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Gössinger E, Dodiuk-Gad R, Mühleisen B, Oon HH, Oh CC, Maul JT, Navarini AA. Generalized Pustular Psoriasis, Acute Generalized Exanthematous Pustulosis, and Other Pustular Reactions: A Clinical Review. Dermatol Clin 2024; 42:317-328. [PMID: 38423690 DOI: 10.1016/j.det.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Generalized pustular rashes have various etiologies and can be challenging to diagnose and manage at first presentation. The authors provide an in-depth analysis of common pustular skin eruptions including generalized pustular psoriasis (GPP) and acute generalized exanthematous pustulosis, focusing on their pathophysiology, triggers, clinical presentation, diagnostic challenges, and management strategies. The article also highlights recent advances in genetic research and biologic therapies for GPP and the future directions in personalized medicine and prevention strategies.
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Affiliation(s)
- Elisabeth Gössinger
- Department of Dermatology, University Hospital of Basel, Burgfelderstrasse 101, Basel 4055, Switzerland
| | - Roni Dodiuk-Gad
- Department of Dermatology, Emek Medical Center, Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, 3525433 Israel; Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario M5S 1A1, Canada
| | - Beda Mühleisen
- Department of Dermatology, University Hospital of Basel, Burgfelderstrasse 101, Basel 4055, Switzerland
| | - Hazel H Oon
- Department of Dermatology, Emek Medical Center, Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, 3525433 Israel; National Skin Centre and Skin Research Institute of Singapore (SRIS), 1 Mandalay Road, Singapore 308205, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore; Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital of Zurich and Faculty of Medicine, Zurich 8091/8006, Switzerland
| | - Alexander A Navarini
- Department of Dermatology, University Hospital of Basel, Burgfelderstrasse 101, Basel 4055, Switzerland; Department of Biomedical Research, University of Basel, Allschwil 4123, Switzerland; Department of Biomedical Engineering, University of Basel, Allschwil 4123, Switzerland; Department of Clinical Research, University of Basel, Allschwil 4123, Switzerland.
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2
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Tay SH, Oh CC. Liquid Biopsies in Advanced Cutaneous Squamous Cell Carcinoma: A Systematic Review. J Invest Dermatol 2024; 144:722-726. [PMID: 37739339 DOI: 10.1016/j.jid.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/24/2023]
Affiliation(s)
| | - Choon Chiat Oh
- Duke-NUS Medical School, Singapore, Singapore; Department of Dermatology, Singapore General Hospital, Singapore, Singapore.
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3
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Tay SH, Oh CC. T Cell Immunity in Human Papillomavirus-Related Cutaneous Squamous Cell Carcinoma-A Systematic Review. Diagnostics (Basel) 2024; 14:473. [PMID: 38472944 DOI: 10.3390/diagnostics14050473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is an invasive malignancy that disproportionately afflicts immunosuppressed individuals. The close associations of cSCC with immunosuppression and human papillomavirus (HPV) infection beget the question of how these three entities are intertwined in carcinogenesis. By exploring the role of T cell immunity in HPV-related cSCC based on the existing literature, we found that the loss of T cell immunity in the background of β-HPV infection promotes cSCC initiation following exposure to environmental carcinogens or chronic trauma. This highlights the potential of developing T-cell centred therapeutic and preventive strategies for populations with increased cSCC risk.
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Affiliation(s)
- Shi Huan Tay
- Duke-NUS Medical School, Singapore 169857, Singapore
| | - Choon Chiat Oh
- Duke-NUS Medical School, Singapore 169857, Singapore
- Department of Dermatology, Singapore General Hospital, Singapore 169608, Singapore
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4
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Ding R, Lian SB, Tam YC, Oh CC. Das kutane Mikrobiom bei Hautkrebs - Eine systematische Übersicht: The cutaneous microbiome in skin cancer - A systematic review. J Dtsch Dermatol Ges 2024; 22:177-185. [PMID: 38361188 DOI: 10.1111/ddg.15294_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/29/2023] [Indexed: 02/17/2024]
Abstract
ZusammenfassungDie Hautkrebs‐Inzidenz ist über die vergangene halbe Dekade weltweit gestiegen und mit signifikanter Morbidität und Mortalität assoziiert. Jüngste Fortschritte in der molekularen Diagnostik ermöglichen ein besseres Verständnis von Mikrobiom‐Veränderungen bei diesen Erkrankungen. Allerdings ist die Literatur zum kutanen Mikrobiom bei Hautkrebs nach wie vor heterogen und spärlich. Wir führten eine systematische Überprüfung durch, um die bestehende Literatur sowie ihren Nutzen bezüglich mikrobiombasierter Biomarker zu evaluieren. Die Datenbanken (PubMed, Medline, EMBASE, GoogleScholar) wurden zwischen Juni und Juli 2022 in Übereinstimmung mit den PRISMA‐Richtlinien gesichtet.Insgesamt wurden 1.543 Artikel ermittelt, von denen 16 in die Übersicht eingeschlossen wurden (11 Artikel zu epithelialen Hauttumoren und 5 Artikel zu Melanomen). Bei Plattenepithelkarzinomen (PEKs) und aktinischer Keratose (AK) wird im Vergleich zu gesunder Haut eine erhöhte Prävalenz von Staphylococcus (S.) aureus bei gleichzeitigem Rückgang der kommensalen Organismen festgestellt. Das Mikrobiom des Melanoms scheint sich zwar von dem der gesunden Haut zu unterscheiden, doch stehen nur wenige Daten für aussagekräftige Schlussfolgerungen zur Verfügung.Die vorliegende Übersicht fasst die aktuellen Erkenntnisse zum Mikrobiom bei epithelialem Hautkrebs und Melanom zusammen. Sie zeigt, dass sich das Mikrobiom bei diesen Erkrankungen von dem gesunder Haut unterscheidet und dass an dieser Dysbiose sowohl pathogene als auch kommensale Organismen beteiligt sind.
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Affiliation(s)
- Ruojun Ding
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | | | - Yew Chong Tam
- Education Resource Centre, Singapore General Hospital, Singapore, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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5
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Ding R, Lian SB, Tam YC, Oh CC. The cutaneous microbiome in skin cancer - A systematic review. J Dtsch Dermatol Ges 2024; 22:177-184. [PMID: 38243841 DOI: 10.1111/ddg.15294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/29/2023] [Indexed: 01/22/2024]
Abstract
The overall incidence of skin cancer has risen over the past half a decade worldwide and is associated with significant morbidity and mortality. Recent advances in molecular testing have allowed us to better characterize microbiome alterations in skin cancer. However, literature specific to skin microbiome and skin cancer remain heterogenous and scattered. A systematic review was performed to identify the existing literature and its usefulness in providing microbiome-based biomarkers. A search of the databases (PubMed, Medline, EMBASE, GoogleScholar) was conducted from June to July 2022 in accordance with the PRISMA guidelines. A total of 1,543 articles were identified, of which 16 were selected for inclusion in the review (11 articles on cancer of the keratinocytes and 5 articles on melanoma). Increased Staphylococcus (S.) aureus prevalence with decline in commensal organisms is seen in squamous cell carcinoma (SCC) and actinic keratosis (AK), compared to healthy skin. While the microbiome of melanoma appears to be distinct from healthy skin, limited data is available to draw meaningful conclusions. Our review summarizes the current evidence on the microbiome of keratinocyte skin cancers and melanoma. The study establishes that the microbiome of these cancers is altered from healthy skin and that this dysbiosis involves both pathogenic and commensal organisms.
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Affiliation(s)
- Ruojun Ding
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | | | - Yew Chong Tam
- Singapore General Hospital Library, Singapore Health System, Singapore, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
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Lian BS, Goh CSL, Koh HY, Oh CC. Reconstruction of a Nasal Cartilage Defect After Mohs Micrographic Surgery. Dermatol Surg 2024; 50:93-95. [PMID: 37602686 DOI: 10.1097/dss.0000000000003912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Affiliation(s)
| | - Cindy Siaw-Lin Goh
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Hong Yi Koh
- Department of Dermatology, Singapore General Hospital, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore
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Nichole TYT, Oh CC. Gamification in dermatology: A systematic review. Australas J Dermatol 2023; 64:e365-e369. [PMID: 37496199 DOI: 10.1111/ajd.14137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Affiliation(s)
| | - Choon Chiat Oh
- Duke-NUS Medical School, Singapore
- Department of Dermatology, Singapore General Hospital, Singapore
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8
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Wang HXE, Ooi XT, Lim KH, Oh CC. Rapidly progressing necrotic hand ulcer in a patient with angioimmunoblastic T-cell lymphoma. Skin Health Dis 2023; 3:e236. [PMID: 37538329 PMCID: PMC10395618 DOI: 10.1002/ski2.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/24/2023] [Accepted: 04/06/2023] [Indexed: 08/05/2023]
Abstract
Mucormycosis is a fungal infection caused by opportunistic fungi of the phylum Glomeromycota, subphylum Mucormycotina. In developed countries, it affects patients with haematological malignancies undergoing chemotherapy and those who have received allogenic stem cell transplants, while in developing countries it is seen in those with uncontrolled diabetes mellitus. Herein, we report a case of cutaneous mucormycosis in a 67yo Chinese gentleman with background of angioimmunoblastic T cell lymphoma (AITL) on chemotherapy. We also share the clinicopathological findings of this and correlate these findings with those present in the current literature. Finally, we outline treatment options and prognosis of cutaneous mucormycosis.
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Affiliation(s)
| | - Xue Ting Ooi
- Division of DermatologyDepartment of MedicineNational University HospitalSingaporeSingapore
| | - Kok Hing Lim
- Department of PathologySingapore General HospitalSingaporeSingapore
| | - Choon Chiat Oh
- Department of DermatologySingapore General HospitalSingaporeSingapore
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9
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Qun Oh DA, Yeo YW, Pang SM, Oh CC, Lee HY, Lin Choo KJ. Perceptions of teledermatology in the COVID-19 era: are patients ready for it? Singapore Med J 2023:375071. [PMID: 37171435 DOI: 10.4103/singaporemedj.smj-2021-290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Introduction The COVID-19 pandemic has changed care provision models, with a rapid increase in the adoption of telemedicine to reduce in-person visits. Although there are many benefits to teledermatology, there are also factors that hinder its widespread adoption. We aimed to examine patients' perceptions of teledermatology to identify the barriers to its adoption. Methods A prospective study was conducted from 15 June to 14 August 2020. Patients were invited to complete a questionnaire in an outpatient dermatology clinic via direct approach by clinical staff or posters posted at the door of consultation rooms. Results Out of 2,276 clinic attendances, 997 survey responses (43.8%) were collected over a 3-month period. When asked if they would change their subsequent visit to teledermatology, 294 (29.5%) patients were keen, 166 (16.6%) were unsure and 537 (53.9%) declined. Significant factors for declining teledermatology were lack of prior exposure to videoconferencing (P < 0.01) and lower educational level (P = 0.019). Patients also raised concerns regarding the ability of teledermatology to address medical concerns (32.1%) and indicated a preference for face-to-face consultation (29.7%). Conclusion Factors that influence patients' decision to adopt teledermatology, such as concerns about its ability to address medical issues, lack of IT literacy or experience in teleconferencing, are modifiable. Targeted strategies such as careful patient selection, a dedicated teleconsultation workflow, and the use of a novel 'teledermatology patient journey' (including a clinic walkthrough at the first visit) and an intuitive audio-enabled user interface, may improve patient perceptions and adoption of teleconsultation service.
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Affiliation(s)
- Dawn Ai Qun Oh
- Department of Dermatology, Singapore General Hospital, Singapore
| | - Yi Wei Yeo
- Department of Dermatology, Singapore General Hospital; Duke-NUS Medical School, Singapore
| | - Shiu Ming Pang
- Department of Dermatology, Singapore General Hospital; Duke-NUS Medical School; Allergy Centre, Singapore General Hospital, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital; Duke-NUS Medical School, Singapore
| | - Haur Yueh Lee
- Department of Dermatology, Singapore General Hospital; Duke-NUS Medical School; Allergy Centre, Singapore General Hospital, Singapore
| | - Karen Jui Lin Choo
- Department of Dermatology, Singapore General Hospital; Duke-NUS Medical School; Allergy Centre, Singapore General Hospital, Singapore
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10
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Tsang DA, Tam SYC, Oh CC. Molecular Alterations in Cutaneous Squamous Cell Carcinoma in Immunocompetent and Immunosuppressed Hosts-A Systematic Review. Cancers (Basel) 2023; 15:cancers15061832. [PMID: 36980718 PMCID: PMC10046480 DOI: 10.3390/cancers15061832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/26/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
The characterization of cutaneous squamous cell carcinoma (cSCC) at the molecular level is lacking in the current literature due to the high mutational burden of this disease. Immunosuppressed patients afflicted with cSCC experience considerable morbidity and mortality. In this article, we review the molecular profile of cSCC among the immunosuppressed and immunocompetent populations at the genetic, epigenetic, transcriptomic, and proteometabolomic levels, as well as describing key differences in the tumor immune microenvironment between these two populations. We feature novel biomarkers from the recent literature which may serve as potential targets for therapy.
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Affiliation(s)
- Denise Ann Tsang
- Department of Dermatology, Singapore General Hospital, Singapore 169608, Singapore
| | - Steve Y C Tam
- Education Resource Centre, Singapore General Hospital, Singapore 169608, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore 169608, Singapore
- Duke-NUS Medical School, Singapore 169608, Singapore
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Chen LH, Oh CC. Teledermatology in Singapore: A Systematic Review. JAAD Int 2023; 11:178-184. [PMID: 37122552 PMCID: PMC10122560 DOI: 10.1016/j.jdin.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
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12
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Ong FLL, Loh CH, Oh CC. Wearable devices for photodynamic therapy - A systematic review. JAAD Int 2023; 11:59-62. [PMID: 36865616 PMCID: PMC9972365 DOI: 10.1016/j.jdin.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
| | - Chee Hoou Loh
- Department of Dermatology, Singapore General Hospital, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Correspondence to: Choon Chiat Oh, MBBS, FRCP, MSc, Department of Dermatology, Level 4, Academia, Singapore General Hospital, 20 College Rd, Singapore 169856
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Tan WH, Ho A, Kadir HA, Zin TK, Jordan HCC, Lee HY, Pang SM, Yeo YW, Choo KJL, Oh CC. Incidence of cutaneous graft-versus-host disease in a Singapore academic medical centre - A retrospective cohort study. Australas J Dermatol 2023; 64:e26-e33. [PMID: 36645420 DOI: 10.1111/ajd.13980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/14/2022] [Accepted: 01/04/2023] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cutaneous graft-versus-host disease (GVHD) is common in allogeneic haematopoietic stem cell transplantation. HLA mismatch is the most significant determinant of GVHD. Our study aimed to compare the incidence of cutaneous GVHD haploidentical (Haplo) and matched donors in an Asian population. METHODS Retrospective cohort study of the 2015-2019 bone marrow transplant registry was conducted in a transplant centre. We compared the incidence of cutaneous GVHD in Haplo with allogeneic matched unrelated donor (MUD) and matched-sibling donor (MSD) transplant recipients. Secondary objectives include acute and chronic GVHD incidence, dermatology referrals, and histological findings. RESULTS One hundred and seventy-nine out of 203 cases were reviewed; 17 (9.5%) Haplo, 80 (44.7%) MUDs and 82 (45.8%) MSDs. The median follow-up for Haplo, MUD and MSD was 15.2, 34.2 and 35.7 months, respectively. Haplo had a higher cumulative incidence of cutaneous GVHD than MUD and MSD (p = 0.053). Chronic GVHD was only reported in MSD. The most common histology was vacuolar interface changes (13 [44.8%]) with a wide range of onset post-transplant (19-456 days). CONCLUSIONS Haplo donors may have a higher GVHD incidence than MUD and MSD in our predominantly Asian cohort. This information may be helpful when counselling patients pre-transplant. Further prospective studies are required.
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Affiliation(s)
- Wen Hao Tan
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Aloysius Ho
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Hanis Abdul Kadir
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore
| | - That Khaing Zin
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | | | - Haur Yueh Lee
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Shiu Ming Pang
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Yi Wei Yeo
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Karen Jui Lin Choo
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
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Tan WH, Goh JY, Busmanis I, Oh CC. Acne agminata: dermoscopic features and a short review. Dermatol Online J 2022; 28. [PMID: 36809092 DOI: 10.5070/d328659725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
Acne agminata is a rare idiopathic inflammatory dermatosis. Treatment is variable with no clear consensus. We herein report a case of a 31-year-old man with sudden onset papulonodular eruptions on his face over two months. Histopathological examination revealed superficial granuloma composed of epithelioid histiocytes and scattered multinucleated giant cells, confirming acne agminata. Dermoscopy showed focal orangish structureless areas with follicular openings with white keratotic plugs. He achieved complete clinical resolution with oral prednisolone in 6 weeks. We also reviewed the literature regarding the reported treatment regimens used.
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Affiliation(s)
| | | | | | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore.
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15
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Lim SS, Hui L, Ohn J, Cho Y, Oh CC, Mun JH. Diagnostic accuracy of dermoscopy for onychomycosis: A systematic review. Front Med (Lausanne) 2022; 9:1048913. [PMID: 36388930 PMCID: PMC9659606 DOI: 10.3389/fmed.2022.1048913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Dermoscopy is a non-invasive adjuvant diagnostic tool that allows clinicians to visualize microscopic features of cutaneous disorders. Recent studies have demonstrated that dermoscopy can be used to diagnose onychomycosis. We performed this systematic review to identify the characteristic dermoscopic features of onychomycosis and understand their diagnostic utility. Methods We searched the Medline, Embase, Scopus, and Cochrane databases from conception until May 2021. Studies on the dermoscopic features of onychomycosis were screened. The exclusion criteria were as follows: fewer than 5 cases of onychomycosis, review articles, and studies including onychomycosis cases that were not mycologically verified. Studies on fungal melanonychia were analyzed separately. We adhered to the MOOSE guidelines. Independent data extraction was performed. Data were pooled using a random effects model to account for study heterogeneity. The primary outcome was the diagnostic accuracy of the dermoscopic features of onychomycosis. This was determined by pooling the sensitivity and specificity values of the dermoscopic features identified during the systematic review using the DerSimonian-Laird method. Meta-DiSc version 1.4 and Review Manager 5.4.1 were used to calculate these values. Results We analyzed 19 articles on 1693 cases of onychomycosis and 5 articles on 148 cases of fungal melanonychia. Commonly reported dermoscopic features of onychomycosis were spikes or spiked pattern (509, 30.1%), jagged or spiked edges or jagged edge with spikes (188, 11.1%), jagged proximal edge (175, 10.3%), subungual hyperkeratosis (131, 7.7%), ruins appearance, aspect or pattern (573, 33.8%), and longitudinal striae (929, 54.9%). Commonly reported features of fungal melanonychia included multicolor (101, 68.2%), non-longitudinal homogenous pigmentation (75, 50.7%) and longitudinal white or yellow streaks (52, 31.5%). Conclusion This study highlights the commonly identified dermoscopic features of onychomycosis. Recognizing such characteristic dermoscopic features of onychomycosis can assist clinicians diagnose onychomycosis by the bedside.
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Affiliation(s)
| | - Laura Hui
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Jungyoon Ohn
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea
- Institute of Human-Environment Interface Biology, Seoul National University, Seoul, South Korea
| | - Youngjoo Cho
- Department of Applied Statistics, Konkuk University, Seoul, South Korea
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Je-Ho Mun
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea
- Institute of Human-Environment Interface Biology, Seoul National University, Seoul, South Korea
- *Correspondence: Je-Ho Mun
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Wang HXE, Tang PY, Oh CC. Dermoscopic features of cutaneous post-transplant lymphoproliferative disorder in a renal transplant recipient. JAAD Case Rep 2022; 27:9-12. [PMID: 35959092 PMCID: PMC9361210 DOI: 10.1016/j.jdcr.2022.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
| | - Po Yin Tang
- Department of Pathology, Singapore General Hospital, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore
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17
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Cheng YJ, Li Y, Lim KH, Oh CC. Dermatoscope of primary localized cutaneous nodular amyloidosis on hallux nail bed. JAAD Case Rep 2022; 27:46-48. [PMID: 36017194 PMCID: PMC9396252 DOI: 10.1016/j.jdcr.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Yong Jian Cheng
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Yihan Li
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Kok Hing Lim
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
- Correspondence to: Choon Chiat Oh, MBBS, MSc, MCI, MRCP, Department of Dermatology, Singapore General Hospital, Outram Road, Singapore 169608.
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Liew YCC, Tam YCS, Oh CC. Treatments for AIDS/HIV-related Kaposi sarcoma: A systematic review of the literature. Int J Dermatol 2022; 61:1311-1324. [PMID: 35775738 DOI: 10.1111/ijd.16318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 05/04/2022] [Accepted: 06/09/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Treatment guidelines are not well established in AIDS-related Kaposi sarcoma (KS). OBJECTIVE We aim to review the evidence on efficacy of treatments for AIDS-related Kaposi sarcoma. METHODS We searched the Cochrane Library, PubMed, and Embase Database from date of database inception till July 2020. Randomized controlled trials reporting intervention consisting of any type of treatment compared to control/placebo to a different treatment modality or different combination of treatment/treatment doses with a diagnosis of AIDS-related KS are selected. MAIN OUTCOMES AND MEASURES Primary outcomes were response rates defined as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). Secondary outcomes were cosmesis and adverse outcomes such as pain and erythema. RESULTS Thirteen out of 536 articles met our eligibility criteria. Three studies reported the efficacy of chemotherapy, two studies looked at different doses of radiotherapy regimes, and three studies compared different antiretroviral therapy (ART) and chemotherapy regimens. Other studies reported topical therapies such as alitretinoin gel, IM862, and bHCG injection which showed varied efficacies. LIMITATIONS Lack of standardization classification of disease activity and clinical outcomes and treatment modalities precluded meaningful comparison of studies. CONCLUSION The evidence of efficacy of any particular intervention is overall varied and there was insufficient evidence to recommend any particular intervention. We have provided an overview of treatments for KS but larger studies need to be carried out to verify the efficacy of treatment options reported in the literature.
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Affiliation(s)
| | - Yew Chong Steve Tam
- Department of Education Resource Centre, Medical Board, Singapore General Hospital, Singapore, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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19
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Tan WH, Koniman R, Tan AL, Wijaya L, Lim KH, Oh CC. Solitary leg ulcer in a renal transplant recipient. JAAD Case Rep 2022; 23:93-95. [PMID: 35495974 PMCID: PMC9046886 DOI: 10.1016/j.jdcr.2021.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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20
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Yi Goh J, Liang W, Yi Koh H, Chiat Oh C. Reconstruction of an Earlobe defect Following Mohs micrographic surgery. J Cosmet Dermatol 2022; 21:5291-5292. [PMID: 35478432 DOI: 10.1111/jocd.15023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/22/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Jia Yi Goh
- Department of Dermatology, Singapore General Hospital, Outram Road, Singapore, 169608
| | - Weihao Liang
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608
| | - Hong Yi Koh
- Department of Dermatology, Singapore General Hospital, Outram Road, Singapore, 169608
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Outram Road, Singapore, 169608
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21
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Tan WH, Wong M, Tay ZEA, Oh CC. Enlarged postauricular nodules in a young South Asian man. Clin Exp Dermatol 2022; 47:1406-1409. [PMID: 35484721 DOI: 10.1111/ced.15173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 11/30/2022]
Abstract
We report a 19-year-old South Asian man with progressively enlarging postauricular nodules over a 5-year period, which were eventually treated by surgical resection.
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Affiliation(s)
- Wen Hao Tan
- Department of, Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Manzhi Wong
- Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Zhi En Amos Tay
- Department of, Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Choon Chiat Oh
- Department of, Dermatology, Singapore General Hospital, Singapore, Singapore
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22
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Affiliation(s)
| | - Ruo Yu Shi
- Department of Pathology, Singapore General Hospital, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore
- Correspondence to: Choon Chiat Oh, MBBS, FRCP, Department of Dermatology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
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23
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Cheng HM, Lim KH, Oh CC. Blasenbildung im Gesicht einer Patientin mit akutem Atemstillstand. J Dtsch Dermatol Ges 2022; 20:117-120. [PMID: 35040562 DOI: 10.1111/ddg.14646_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hui Mei Cheng
- Department of Dermatology, Singapore General Hospital, Singapore.,Department of Dermatology, National Skin Centre, Singapore
| | - Kok Hing Lim
- Department of Pathology, Singapore General Hospital, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore
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24
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Affiliation(s)
- Chee Hoou Loh
- Department of Dermatology, Singapore General Hospital
| | - Felicia Ong
- Department of Dermatology, Singapore General Hospital
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital.,Duke-NUS Medical School
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25
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Cheng HM, Lim KH, Oh CC. Facial blistering eruption in a patient with acute respiratory failure. J Dtsch Dermatol Ges 2021; 20:117-120. [PMID: 34850553 DOI: 10.1111/ddg.14646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Hui Mei Cheng
- Department of Dermatology, Singapore General Hospital, Singapore.,Department of Dermatology, National Skin Centre, Singapore
| | - Kok Hing Lim
- Department of Pathology, Singapore General Hospital, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore
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26
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Ong FLL, Busmanis I, Oh CC. Penile melanosis with annular fibrillar pattern. J Cosmet Dermatol 2021; 21:3308-3312. [PMID: 34846784 DOI: 10.1111/jocd.14645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/13/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022]
Abstract
Penile melanosis is an uncommon but benign condition. Its appearance, however, can cause significant distress to patients. We report a case of a patient presenting with hyperpigmented annular penile macules, with a fibrillar pattern seen on dermoscopy. Histopathological examination revealed basal keratinocyte hyperpigmentation with no melanocytic proliferation or atypia, confirming our diagnosis of penile melanosis. The patient was managed conservatively. We also reviewed the literature surrounding the clinical assessment and management of penile melanosis. Future reports on this topic with clinical-dermoscopic-pathological correlations will aid further understanding of this seldom reported condition.
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Affiliation(s)
| | - Inny Busmanis
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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27
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Lua ACY, Ong FLL, Choo KJL, Yeo YW, Oh CC. An unusual presentation of pemphigus foliaceus following COVID-19 vaccination. Australas J Dermatol 2021; 63:128-130. [PMID: 34817063 DOI: 10.1111/ajd.13755] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/17/2021] [Accepted: 11/07/2021] [Indexed: 01/02/2023]
Affiliation(s)
- Angelyn Chen Yin Lua
- Department of Dermatology, Singapore General Hospital, Singapore City, Singapore
| | - Felicia Li Ling Ong
- Department of Dermatology, Singapore General Hospital, Singapore City, Singapore
| | - Karen Jui Lin Choo
- Department of Dermatology, Singapore General Hospital, Singapore City, Singapore.,Duke-NUS Medical School, Singapore City, Singapore
| | - Yi Wei Yeo
- Department of Dermatology, Singapore General Hospital, Singapore City, Singapore.,Duke-NUS Medical School, Singapore City, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore City, Singapore.,Duke-NUS Medical School, Singapore City, Singapore
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28
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Sun Q, McMahon DE, Ugwu-Dike PO, Sun Q, Tang K, Zhang H, Suchonwanit P, Oh CC, Chong AH, Willems A, Galván C, Dodiuk-Gad RP, Fantini F, Recalcati S, Avancini J, Miyamoto D, Sanches JA, Raboobee N, Bravo F, Freeman EE. How Coronavirus Disease 2019 Changed Dermatology Practice in 1 Year Around the World: Perspectives from 11 Countries. Dermatol Clin 2021; 39:639-651. [PMID: 34556253 PMCID: PMC8452267 DOI: 10.1016/j.det.2021.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Qisi Sun
- Department of Dermatology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Devon E McMahon
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Pearl O Ugwu-Dike
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Qiuning Sun
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 9 Dongdan 3rd Alley, Dong Dan, Dongcheng Qu, Beijing Shi, China
| | - Keyun Tang
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 9 Dongdan 3rd Alley, Dong Dan, Dongcheng Qu, Beijing Shi, China
| | - Hanlin Zhang
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 9 Dongdan 3rd Alley, Dong Dan, Dongcheng Qu, Beijing Shi, China
| | - Poonkiat Suchonwanit
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Thanon Rama VI, Khwaeng Thung Phaya Thai, Khet Ratchathewi, Krung Thep Maha Nakhon 10400, Thailand
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore, Outram Rd, Singapore 169608, Singapore
| | - Alvin H Chong
- Skin Health Institute, level 1/80 Drummond St, Carlton, VIC 3053, Australia; Department of Medicine (Dermatology), St Vincent's Hospital Melbourne, University of Melbourne, Parkville, VIC 3010, Australia
| | - Anneliese Willems
- Skin Health Institute, level 1/80 Drummond St, Carlton, VIC 3053, Australia
| | - Cristina Galván
- Department of Dermatology, Hospital Universitario de Móstoles, Calle Río Júcar, S/N, 28935 Móstoles, Madrid, Spain
| | - Roni P Dodiuk-Gad
- Bruce Rappaport Faculty of Medicine, Technion - Institute of Technology, Haifa, 3200003, Israel; Department of Dermatology, Emek Medical Center, Yitshak Rabin Boulevard 21, Afula, 1834111, Israel; Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - Fabrizio Fantini
- Department of Dermatology, Dermatology Unit, ASST Lecco, Alessandro Manzoni Hospital, Via dell'Eremo, 9/11, 23900 Lecco LC, Italy
| | - Sebastiano Recalcati
- Department of Dermatology, Dermatology Unit, ASST Lecco, Alessandro Manzoni Hospital, Via dell'Eremo, 9/11, 23900 Lecco LC, Italy
| | - Joao Avancini
- Department of Dermatology, Hospital das Clínicas of the University of Sao Paulo, Rua, Av. Dr. Enéas Carvalho de Aguiar, 255-Cerqueira César, São Paulo-SP, 05403-000, Brazil
| | - Denise Miyamoto
- Department of Dermatology, Hospital das Clínicas of the University of Sao Paulo, Rua, Av. Dr. Enéas Carvalho de Aguiar, 255-Cerqueira César, São Paulo-SP, 05403-000, Brazil
| | - Jose A Sanches
- Department of Dermatology, Hospital das Clínicas of the University of Sao Paulo, Rua, Av. Dr. Enéas Carvalho de Aguiar, 255-Cerqueira César, São Paulo-SP, 05403-000, Brazil
| | - Noufal Raboobee
- Department of Dermatology, Westville Hospital, 7 Harry Gwala Rd, Westville, Durban, 3630, South Africa
| | - Francisco Bravo
- Department of Dermatology, Universidad Peruana Cayetano Heredia, Hospital Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres 15102, Peru; Department of Pathology, Universidad Peruana Cayetano Heredia, Hospital Cayetano Heredia, 1 CV Zac, Av. Honorio Delgado 262, San Martín de Porres 15102, Peru
| | - Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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Abstract
Cutaneous sarcoidosis has a wide variety of manifestations and can be challenging to diagnose clinically. Dermoscopy is a useful tool to support the clinical diagnosis. Herein, we report an elderly woman with pruritic facial plaques. Dermoscopy showed translucent orange globules with shiny white lines, and microscopic examination showed non-necrotizing granulomas with perigranulomatous fibrosis. Shiny white structures on dermoscopy are conventionally associated with basal cell carcinoma, melanoma, and dermatofibroma, and have not yet been reported in sarcoidosis. Current descriptions of dermoscopy findings of sarcoidosis in the literature are summarized. Further differential diagnostic entities for this presentation are described and treatment options for cutaneous sarcoidosis are discussed.
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30
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Lee KCH, Ko JP, Oh CC, Sewa DW. Managing respiratory complications in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Int J Dermatol 2021; 61:660-666. [PMID: 34494255 DOI: 10.1111/ijd.15888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 07/29/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022]
Abstract
In the recently published guidelines by the Society of Dermatology Hospitalists on the management of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), a brief section was included on airway management. These recommendations provide an easy reference on how to manage respiratory complications of the disease. Understanding the evidence that underlies these recommendations would offer physicians greater clarity on the considerations behind every decision and treatment offered. We present a review of the literature on respiratory manifestations associated with SJS and TEN. In addition, we aim to address specific concerns regarding the respiratory management of these patients. These include issues such as the indications and optimal timing of intubation, tracheostomy, role of flexible nasoendoscopy, bronchoscopy, ventilation strategies, and management of chronic respiratory complications.
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Affiliation(s)
- Ken Cheah Hooi Lee
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | - Joanna Phone Ko
- Nursing Division (Specialty Nursing), Singapore General Hospital, Singapore, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Duu Wen Sewa
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
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31
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Keng BMH, Gan WH, Tam YC, Oh CC. Personal protective equipment-related occupational dermatoses during COVID-19 among health care workers: A worldwide systematic review. JAAD Int 2021; 5:85-95. [PMID: 34485949 PMCID: PMC8407949 DOI: 10.1016/j.jdin.2021.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 12/22/2022] Open
Abstract
Background Occupational dermatoses caused by personal protective equipment (PPE) in the ongoing COVID-19 pandemic are emerging occupational health challenges that must be promptly and effectively addressed to ease burden on our health care workers. Objective A systematic review was conducted to determine common PPE-related dermatoses, affected body sites, and implicated occupational contactants. We further proposed solutions to mitigate this problem. Methods Online databases were searched for articles on PPE-related dermatoses in health care workers during the COVID-19 pandemic written in English and published from January 1, 2020, to January 30, 2021. Results Sixteen studies, including a total of 3958 participants, were included. The most common dermatoses were xerosis, pressure-related erythema, and contact dermatitis, mainly affecting the face and hands. The most widely implicated contactants were increased frequency of hand hygiene, gloves, N95 masks, and goggles. Proposed solutions were categorized as individual self-care, protection of the workforce, and long-term preventive measures. Conclusion Through measures such as regular basic skin care education, early access to specialty clinics via telemedicine, and designing of better-fit PPE, the challenges posed by PPE-related occupational dermatoses can be significantly reduced.
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Affiliation(s)
| | - Wee Hoe Gan
- Department of Occupational and Environmental Medicine, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yew Chong Tam
- Education Resource Centre, Singapore General Hospital, Singapore, Singapore
| | - Choon Chiat Oh
- Duke-NUS Medical School, Singapore, Singapore.,Department of Dermatology, Singapore General Hospital, Singapore, Singapore
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32
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ShengYang Lian B, Lee Krishnamoorthy T, Oh CC. Skin conditions in liver transplant recipients in a Singapore academic medical center: A retrospective cohort study. JAAD Int 2021; 4:70-78. [PMID: 34409397 PMCID: PMC8362318 DOI: 10.1016/j.jdin.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 01/04/2023] Open
Abstract
Background Liver transplant recipients are at lifelong risk of immunosuppression-related cutaneous complications, such as malignancy and infection. Objective Our study aims to assess the epidemiology of dermatologic conditions among liver transplant recipients in an academic medical center in Singapore. Methods Medical records of liver transplant recipients on follow-up with gastroenterology and dermatology departments at the Singapore General Hospital between 2006 and 2021 were retrospectively reviewed. A literature review was subsequently performed on the keywords “liver transplant” and “dermatology.” Results A total of 99 liver transplant recipients were identified in this study. Sixty-nine patients (70%) had at least 1 dermatologic condition. Inflammatory skin conditions were the most common (53%), followed by cutaneous infection (36%) and benign cutaneous tumors (30%). Malignant and premalignant lesions were the least common skin conditions reported (10%). Our study results concurred with many other studies reported worldwide, demonstrating a low cutaneous malignancy burden after liver transplantation. Limitations The study included a small population size in a single center and did not have a pre-existing protocol for pretransplant dermatologic surveillance. Conclusion Although the incidence of skin cancer after liver transplant in Singapore is low, the patients will benefit from long-term dermatology surveillance, given the long-term risks of infection and malignant skin conditions.
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Affiliation(s)
| | - Thinesh Lee Krishnamoorthy
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.,DUKE-NUS Medical School, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore.,DUKE-NUS Medical School, Singapore
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Clark AE, Fook-Chong S, Choo K, Oh CC, Yeo YW, Pang SM, Lee HY. Delayed admission to a specialist referral center for Stevens-Johnson syndrome and toxic epidermal necrolysis is associated with increased mortality: A retrospective cohort study. JAAD Int 2021; 4:10-12. [PMID: 34409382 PMCID: PMC8361915 DOI: 10.1016/j.jdin.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Abigail E Clark
- Duke University School of Medicine, Durham, North California
| | | | | | - Choon Chiat Oh
- Singapore General Hospital, Singapore.,Duke-National University of Singapore Medical School, Singapore
| | - Yi Wei Yeo
- Singapore General Hospital, Singapore.,Duke-National University of Singapore Medical School, Singapore
| | | | - Haur Yueh Lee
- Singapore General Hospital, Singapore.,Duke-National University of Singapore Medical School, Singapore
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Abstract
Background Teledermatology (TD) has emerged as a critical way of delivering care remotely in the COVID-19 pandemic. Objective We conducted a systematic review to assess how TD has been implemented worldwide. Methods We searched PubMed, Scopus, Embase, Web of Science, and Google Scholar for articles on the use of TD for patient care, written in English and published from December 1, 2019, to October 15, 2020. Results Twenty-seven studies were included, involving 16,981 patients. There was significant uptake of TD during the pandemic. Synchronous TD appeared to be more commonly implemented than asynchronous TD. Common ambulatory dermatoses such as acne or eczema were reported to be more amenable to TD assessment and management. TD also appeared to be useful for the diagnosis of cutaneous involvement of COVID-19 infection and follow-up of stable oncodermatology cases. Limitations A pooled analysis of all relevant outcomes was not always possible due to the heterogeneity in the methodologies of included studies. Conclusion TD is a useful and convenient tool for the management of common ambulatory dermatoses in the COVID-19 pandemic.
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Affiliation(s)
- C H Loh
- Department of Dermatology, Singapore General Hospital
| | - Y C Tam
- Education Resource Centre, Singapore General Hospital
| | - C C Oh
- Department of Dermatology, Singapore General Hospital.,Duke-NUS Medical School, Singapore
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35
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Tan WH, Loh CH, Chai ZT, Oh DAQ, Oh CC, Yeo YW, Choo KJL, Lee HY. Early experience of inpatient teledermatology in Singapore during COVID-19. Ann Acad Med Singap 2021. [DOI: 10.47102/annals-acadmedsg.202130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Lee HY, Oh CC. Melanoma in Singapore: Putting our best foot forward! Ann Acad Med Singap 2021; 50:454-455. [PMID: 34195751 DOI: 10.47102/annals-acadmedsg.2021211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Haur Yueh Lee
- Department of Dermatology, Singapore General Hospital, Singapore
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37
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Goh JY, Chan MMF, Oh CC. Feelers projection of the toe. JAAD Case Rep 2021; 12:91-93. [PMID: 34041342 PMCID: PMC8144101 DOI: 10.1016/j.jdcr.2021.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jia Yi Goh
- Department of Dermatology, Singapore General Hospital, Singapore
| | | | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore
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38
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Affiliation(s)
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore
| | - Yi Wei Yeo
- Department of Dermatology, Singapore General Hospital, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore
| | - Haur Yueh Lee
- Department of Dermatology, Singapore General Hospital, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore
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39
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Jiang B, Oh CC, Tan KW, Lee HY. Carbamazepine-induced toxic epidermal necrolysis in a patient despite testing negative for HLA B*15:02 allele. Ann Acad Med Singap 2021; 50:258-260. [PMID: 33855323 DOI: 10.47102/annals-acadmedsg.2020405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Bochao Jiang
- Department of Dermatology, Singapore General Hospital, Singapore
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40
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Oh DAQ, Yeo YW, Choo KJL, Pang SM, Oh CC, Lee HY. Acute generalized exanthematous pustulosis: Epidemiology, clinical course, and treatment outcomes of patients treated in an Asian academic medical center. JAAD Int 2021; 3:1-6. [PMID: 34409363 PMCID: PMC8362292 DOI: 10.1016/j.jdin.2020.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 11/03/2022] Open
Abstract
Background Acute generalized exanthematous pustulosis (AGEP) is a rare severe cutaneous adverse drug reaction. Although acutely patients have significant morbidity and occasional systemic involvement, the clinical course is generally self-limited. To date, there has been no consensus on treatment. Objective The aim of our current study was to evaluate the clinical features, drug association, treatment, and outcomes in a cohort of patients treated in an academic medical center. Methods A retrospective review of electronic medical records over a period of 10 years from 2009 to 2018 in a single tertiary academic medical center in Singapore was performed. Forty-three medical records with probable/definite diagnosis of AGEP were identified and analyzed for statistical significance. Results Drug association was identified in 93% of cases. The most frequent drug class was antibiotics, including penicillins, cephalosporins, and vancomycin. Systemic involvement was reported in 13.9% of patients. All cases of AGEP resolved with cessation of the offending drug. There was no mortality attributed to AGEP. Treatment with systemic steroid was associated with a decreased length of hospital stay (P = .035) in patients with AGEP. Conclusion AGEP was a self-limiting adverse drug reaction that was commonly caused by antibiotics. Although there was no difference in mortality, there was a significant reduction in the length of hospitalization with systemic corticosteroid treatment compared with that of topical corticosteroid treatment of AGEP.
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Affiliation(s)
- Dawn Ai Qun Oh
- Department of Dermatology, Singapore General Hospital, Singapore
| | - Yi Wei Yeo
- Department of Dermatology, Singapore General Hospital, Singapore.,DUKE-NUS Medical School, Singapore
| | - Karen Jui Lin Choo
- Department of Dermatology, Singapore General Hospital, Singapore.,Allergy Centre, Singapore General Hospital, Singapore.,DUKE-NUS Medical School, Singapore
| | - Shiu Ming Pang
- Department of Dermatology, Singapore General Hospital, Singapore.,Allergy Centre, Singapore General Hospital, Singapore.,DUKE-NUS Medical School, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore.,DUKE-NUS Medical School, Singapore
| | - Haur Yueh Lee
- Department of Dermatology, Singapore General Hospital, Singapore.,Allergy Centre, Singapore General Hospital, Singapore.,DUKE-NUS Medical School, Singapore
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Tan SW, Wong J, Kee T, Chai ZT, Ho QY, Chan M, Chew KY, Oh CC. Successful treatment of calciphylaxis in a renal transplant recipient with combination of intralesional sodium thiosulphate, intravenous sodium thiosulphate and fish skin graft. Australas J Dermatol 2021; 62:e358-e359. [PMID: 33550623 DOI: 10.1111/ajd.13556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 11/29/2022]
Affiliation(s)
- See Wei Tan
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Jiunn Wong
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Terence Kee
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Zi Teng Chai
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Quan Yao Ho
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Michelle Chan
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Khong Yik Chew
- Department of Plastic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
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Abstract
Objective Because of the increasing emergence of skin manifestations of COVID-19 worldwide, we investigated the published reports of these lesions. Methods We conducted a literature search for original and review articles published from November 11, 2019 to September 30, 2020. Results We identified 5 skin lesions common in patients with COVID-19: pseudo-chilblains, rashes containing macules and papules, and urticarial, vesicular, and vaso-occlusive lesions. These lesions manifested at various times in relation to the COVID-19 symptoms, which may indicate whether the lesions are virus-induced or are delayed immunological responses to the infection. Skin lesions were more prevalent among Europeans and United States residents than among Asians, as was pseudo-chilblain, and the morphology of the skin lesions varied among continents. Pseudo-chilblains were the most common COVID-19 skin manifestation in Europe and the United States, but there was only 1 reported case from Asian populations. Additionally, patients with vaso-occlusive lesions were more likely than those with pseudo-chilblains to be admitted to the intensive care unit and to die. Conclusion Different cutaneous manifestations in patients with COVID-19 could reflect a wide spectrum of viral interactions with the skin, though reporting bias may play a role as well.
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Affiliation(s)
- See Wei Tan
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | | | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
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Chong T, Rui Chong TY, Oh CC, Song HJ, Jeon J. 14265 Having the (b)lues: A case of malignant syphilis with paronychia and asymptomatic neurosyphilis. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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44
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Tan WH, Chai ZT, Guo W, Tang PY, Loh A, Oh CC. Cutaneous IgA vasculitis with crescentic nephropathy presenting with ulcers resembling pyoderma gangrenosum. Australas J Dermatol 2020; 62:e327-e329. [PMID: 33216944 DOI: 10.1111/ajd.13497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/09/2020] [Accepted: 09/27/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Wen Hao Tan
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Zi Teng Chai
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Weiwen Guo
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Po Yin Tang
- Division of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Alwin Loh
- Division of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
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45
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Liew YCC, Kee TYS, Kwek JL, Tang PY, Oh CC. Photodynamic therapy for the treatment of trichodysplasia spinulosa in an Asian renal transplant recipient: A case report and review of literature. JAAD Case Rep 2020; 7:74-83. [PMID: 33354613 PMCID: PMC7744799 DOI: 10.1016/j.jdcr.2020.10.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | - Jia Liang Kwek
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Po Yin Tang
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
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46
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Teh F, Oh CC. Calcium gluconate extravasation injury with good response to sodium thiosulfate treatment. Clin Exp Dermatol 2020; 46:984-986. [PMID: 33145844 DOI: 10.1111/ced.14485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/31/2020] [Accepted: 09/29/2020] [Indexed: 11/26/2022]
Affiliation(s)
- F Teh
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | - C C Oh
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
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47
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Abstract
Coronavirus disease 2019 (COVID-19) pandemic continues to spread globally at a staggering speed. At present, there is no effective treatment or vaccine for COVID-19. Hand disinfection is a cost-effective way to prevent its transmission. According to the Centres for Disease Control and Prevention (CDC) guidelines, we should wash our hands with soap and water for at least 20 seconds. If soap and water are not readily available, alcohol-based hand rubs (ABHRs) with at least 60% alcohol are the alternative. With diligent hand disinfection reinforced during COVID-19, there is an increased prevalence of contact dermatitis. This commentary highlights the fact that contact dermatitis is a readily treatable condi tion and should not cause any deviation of proper hand hygiene. In irritant contact dermatitis (ICD), the management strategies are selection of less irritating hand hygiene products, frequent use of moisturisers to rebuild the skin barrier, and education on proper hand hygiene practices. In allergic contact dermatitis (ACD), the identification and avoidance of the contact allergen is the key to treatment. However, ACD is less common and only accounts for 20% of the cases. The identified allergens in hand cleansers are predominantly preservative excipients a nd ACD attributable to ABHR are very uncommon. Alcohol-free hand rubs are widely available on the market but it is not a recommended alternative to ABHRs by the CDC.
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48
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Tan SW, Oh CC. Contact Dermatitis from Hand Hygiene Practices in the COVID-19 Pandemic. Ann Acad Med Singap 2020; 49:674-676. [PMID: 33241256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Coronavirus disease 2019 (COVID-19) pandemic continues to spread globally at a staggering speed. At present, there is no effective treatment or vaccine for COVID-19. Hand disinfection is a cost-effective way to prevent its transmission. According to the Centres for Disease Control and Prevention (CDC) guidelines, we should wash our hands with soap and water for at least 20 seconds. If soap and water are not readily available, alcohol-based hand rubs (ABHRs) with at least 60% alcohol are the alternative. With diligent hand disinfection reinforced during COVID-19, there is an increased prevalence of contact dermatitis. This commentary highlights the fact that contact dermatitis is a readily treatable condition and should not cause any deviation of proper hand hygiene. In irritant contact dermatitis (ICD), the management strategies are selection of less irritating hand hygiene products, frequent use of moisturisers to rebuild the skin barrier, and education on proper hand hygiene practices. In allergic contact dermatitis (ACD), the identification and avoidance of the contact allergen is the key to treatment. However, ACD is less common and only accounts for 20% of the cases. The identified allergens in hand cleansers are predominantly preservative excipients and ACD attributable to ABHR are very uncommon. Alcohol-free hand rubs are widely available on the market but it is not a recommended alternative to ABHRs by the CDC.
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Affiliation(s)
- See Wei Tan
- Department of Dermatology, Singapore General Hospital, Singapore
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49
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Lim A, Tang PY, Oh CC. Lichen planus pemphigoides after body tattooing. J Cosmet Dermatol 2020; 19:3048-3052. [PMID: 32542984 DOI: 10.1111/jocd.13553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 11/27/2022]
Abstract
Decorative tattooing is very popular worldwide and is associated with cutaneous complications, ranging from infections to localized or generalized skin reactions. We report a case of a patient presenting with generalized violaceous pruritic papular lesions 1 month after obtaining a black ink tattoo. Histological examination of a papular lesion distal to the tattoo site showed focal band-like lymphocytic infiltrate. He subsequently developed bullae over the papular lesions, with elevated serum BP180 antibody levels. A diagnosis of generalized lichen planus and lichen planus pemphigoides was made. He responded to treatment with potent topical corticosteroids and ciclosporin. We also reviewed the presentation and treatment of published cases of lichenoid reactions in the literature. With the increasing popularity of tattoos, awareness of this potential complication and possible treatments is important.
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Affiliation(s)
- Agnes Lim
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Po Yin Tang
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
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50
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Chai ZT, Oh CC. Facial cytomegalovirus ulcers in transformed mycosis fungoides. JAAD Case Rep 2020; 6:524-527. [PMID: 32490116 PMCID: PMC7256224 DOI: 10.1016/j.jdcr.2020.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Zi Teng Chai
- Department of Dermatology, Singapore General Hospital, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore
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