients with clinical tolerance continued using PPD hair dyes with no dermatitis. [ABSTRACT FROM AUTHOR]

Describes the pathogenesis, clinical characteristics and treatment options for post herpetic neuralgia; Mechanisms of post herpetic neuralgia; Prevention; Role of dermatologists, neurologists and pain specialists.

In a retrospective epidemiologic study of 202 patients with eczematous cheilitis attending a patch test clinic, females (182 (90%)) predominated over males (20 (10%)). The mean age of our patients was 30.9 years. There was no significant difference between the mean age of females (31 years) presenting with cheilitis compared to males (29 years). Endogenous cheilitis (53%) was the commonest diagnosis, followed by allergic contact dermatitis (34%) and irritant contact dermatitis (5.4%). A personal history of atopy was recorded in 33%. There was no significant difference in the prevalence of atopy between the sexes or among the diagnoses. The mean duration of cheilitis was 16.4 months. The duration was significantly longer in males (29 months) than in females (15 months) (p=0.004). The mean number of positive patch test reaction in patients with allergic contact cheilitis (2.8) was significantly higher than in those with irritant contact cheilitis (0.2) (p=0.012) or endogenous cheilitis (0.5) (p=0.00). The commonest cause of allergic contact cheilitis were lip cosmetics, including lipsticks and lipbalms, followed by toothpastes. The commonest cause of irritant contact cheilitis was lip-licking, lipsticks and medication. In 81/202 (40%) patients, 1 or more causes of contact cheilitis could be ascertained. In females, lip cosmetics were the commonest cause, accounting for 54% (44/81) of cases. Toothpastes accounted for 21% (17/81), followed by topical medication 7% (6/81). For males, toothpastes were the commonest cause of allergic contact cheilitis. Ricinoleic acid and the patient's own lip preparations were the commonest relevant contact allergens. [ABSTRACT FROM AUTHOR]

This is an epidemiologic study of occupational skin disease in Singapore. All patients diagnosed with occupational dermatoses in the National Skin Centre, Singapore, over the 10-year period 1989–1998 were studied retrospectively. Irritant contact dermatitis was found to be more common than allergic contact dermatitis. The major sources of occupational dermatitis in Singapore were the metal/engineering, building/construction, electrical/electronics and transport industries. The main irritants were detergents/wet work, solvent and oil/grease. The main allergens were chromate, rubber chemicals and nickel. We concluded that the main sources of occupational skin disease and main allergens in Singapore had remained the same compared to a similar study of occupational skin diseases in 1984–85. Weak irritants are still the predominant causes of occupational irritant contact dermatitis, though the main irritants have changed compared to the previous study, where cutting fluids, cement and solvent were the most common irritants. [ABSTRACT FROM AUTHOR]

Background Although infection by Mycobacterium marinum is well reported in the literature, there have been few epidemiologic studies. The purpose of this study was to review the epidemiology of patients with cutaneous M. marinum infection over a 3-year period at the National Skin Centre in Singapore. Methods Patients with a diagnosis of cutaneous M. marinum infection, confirmed histologically, were collated from computerized data from 1995 to 1997. Thirty-eight patients were diagnosed as having cutaneous M. marinum infection based on history, and clinical and histologic features. Results Out of the 38 cases of M. marinum infection, there were 30 men and eight women. The age range was 14–85 years (mean: 44.7 years). The duration of disease ranged from 1 to 132 months (mean: 19 months). Thirteen patients (34.2%) had fish rearing as a hobby and four patients (10.5%) had occupational exposure to fish. Twelve patients (31.5%) gave a history of trauma to the disease site. All patients had biopsies of the lesions. All showed infective granulomas/granulomatous inflammation on histology. Acid-fast bacilli were identified in five out of 38 patients (13.2%) and mycobacteria were isolated in one out of 35 patients (2.9%). Nineteen patients received treatment with cotrimoxazole—trimethoprim alone, three with minocycline alone, five with minocycline and cotrimoxazole—trimethoprim, seven with various combinations of drugs, one with excision, and three defaulted treatment. The duration of treatment ranged from 4 to 38 weeks (mean: 14.9 weeks). Twenty-six patients (68.4%) showed clinical improvement, two (5.3%) had no response, and 10 (26.3%) were Iost to follow-up. None of the patients worsened with treatment. The follow-up period ranged from 1 to 20 months (mean: 6.8 months). Conclusions The diagnosis of cutaneous M. marinum infection is mainly clinical, with supporting evidence from histologic features and the response to therapy. Risk factors include ... [ABSTRACT FROM AUTHOR]

This is a retrospective study of 114 patients who received oral isotretinoin for acne vulgaris for a minimum of 6 weeks between January 1994 and March 1995. Relapse was defined as deterioration in acne sufficient to merit systemic therapy, either with antibiotics or with another course of isotretinoin. Patients were considered nonrelapsers after a minimum period of 1 year post-treatment with isotretinoin. Case notes were traced and the following data were retrieved: age, sex, duration of acne, site of acne, previous treatment with either antibiotics or isotretinoin, indications for treatment, total cumulative dose of oral isotretinoin, average daily dose of isotretinoin,. response, relapse, time taken to relapse, and subsequent treatment. Those with either complete or partial (>80%) clearance were considered as responders because of the difficulty in categorizing them accurately due to the retrospective nature of the study. A telephone interview was conducted as far as possible with all patients who had an inadequate follow-up period to ascertain if they had relapsed, i.e. if they had been prescribed systemic therapy for further flares of acne. Analyses of laboratory abnormalities were performed only in patients who had serial alanine aminotransferase (ALT), total cholesterol, and triglyceride readings. Data were analyzed using the chi-squared test, Student’s t-test, Mann–Whitney U-test, and Fisher’s exact test. Of the 114 cases studied, 21 were excluded because of the following reasons: no weight was documented, 12; antibiotics were started immediately after completion of treatment making it impossible to document relapse, 2; patients were not seen at all after completing treatment and were uncontactable, 7. A further four cases with a break of 4 weeks or more during treatment were excluded as the accuracy of the calculated total cumulative dose of isotretinoin may be affected, given the half-life of 10–20 h. [ABSTRACT FROM AUTHOR]

AbstractBackground Atopic dermatitis is a common, chronic, relapsing, pruritic, eczematous skin condition occurring in patients with a personal or family history of atopy. The aim of this study is to describe the profile of atopic dermatitis seen at a tertiary referral skin center in a tropical multiracial country. Methods A retrospective chart review was conducted of all the patients with atopic dermatitis seen during the first six months of 1994. Results There were 492 patients, age range from 1 month to 74 years, with an equal sex ratio. The prevalence was 2%. The onset of the disease occurred before the age of 10 years in 61.2% of patients. In 13.6% of patients, the onset was after the age of 21 years. Two hundred and fifty four patients (52%) had “pure” atopic dermatitis without concomitant respiratory allergies; 238 patients (48%) suffered from a “mixed” type, with 23% having allergic rhinitis, 12% having asthma, and 13% having both asthma and allergic rhinitis; 231 patients (47%) had at least one first-degree family member with atopy: atopic dermatitis (17%), asthma (15%), and allergic rhinitis (15%). Most of the patients, 416 (84.5%), had subacute dermatitis at presentation. Ichthyosis vulgaris was present in 38 patients (8%) and pityriasis alba in 13 patients (3%). The most common infective complication was bacterial infection (impetiginized dermatitis, folliculitis, cellulitis) present in 95 patients (19%), followed by viral infections (dermatitis herpeticum, viral warts, and molluscum contagiosum) in 17 patients (3%). Allergies were noted in 43 patients (9%). The most common was drug allergy (penicillin and cotrimoxazole) in 28 patients, followed by food allergy in 11 patients. Common aggravating factors reported included heat, sweating, stress, thick clothing, and grass intolerance. Most patients could be controlled with a fairly simple regimen of moisturizers, topical steroids, and antibiotics for acute flares. Short courses of systemic steroids were used in 78 patients (16%). Three patients were treated with phototherapy: two on combined UVA and UVB (UVAB) and one on oral psoralen photochemotherapy (PUVA). Conclusions The pattern of atopic dermatitis in Singapore is similar to that reported in the Western literature, except for a lower prevalence and a significant proportion of adult-onset atopic dermatitis. [ABSTRACT FROM AUTHOR]

AbstractBackground Bacterial skin infections in children and adults are caused by different organisms with different antimicrobial susceptibility. Methods A comparative retrospective study was carried out on 233 adults and 53 children with bacterial skin infections. Skin swab cultures and sensitivity tests were performed using standard methods. Statistical analysis was performed using the Pearson chi-squared and Fisher tests. A P value of <0.05 was considered to be significant. Results Primary and secondary skin infections occurred in equal proportions in children, whereas secondary skin infections were more common in adults (70.8%). Staphylococcus aureus was the main cause of skin infections, particularly in children (72.6%). S. aureus in children and adults was highly susceptible to cloxacillin, cephalexin, chloramphenicol, neomycin, cotrimoxazole, and clindamycin, moderately susceptible to erythromycin, and insensitive to tetracycline, ampicillin, and penicillin. Conclusions It is important to monitor the trends of bacterial infections and their antibiotic susceptibility as this can assist medical practitioners in their choice of antimicrobial therapy. Such monitoring will also help to detect the emergence of resistant bacterial strains and caution us to take care in the use of certain drugs. [ABSTRACT FROM AUTHOR]

Background. Superficial cutaneous fungal infection, principally dermatophytosis, is an extremely common skin disease. Various in vitro test systems have been developed in recent years to determine the antifungal activity of various drugs. The minimum inhibitory concentration (MIC) obtained may give an indication of the in vivo potency of the drugs. Methods. One hundred patients (69 men and 31 women) with a clinical diagnosis of dermatophytosis were entered into the study. Direct microscopy and culture were done on all patients. The MICS were determined using the broth dilution method. Results. The age range was 1-76 years. The most common diagnosis was tinea corporis (36%). followed by tinea cruris (22%), and tinea pedis (19%). The most common fungus isolated was T. rubrum (58%). followed by E. floccosum (14%), and T. mentagrophytes (10%). The majority of the isolates was sensitive to the three drugs tested (griseofulvin, ketoconazole, and itraconazole). Of the isolates, 82% were sensitive to griseofulvin, 78% to ketoconazole, and 81% to itraconazole, all at a concentration of < 0.25 μg/mL. For T. rubrum, there were four isolates that had an MIC of ≥ 64 μg/mL to griseofulvin, seven isolates and nine isolates with an MIC ≥ 64 μg/mL to ketoconazole and itraconazole, respectively. T. interdigitale was relatively resistant to the three drugs in vitro with four of seven isolates having an MIC ≥ 4 μg/mL with griseofulvin, one of seven isolate with an MIC ≥ 64 μg/mL with ketoconazole, and three of seven isolates with an MIC ≥ 32 μg/mL with itraconazole. Conclusions. The in vitro antifungal activity of griseofulvin, ketoconazole, and itraconazole are similar against dermatophytes in Singapore. Griseofulvin may be given as the firstline drug for treating such infections in Singapore. [ABSTRACT FROM AUTHOR]

Background. The use of isotretinoin, a first generation synthetic retinoid, in the treatment of patients with severe acne vulgaris was a major therapeutic advance in dermatology. This 10-year retrospective study reviews the effectiveness of isotretinoin in patients with acne vulgaris seen in a skin clinic in Singapore. Methods. The case records of 250 cases of severe inflammatory and nodulocystic acne treated with isotretinoin were analyzed with reference to the demographic data, response to isotretinoin, dosage and cost of isotretinoin used, adverse effects, clinical follow-up, and relapse. Results. Two hundred and fifty patients, 171 men (68.4%) and 79 women (31.6%), with different types and grades of acne vulgaris were studied. The dose of isotretinoin used ranged from 0.33 to 1.0 mg/kg/day (median 0.5 mg/kg/day) for a period ranging from 1 to 12 months (median 4 months). Response was excellent in 127 (50.8%) patients, good in 86 (34.4%), fair in 30 (12.0%) and poor in 7 (2.8%). Relapse occurred in 14 (5.6%) patients over a 6-month follow-up period. Adverse effects were noted in 140 (56.0%) patients and were mild in most cases. Eighteen (7.2%) patients had to discontinue the drug due to significant side effects. Conclusion. This study confirms that isotretinoin is very effective for severe acne, and complete remission can be induced in more than 90% of cases even with lower dosage regimens. Significant clinical improvement can be achieved with the use of lower doses (mean 0.5 mg/kg/day) for an average of 4 months of treatment with lower risk of adverse effects. [ABSTRACT FROM AUTHOR]

Background. Etretinate, a second generation retinoic acid, has been reported to be useful in the treatment of psoriasis and other keratinizing disorders. The effectiveness of etretinate for these disorders are studied in a 10-year retrospective study of all patients treated with etretinate in a skin clinic in Singapore. Methods. The case records of 190 cases of psoriasis and other keratinizing disorders treated with etretinate were analyzed. Information collected included demographic data, dosage of etretinate taken, response and side effects, clinical follow-up, and relapse. Results. Most of the cases (72.6%) had psoriasis (138/190). The others had different keratinizing disorders. The dose of etretinate used was 0.15 to 1 mg/kg/day (median 0.36 mg/kg/day), and the duration of the treatment varied from 1 to 120 months (median 6 months). Etretinate was coadministered with UVB (ReUVB) or PUVA (RePUVA) in 89 (46.8%) patients. In psoriasis, the response to treatment was excellent in 41.3% (57/138), good in 36.2% (50/138), fair in 15.9% (22/1 38), and poor in 6.5% (9/138) of the cases. Patients with plaque-type psoriasis did better with combination therapy than with monotherapy. Those with keratinizing disorders showed excellent, good, fair, and poor responses in 32.7% (17/52), 32.7% (17/52), 25.0% (13/52), and 9.6% (5/52) respectively. Adverse effects were noted in 102 (53.7%) cases and were generally mild and tolerable. Etretinate was discontinued in 24 (12.6%) patients due to significant toxicity. Conclusions. Etretinate is effective for treating psoriasis and other keratinizing disorders. Combination therapy is preferred in chronic plaque psoriasis. Adverse effects are common, but mild and tolerable. [ABSTRACT FROM AUTHOR]

The incidence of chromate sensitivity in a South East Asian country was found to be 3.22%, the female:male ratio being 1:5, with the majority of the allergies being occupational in origin in men and unexplained in women. Cement was the most common cause among the occupational allergies. Housewives and office workers were the most common occupations in those with unexplained allergies. [ABSTRACT FROM AUTHOR]

Abstract Background The objective of this study was to explore the role of the polymerase chain reaction (PCR) for the detection of Mycobacterium tuberculosis DNA as a diagnostic aid in cutaneous tuberculosis, using routinely processed skin biopsy specimens. Methods and results A wide range of clinical specimens representing different forms of cutaneous tuberculosis and so-called tuberculids were studied. A sensitive and specific PCR assay targeting the sequence IS6110 of Mycobacterium tuberculosis complex was used. The specimens were categorized as follows. 1 Acid-fast bacilli (AFB) positive on biopsy (nine specimens from seven patients who were immunocompromised). PCR was positive in five specimens. Of these, one specimen was culture positive and three specimens were culture negative. 2 AFB negative on biopsy: (a) tuberculosis verrucosa cutis (23 specimens); (b) lupus vulgaris (three specimens); (c) cutaneous tuberculosis clinically suspected (six specimens). PCR was negative in all specimens. 3 “Tuberculids.” (a) erythema induratum/nodular vasculitis (20 specimens); (b) papulonecrotic tuberculid (two specimens); (c) erythema nodosum (20 specimens). PCR was negative in all specimens. Conclusions The role of PCR in clinical dermatologic practice, at this stage, may be in differentiating between cutaneous tuberculosis and atypical mycobacterial infections in the context of an immunocompromised patient where AFB can be demonstrated on biopsy and cultures may be negative. In this clinical situation, PCR allows the prompt diagnosis and early institution of appropriate therapy. We have not found PCR to be a useful complement to the clinical and histologic diagnosis of “paucibacillary” forms of cutaneous tuberculosis. [ABSTRACT FROM AUTHOR]

BackgroundCandidal infections of the skin/nails and vagina are very common worldwide. Various in vitro test systems are available to help to determine the antifungal activity of drugs. The minimum inhibitory concentration (MIC) is a standard measure of the in vitro potency of drugs against yeasts. MethodsVaginal smears and skin/nail scrapings of 50 consecutive patients with candidal vaginitis and 46 consecutive patients (28 women, 18 men) with cutaneous/nail candidosis were used in the study. Direct microscopy and culture from vaginal smears and skin scrapings were performed on all patients. The MICs were determined using the broth dilution method. ResultsFor vaginal candidosis, the mean age of the patients was 28.2 years (range, 9–49 years). Candida albicans accounted for 58% of the isolates, C. glabrata for 32%, C. tropicalis for 6%, and C. parasilosis for 4%. At the MIC of <=4 mg/L, 65–95% of C. albicans, 66–94% of C. glabrata, 33–100% of C. tropicalis, and 0–50% of C. parasilosis were susceptible to the drugs tested (ketoconazole, itraconazole, nystatin, amorolfine, clotrimazole, and miconazole). For cutaneous/nail candidosis, the mean age of the patients was 45 years (range, 19–82 years). C. albicans made up 59% of the isolates, C. parasilosis 20%, C. krusei 13%, C. glabrata 4%, and C. tropicalis 4%. At the MIC of <=4 mg/L, 59–96% of C. albicans, 100% of C. glabrata, 83–100% of C. krusei, 89–100% of C. parasilosis, and 100% of C. tropicalis were susceptible to the drugs tested (ketoconazole, itraconazole, nystatin, amorolfine, clotrimazole, and miconazole). ConclusionsC. albicans is the most common Candida species causing cutaneous/nail and vaginal candidosis in Singapore. The in vitro antifungal activities of ketoconazole, itraconazole, nystatin, amorolfine, clotrimazole, and miconazole are similar against the various Candida species. C. parasilosis in vaginal candidosis appears to be less... [ABSTRACT FROM AUTHOR]

The article presents a case study of a 35-year-old African man who was diagnosed with frontal fibrosing alopecia (FFA). The man has developed an asymptomatic progressive recession of the frontal hairline with loss of follicular orifices and partial loss of both eyebrows. He was treated with hydroxychloroquine 200 mf twice per day for six months which slowed the progression of FFA.

Post-inflammatory hyperpigmentation (PIH) is a problematic and distressing acne sequela. The difficulty of clinically assessing and managing post-inflammatory hyperpigmentation is especially prevalent in Asian populations. The Asian Acne Board conducted a study to evaluate concordance in diagnosis of post-inflammatory hyperpigmentation in patients with active acne, acne scarring, and pigmentation problems. Seven dermatologists reviewed 64 anonymous clinical photographs projected onto a screen during a single session. Results showed that there were two groups of raters, those who found a high frequency of PIH and those who found a low frequency. There was significant variability in these two groups in rating the presence of PIH, with an average of 30 diagnoses (24%) difference between high- and low-frequency raters. Results of severity ratings showed that while most cases of PIH were assessed as mild, there was marked variability between raters in their assessments of severity. Overall, variability in PIH diagnosis was greatest when active acne was present; in these cases, low PIH raters were more likely to report skin coloration as erythema instead of PIH. These findings uphold the importance of utilizing specific clinical criteria to improve accurate evaluation of skin color and we advocate future research into this area. [ABSTRACT FROM AUTHOR]

Our purpose was to determine the proportion of relevant patch test reactions among all patch tested patients in the National Skin Centre (NSC), Singapore, from 1 January 1999 to 31 December 2000. A retrospective study was made of the patch test records of all patients patch tested in the study period. The proportion of relevant patch tests in this population was then determined. The allergens most likely to have present or past relevance were: nickel sulfate (79%), p-phenylenediamine (76%), colophonium (73%), cobalt chloride (68%) and potassium dichromate (67%). The most common allergens for each of the following relevance categories were as follows – present: p-phenylenediamine, thiuram mix, potassium dichromate; past: colophony, nickel sulfate, cobalt chloride; exposed: neomycin, gold sodium thiosulfate, fragrance mix and unknown: gold sodium thiosulfate, potassium dichromate, cobalt chloride. Evaluating relevance is difficult, and the results of relevance scoring vary widely between different groups. A consensus on the definition and standardization of the concept of relevance is needed. [ABSTRACT FROM AUTHOR]

Sixteen Asian patients (6 men and 10 women), in the age range 41–74 years, presenting clinically with symmetrically distributed lichen amyloidosis (LA) on the extremities, were enrolled in this double-blind, right–left comparison pilot study to evaluate the efficacy of calcipotriol ointment (50 μg/g) vs. betamethasone 17-valerate ointment (0.1%). This trial was conducted in a tertiary skin referral center in Singapore and consecutive patients with LA were recruited over a 3-month period. Excluded were patients who were pregnant or lactating, patients with known contact allergy to either calcipotriol or topical steroid, patients with hypercalcemia, and those with significant hepatic or renal disease. After a washout period of 2 weeks, the ointments were applied separately to either the right or left extremities twice daily for a period of 12 weeks. Assessments were made at weeks 0, 4, 8, and 12 by both the physician and the patient. Treatment responses were assessed as follows: roughness (visual analog scale of 1–10, 1 being the least rough and 10 being the most rough), hyperpigmentation (visual analog scale of 1–10, 1 being the least hyperpigmented and 10 being the most hyperpigmented), and any adverse events. An additional parameter assessed by the patient was pruritus (visual analog scale of 1–10, 1 being the least pruritic and 10 being the most pruritic). Clinical photographs were taken during each review. For analyses of the responses, the mean roughness score is defined as the average sum of the roughness score of all patients for each treated side. Likewise the mean hyperpigmentation score and the mean pruritus score are defined as the average sum of hyperpigmentation and the average sum of pruritus, respectively. Any score differences observed between week 0 and week 12 within the two treatment groups were analyzed by Wilcoxon signed ranked test for statistical significance; differences in scores between the two treatment groups were analyzed by Mann–Whitney U-test. [ABSTRACT FROM AUTHOR]

Focuses on a study which examined the clinical outcome of herpes zoster in patients treated with acyclovir or valaciclovir. Demographic characteristics of the study population; Description of pain associated with the disease; Correlation between age and the risk of herpes zoster; Physiological impact of valaciclovir.

Presents information on a study which hypothesized the involvement of human herpesvirus 8 (HHV8) as a cofactor in the pathogenesis of arsenical skin cancers. Presence of HHV8 in patients with arsenical skin cancers; Mechanism by which arsenic leads to cutaneous malignancies.