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AbstractBackground There is a lack of real-life safety data on treatment options for chronic urticaria in the presence of comedication and comorbidities.Methods We present a single-center UCARE pilot study of 212 outpatients with chronic urticaria. Patients were divided into three groups according to different CU therapies according to international guidelines.Results Of 212 patients, 108 (mean age 48.9 years, 71.3% female) had 59 comorbidities, including cardiovascular, autoimmune and malignant diseases. Patients were followed for a mean of 24.6 months (SD ± 21.3). Urticaria therapies were divided into three groups: A: 105 (97.2%) with omalizumab and 2nd generation antihistamines), B: 16 patients (14.8%): dual therapy with antihistamines and cyclosporine in 10 (9.3%), montelukast in five (4. 6%), dapsone in four (3.7%), hydroxychloroquine in one patient (0.9%), C: 12 (11.1%) patients received a third drug for 4.9 months (SD ± 3.2) and one quadruple therapy (2.1 months). 10 out of 12 (83.3%) patients received montelukast, two (16.7%) cyclosporine, two (16.7%) dapsone and one (8.3%) hydroxychloroquine as a third drug for chronic urticaria.Conclusions Combining treatment modalities for chronic urticaria and comorbidities are available and feasible with a good safety profile.

Background: Chronic urticaria (CU), in both inducible and spontaneous forms, is associated with a substantial burden in the Asia-Pacific region (APAC). Patient-centred care recognises patients desire to be involved in decisions regarding their health. Although patient-centred approaches have previously not been studied in the context of CU management, they have demonstrated benefits in the management of other chronic conditions. Methods: Information and opinions regarding the barriers and solutions to the implementation of patient-centred approaches to the management of CU were gathered from a group of 13 expert dermatologists and allergist/immunologists from APAC through surveys and a face-to-face meeting. Results: Barriers identified there included a lack of awareness of CU amongst patients, delays in consulting healthcare providers, financial constraints, and low adherence. Particular issues raised included a lack of suitable online information for patients (83% of experts), and patients accessing oral corticosteroids without a prescription. Compliance issues were also identified as key reasons for inadequate responses to treatments (67% of experts). Solutions proposed by the authors were improving patients' knowledge about their condition (92% strongly agree, 8% agree), physicians’ consideration of patient characteristics when choosing treatments (92% strongly agree, 8% agree), implementing shared decision-making (85% strongly agree, 15% agree), and using patient-reported outcome measures (70% strongly agree, 23% agree). Conclusion: Expert opinion within APAC supports the use of patient-centred approaches to improve the management of CU. We provide several recommendations focusing on patient education and involvement in disease management as well as disease monitoring methods that can be implemented by physicians in APAC.

Background. Limited knowledge exists about genital psoriasis in Thai individuals. Objectives. This study aimed to assess the clinical features of genital psoriasis and its effects on quality of life and sexual health in Thai patients. Materials and Methods. A cross-sectional, self-administered question-based study was conducted at Siriraj Hospital. Participants were psoriasis patients older than 18 years of age with past or current genital involvement. The study assessed quality of life and sexual health. Results. Among the 50 patients, 33 (66%) were female. The mean (standard deviation) age was 45.4 (±13.4) years. Genital psoriasis was active in 34% of the participants. The mons pubis (48.5%) and labia majora (18.2%) were the most frequently affected sites in females, while in males, the penile shaft (52.9%) and glans (47.1%) were the most common sites. Itch-related symptoms predominated, affecting 82% of patients. The median dermatology life quality index score was 6.5 for females and 10 for males. A sexual health survey revealed that 54% of participants had low self-esteem. This issue was more pronounced in males, with 76.5% reporting lower self-esteem compared to 42.4% of females (P=0.022). Males were also more inclined to postpone or avoid marriage (47.1% vs. 15.6%, P=0.038) and more embarrassed about sexual activities (63.6% vs. 14.3%, P=0.017). In addition, males were more inclined to avoid sexual encounters due to their genital condition. Notably, 42.9% of all patients had never disclosed to a doctor that they had genital psoriasis. Conclusions. Genital psoriasis impacts quality of life and sexual function, with male patients being particularly impacted. Improved awareness of these issues among health professionals might increase patient satisfaction.

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.

Abstract Introduction The integrated care pathways for atopic dermatitis (AD‐ICPs) aim to bridge the gap between existing AD treatment evidence‐based guidelines and expert opinion based on daily practice by offering a structured multidisciplinary plan for patient management of AD. ICPs have the potential to enhance guideline recommendations by combining interventions and aspects from different guidelines, integrating quality assurance, and describing co‐ordination of care. Most importantly, patients can enter the ICPs at any level depending on AD severity, resources available in their country, and economic factors such as differences in insurance reimbursement systems. Methods The GA2LEN ADCARE network and partners as well as all stakeholders, abbreviated as the AD‐ICPs working group, were involved in the discussion and preparation of the AD ICPs during a series of subgroup workshops and meetings in years 2020 and 2021, after which the document was circulated within all GAL2EN ADCARE centres. Results The AD‐ICPs outline the diagnostic procedures, possible co‐morbidities, different available treatment options including differential approaches for the pediatric population, and the role of the pharmacists and other stakeholders, as well as remaining unmet needs in the management of AD. Conclusion The AD‐ICPs provide a multidisciplinary plan for improved diagnosis, treatment, and patient feedback in AD management, as well as addressing critical unmet needs, including improved access to care, training specialists, implementation of educational programs, assessment on the impact of climate change, and fostering a personalised treatment approach. By focusing on these key areas, the initiative aims to pave the way for a brighter future in the management of AD.

Background: There are gaps in our understanding of the epidemiology of atopic dermatitis (AD) in adults. Objective: To evaluate the prevalence and severity of AD in adults from countries/regions within Asia, Eurasia, Latin America, Middle East, and Russia. Methods: This international, web-based survey was performed in Argentina, Brazil, China, Colombia, Egypt, Hong Kong, Israel, Malaysia, Mexico, Russia, Kingdom of Saudi Arabia (KSA), Singapore, Taiwan, Thailand, Turkey, and United Arab Emirates. Questionnaires were sent to adult members of online respondent panels for determination of AD and assessment of severity. A diagnosis of AD required respondents to meet the modified United Kingdom (UK) Working Party criteria and to self-report they had a physician diagnosis of AD. Severity of AD was determined using Patient-Oriented Scoring of Atopic Dermatitis (PO-SCORAD), Patient-Oriented Eczema Measure (POEM), and Patient Global Assessment (PGA). Results: Among respondents by country/region the prevalence of AD ranged from 3.4% in Israel to 33.7% in Thailand. The prevalence was generally higher in females versus males. Severity varied by scale, although regardless of scale the proportion of respondents with mild and moderate disease was higher than severe disease. PGA consistently resulted in the lowest proportion of severe AD (range 2.4% China – 10.8% Turkey) relative to PO-SCORAD (range 13.4% China – 41.6% KSA) and POEM (range 5.1% China – 16.6% Israel). Conclusions: This survey highlights the importance of AD in adults, with high prevalence and high morbidity among respondents and emphasizes that AD is not just a disease of childhood—there is disease persistence and chronicity in adults.

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.

BackgroundChronic inducible urticaria (CIndU) constitutes a group of nine different CIndUs in which pruritic wheals and/or angioedema occur after exposure to specific and definite triggers. Histamine released from activated and degranulating skin mast cells is held to play a key role in the pathogenesis of CIndU, but evidence to support this has, as of yet, not been reviewed systematically or in detail. We aim to characterize the role and relevance of histamine in CIndU.MethodsWe systematically searched 3 electronic databases (PubMed, Scopus, and Embase) for studies that reported increased serum or skin histamine concentration (direct evidence) or in vitro or ex vivo histamine release (indirect evidence) following trigger exposure.ResultsAn initial total of 3,882 articles was narrowed down to 107 relevant studies of which 52 were in cold urticaria, 19 in cholinergic urticaria, 14 in heat urticaria, 10 in contact urticaria, 7 each in solar urticaria and vibratory angioedema, 4 each in symptomatic dermographism and aquagenic urticaria, and 3 in delayed pressure urticaria. The results of our review support that histamine has a key pathogenic role in the pathogenesis of all CIndUs, but it is not the sole mediator as evidenced by the often poor relationship between the level of histamine and severity of symptoms and the variable clinical efficacy of H1-antihistamines.ConclusionsHistamine released from skin mast cells is a key driver of the development of signs and symptoms and a promising therapeutic target in CIndU.

Background. Association between chronic spontaneous urticaria (CSU) and autoimmunity has been well documented. Autologous serum skin testing could support the autoimmune etiology of CSU, whereas it is difficult to interpret and could not be performed on antihistamine omitted patients. It was found that immunoglobulin G (IgG) autoantibodies (autoAbs) against high-affinity IgE receptor (FcεR1) were suggested as a potential trigger in the pathogenesis of CSU. Although many ELISA protocols have been developed to detect these autoAbs, they lacked validation or a reliable cut-off point. We, therefore, aimed to develop a validated ELISA with a reliable cut-off point to quantitate IgG anti-FcεR1α autoAbs for CSU. Methods. We developed an in-house ELISA to quantitate IgG anti-FcεR1α autoAbs. Sera from 233 CSU patients and 25 healthy people were used to test with ELISA. The cut-off point was obtained from the results subjected to analyze with receiver operating characteristic (ROC) analysis. ELISA was validated with 116 CSU patients and 150 healthy donors. Results. ELISA revealed that healthy people had a basal level of IgG anti-FcεR1α autoAbs, whereas their levels were significantly lower than autoAbs levels in CSU patients. ROC analysis of ELISA determined the cut-off point at 936.7 ng/ml. Our ELISA was validated and provided excellent sensitivity and specificity at 98.28% and 92.67%, respectively. Conclusion. Our ELISA could detect significant levels of IgG anti-FcεR1α autoAbs in CSU, supporting that these autoAbs were associated with CSU etiology. Our validated ELISA with the reliable cut-off point provided excellent accuracy at 95.11% (98.28% sensitivity and 92.67% specificity). Our ELISA could be an alternative test benefit for the patient who is unable to omit antihistamine treatment.

Abstract Background The Angioedema Quality of Life (AE-QoL) is the first patient reported outcome measure developed for the assessment of quality of life (QoL) impairment in patients with recurrent angioedema (RAE). This study aimed to evaluate the clinimetric properties of the AE-QoL in Thai patients and to establish categories of QoL impairment assessed by the AE-QoL. Methods The validated Thai version of the Dermatology Life Quality Index (DLQI) and Patient Global Assessment of Quality of Life (PGA-QoL) were used to comparatively evaluate the Thai version of AE-QoL. Spearman correlations between the Thai AE-QoL and two other standard measurements (DLQI and PGA-QoL) were investigated to determine convergent validity. The Thai DLQI and PGA-QoL were used to categorize patients according to their QoL. Known-group validity of the Thai AE-QoL was later analyzed. The reliability of the Thai AE-QoL was investigated using Cronbach’s alpha and intraclass correlation. Three different approaches including the distribution method, receiver operating characteristic curve analysis, and the anchor based-method were used for the interpretability. Results A total of 86 patients with RAE with a median age of 38.0 ± 15.1 years (range 18–76) were enrolled. Of those, 76 patients (88%) had RAE with concomitant wheals, and 10 patients (11.6%) had RAE only. The AE-QoL assessed RAE-mediated QoL impairment with high convergent validity and known-groups validity, high internal consistency and test-retest reliability, and good sensitivity to change. Although the AE-QoL did not differentiate between patients with moderate and large effect as measured by PGA-QoL or DLQI in this study, AE-QoL total values of 0–23, 24 to 38, and ≥ 39 could define patients with “no effect”, “small effect”, and “moderate to large effect” of RAE on their QoL, respectively. Conclusions This study supports the validity and reliability of the Thai version of the AE-QoL, which is a very different language from the original version. Categories allow to classify the effect of RAE on patients’ QoL as “none”, “small”, and “moderate to large”. Further studies are needed to confirm the applicability of AE-QoL in other Asian populations”.

Objective: To evaluate the clinical, histopathological, and immunopathological findings of the pathergy test in Thai patients with Behcet's disease. Methods: A pathergy test using the needle prick method with a 20G disposable needle after cleaning with 70% alcohol was performed in 5 patients (4 females and 1 male), with Behcet's disease according to International Study Group (ISG) criteria. The skin was pricked making a 45o angle with the skin surface to a depth of 3 mm at an avascular and hairless point of both forearms symmetrically. After 4 and 48 hours, the test sites were evaluated clinically and skin biopsies were performed at a prick site on the right forearm after 4 hours for direct immunofluorescence study and after 48 hours at the prick site on the left forearm for histopathological study. Results: Clinical pathergy tests were positive (a single papular lesion at the needle prick site) in 3 out of 5 patients at 48 hours. No response was observed at 4 hours. Direct immunoflurorescence study showed no deposition of immnoglobulins (IgG, IgM, IgA) and C3 in any case. The histopathological findings 48 hours after the test revealed definite neutrophilic infiltration around a superficial vascular plexus in 4 cases, in addition, one of these had endothelial cell swelling with red blood cell extravasation. The rest (1 case) showed nonspecific findings. Conclusion: We conclude that a pathergy test is a useful tool for the diagnosis of Behcet's disease. The intradermal needle prick method using 20G disposable needle after cleaning the skin with 70% alcohol, yields results of moderately high sensitivity. The results should be evaluated at 48 hours both clinically and histopathologically.

Eosinophilic fasciitis (EF) is a rare scleroderma-like syndrome. There has been no previous published report of EF in a Thai patient. We described a 41 year-old Thai man who presented with symmetric induration of the skin of forearms, arms, hands, fingers, lower aspects of the legs, and feet. Physical examination revealed bilateral symmetrical woody induration of the skin with peau d’orange appearance. A groove sign was positive on the flexural surface of both arms. Laboratory testing revealed a peripheral eosinophil count of 54%. The skin and superficial fascia biopsy specimen from the inner aspect of the left forearm was consistent with EF. He was treated with prednisolone, methotrexate, and colchicine. He experienced a gradual improvement within 4 months. A history of acute onset of scleroderma-like syndrome and careful physical examination can lead us to the diagnosis of EF.

Background: Chronic urticaria (CU) is a condition characterized by recurrent itchy hives and/or angioedema for ≥6 weeks. Most of the data about CU come from western countries with very little information available about CU in Asia, Africa, and the Middle East. Methods: AWARE-AMAC is a 24-month prospective, observational, real-world, non-interventional study in patients aged ≥18 years from Asia, the Middle East, and Africa (AMAC) with CU refractory to H1-antihistamines (H1-AH). The main objective was to describe the real-world experience with CU, including clinical characteristics, presence of angioedema, treatment patterns (shifts between treatment classes and changes within a treatment class), investigator-assessed disease control, and the impact on quality of life. Subgroups of interest were type of CU at Baseline and treatment class (based on 2013 urticaria guidelines). There were no mandatory visits and diagnostic/monitoring procedures additional to routine practice, except the patient diary (7-day Urticaria Activity Score) and patient reported outcome assessments. Results: The focus of the current manuscript is on patients with chronic spontaneous urticaria (CSU), who formed 98% of the sample. Patients were predominantly female (69.6% female, mean age ± SD 39.8 ± 13.29 years). Time since current diagnosis (Mean ± SD) was 28.6 ± 49.06 months. Amongst patients with CSU, 31.0% had comorbid chronic inducible urticaria (CINDU) and 46.4% had a history of angioedema. 91.9% received H1-AH therapy (±other treatments). The most frequently prescribed treatment classes at Baseline were any/combination of medications, not classified under the other 7 treatment classes, named “Others” (30.5%) followed by, omalizumab (OMA; 23.6%) and second-generation H1-AH monotherapy (sgAH; 15.1%). At Month 12, the most prescribed treatment classes (>15%) for patients were OMA (23.5%) and ''Other'' (21.3%); 19.7% received ''No drug''. At Month 24, OMA (22.5%), and ''Other'' (17.9%) were most frequently prescribed; 28.6% received ''No drug''. Overall, 79.5% of patients had some type of change in treatment. Over the study period, improvement in self-reported QoL increased, which was mirrored by better disease control. Conclusion: In AMAC countries, the non-recommended ''Other'' treatment class played a major role in the initial management of CU patients. High usage of H1-AH (±other treatments) and OMA was observed. Treatment changes were observed in a majority of patients. Treatment escalation from sgAH was mostly via OMA. Improvement of disease control and QoL was achieved during the study period. Trial registration: Observational study (NA).

Abstract Background Vitamin D has been reported to be associated with many allergic diseases. There are a limited number of the studies of vitamin D supplementation in patients with chronic spontaneous urticaria (CSU). This study aims to study the relationship between vitamin D and CSU in terms of serum vitamin D levels, and the outcomes of vitamin D supplementation. Methods A literature search of electronic databases for all relevant articles published between 1966 and 2018 was performed. The systematic literature review was done following Preferred Reporting Items for Systematic Reviews and Meta-analysis recommendations. Results Seventeen eligible studies were included. Fourteen (1321 CSU cases and 6100 controls) were concerned with serum vitamin D levels in CSU patients. Twelve studies showed statistically significant lower serum vitamin D levels in CSU patients than the controls. Vitamin D deficiency was reported more commonly for CSU patients (34.3–89.7%) than controls (0.0–68.9%) in 6 studies. Seven studies concerned with vitamin D supplementation in CSU patients showed disease improvement after high-dosages of vitamin D supplementation. Conclusion CSU patients had significantly lower serum vitamin D levels than the controls in most studies. However, the results did not prove causation, and the mechanisms were not clearly explained. Despite the scarcity of available studies, this systematic review showed that a high dosage of vitamin D supplementation for 4–12 weeks might help to decrease the disease activity in some CSU patients. Well-designed randomized placebo-controlled studies are needed to determine the cut-off levels of vitamin D for supplementation and treatment outcomes.

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.

Abstract Background Allergic diseases are on the rise in many parts of the world, including the Asia–Pacific (APAC) region. Second-generation antihistamines are the first-line treatment option in the management of allergic rhinitis and urticaria. International guidelines describe the management of these conditions; however, clinicians perceive the additional need to tailor treatment according to patient profiles. This study serves as a consensus of experts from several countries in APAC (Hong Kong, Malaysia, the Philippines, Singapore, Thailand, Vietnam), which aims to describe the unmet needs, practical considerations, challenges, and key decision factors when determining optimal second-generation antihistamines for patients with allergic rhinitis and/or urticaria. Methods Specialists from allergology, dermatology, and otorhinolaryngology were surveyed on practical considerations and key decision points when treating patients with allergic rhinitis and/or urticaria. Results Clinicians felt the need for additional tools for diagnosis of these diseases and a single drug with all preferred features of an antihistamine. Challenges in treatment include lack of clinician and patient awareness and compliance, financial constraints, and treatment for special patient populations such as those with concomitant disease. Selection of optimal second-generation antihistamines depends on many factors, particularly drug safety and efficacy, impact on psychomotor abilities, and sedation. Country-specific considerations include drug availability and cost-effectiveness. Survey results reveal bilastine as a preferred choice due to its high efficacy and safety, suitability for special patient populations, and the lack of sedative effects. Conclusions Compliance to the international guidelines is present among allergists, dermatologists and otorhinolaryngologists; however, this is lower amongst general practitioners (GPs). To increase awareness, allergy education programs targeted at GPs and patients may be beneficial. Updates to the existing international guidelines are suggested in APAC to reflect appropriate management for different patient profiles and varying symptoms of allergic rhinitis and urticaria.

Objective: The objective of this study was to determine the cost of the Division of Dermatoimmunology. Methods: This was a retrospective study using the database of the Division of Dermatoimmunology, Department of Derma- tology including number of investigations, labor cost, material cost, maintenance cost and depreciation cost of durable items and buildings during from 1 January 2011 to 31 December 2011. Results: The results showed that the total cost of direct immunofluorescence study, indirect immunofluorescence study, skin prick testing, and autologous serum skin testing were 516.80, 431.66, 233.73, and 132.48 Baht, respectively. Conclusion: This study helped us and the hospital to estimate the unit cost of investigations in the Division of Dermato- immunology and to fix the price of each investigation. Keywords: Unit cost, dermatoimmunology, dermatology, investigation Siriraj Med J 2014;66:39-41

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

Background: Nail abnormalities are common in psoriasis. The relationship between nail abnormalities and disease severity or impact on quality of life has scarcely been reported. Objectives: The aims of this study were to find the proportion and types of nail abnormalities among Thai psoriasis patients and to assess the association between nail abnormalities, disease severity and the quality of life. Methods: A retrospective medical record review of 1,027 psoriasis patients who attended the dermatology clinic from Fe- bruary 2005 to May 2008 was performed. Demographic data, type of nail abnormalities and severity of psoriasis as well as the dermatology life quality index (DLQI) were recorded. Results: Nail abnormalities in Thai psoriasis patients were diagnosed in 63.4% of them. The most common type was ony- cholysis (45.9%) followed by nail pittings (42.8%). Nail abnormalities were significantly associated with higher psoriasis area severity index (PASI) with adjusted odds ratio of 2.45 (95% CI 1.86-3.23, p

Objective: Acne is an inflammatory disease of pilosebaceous units. Major complications of acne are scarring and psychosocial effects. When compared to other chronic illnesses, patients with acne have been shown to have levels of social, psychological, and emotional impairments similar to those with serious diseases. This study is aimed to assess the effects of acne, including acne severity and acne scar on the patientûs quality of life using a Thai version of the Dermatology Life Quality Index (DLQI). Methods: One hundred and ten patients with acne who attended the Dermatology Outpatient Clinic, Siriraj Hospital, were asked to complete the Thai version of the DLQI questionnaires by themselves. Clinical severity of acne and acne scars were assessed. Results: Of 110 patients, 80 (72.7%) were females with a mean (SD) age of 26.0 (6.6) years and a range of 16-52 years. Most of the patients were students. The mean total DLQI score was 8.95 (range 0-24). Questions concerning embarrassment had the highest mean DLQI score, which meant the greatest impairment of the quality of life. The others that also had high mean DLQI scores were questions which represented social activities, itchy/sore/painful/stinging skin, and treatment difficulties, respectively. Concerning personal relationship problems, female patients had significant higher mean DLQI scores than male patients (p

Angioedema is an abrupt swelling of the skin, mucous membrane, or both including respiratory and gastrointestinal tracts. This study aimed to report an experience of angioedema in a university hospital with respect to etiologies, clinical features, treatment, and outcome. One hundred and five patients were enrolled. About half had angioedema without urticaria. The common sites of involvement were periorbital area and lips. Forty five patients (49%) had systemic symptoms. The most common cause of angioedema was allergic angioedema. Nonsteroidal anti-inflammatory drug-induced angioedema and idiopathic angioedema were detected in 20% and 18%, respectively. Among patients with allergic angioedema, 41.7% were caused by food, 39.6% by drugs. Thirty seven patients (39%) had recurrent attacks of angioedema. Mean standard deviation (SD) number of attacks in patients with recurrent angioedema was 3.9 (2.7) (ranging from 2 to 10 times). Patients who had older age and multiple sites of skin involvement had tendency to have systemic symptoms.

Background: Seborrheic dermatitis is a common chronic inflammatory skin condition that can have a negative impact on a patient′s quality of life. Few studies have been conducted to assess the clinical characteristics of the disease and quality of life of the patients, especially in tropical countries. Aims and Objectives: The aim of this study was to demonstrate the clinical characteristics and quality of life of patients with seborrheic dermatitis in Thailand. Materials and Methods: A cross-sectional study was performed at a university-based hospital and tertiary referral center in Bangkok, Thailand. The validated Thai version of the dermatology life quality index (DLQI) was used to evaluate patients′ quality of life. Results: A total of 166 participants were included. One hundred and forty-seven patients (88.6%) experienced multiple episodes of the eruption. The mean of outbreaks was 7.8 times per years, ranging from once every 4 years to weekly eruption. The most common factor reported to aggravate seborrheic dermatitis was seasonality (34.9%), especially hot climate. The mean (SD) of the total DLQI score was 8.1 (6.0) with a range of 0 to 27. There was no statistically significant difference between the two DLQI categories regarding duration of disease, extent of involvement, symptoms or course of the disease. Conclusion: Although mild and asymptomatic, seborrheic dermatitis can have a great impact on the quality of life. Youth, female gender, and scalp lesions were significantly associated with higher DLQI scores.

A patient with arthritis receiving allopurinol for 4 weeks developed Stevens-Johnson syndrome (SJS). SJS is a potentially life-threatening adverse drug reaction and is most commonly associated with the sulfa antibiotics, allopurinol, NSAIDs, and anticonvulsants. The skin reaction spread symmetrically over the body and involved the conjunctiva. The diagnosis and different models of treatment for this case are discussed. Alternative treatments for gouty arthritis are presented. Strategic planning for novel research opportunities arising from this disease is outlined.

Background: There is a lack of real-life safety data on treatment options for chronic urticaria in the presence of comedication and comorbidities. Methods: We present a single-center UCARE pilot study of 212 outpatients with chronic urticaria. Patients were divided into three groups according to different CU therapies according to international guidelines. Results: Of 212 patients, 108 (mean age 48.9years, 71.3% female) had 59 comorbidities, including cardiovascular, autoimmune and malignant diseases. Patients were followed for a mean of 24.6months (SD ± 21.3). Urticaria therapies were divided into three groups: A: 105 (97.2%) with omalizumab and 2nd generation antihistamines), B: 16 patients (14.8%): dual therapy with antihistamines and cyclosporine in 10 (9.3%), montelukast in five (4. 6%), dapsone in four (3.7%), hydroxychloroquine in one patient (0.9%), C: 12 (11.1%) patients received a third drug for 4.9months (SD ± 3.2) and one quadruple therapy (2.1months). 10 out of 12 (83.3%) patients received montelukast, two (16.7%) cyclosporine, two (16.7%) dapsone and one (8.3%) hydroxychloroquine as a third drug for chronic urticaria. Conclusions: Combining treatment modalities for chronic urticaria and comorbidities are available and feasible with a good safety profile. [ABSTRACT FROM AUTHOR]