1
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Soenjoyo KR, Lee EY, Koh MJA. Cutaneous adenovirus infection in an immunocompromised child. Pediatr Dermatol 2024; 41:162-163. [PMID: 38072003 DOI: 10.1111/pde.15488] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/19/2023] [Indexed: 01/30/2024]
Abstract
Adenoviruses are common viral pathogens in childhood; however, cutaneous manifestations are not well-documented. We present a rare case of cutaneous adenovirus infection in a 23-month-old boy with a background of CD40 ligand deficiency, post bone marrow transplant. The clinical morphology of the skin lesions in our patient, described as skin-colored papules with central crusting, has not been previously described and contributes to the growing literature of cutaneous adenovirus cases.
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Affiliation(s)
| | - Elis Yuexian Lee
- Department of Dermatology, KK Women's and Children's Hospital, Singapore
| | - Mark Jean Aan Koh
- Department of Dermatology, KK Women's and Children's Hospital, Singapore
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2
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Au CY, Leow SY, Yi C, Ang D, Yeo JC, Koh MJA, Bhagat AAS. A Sensorised Glove to Detect Scratching for Patients with Atopic Dermatitis. Sensors (Basel) 2023; 23:9782. [PMID: 38139628 PMCID: PMC10748247 DOI: 10.3390/s23249782] [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] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/28/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
In this work, a lightweight compliant glove that detects scratching using data from microtubular stretchable sensors on each finger and an inertial measurement unit (IMU) on the palm through a machine learning model is presented: the SensorIsed Glove for Monitoring Atopic Dermatitis (SIGMA). SIGMA provides the user and clinicians with a quantifiable way of assaying scratch as a proxy to itch. With the quantitative information detailing scratching frequency and duration, the clinicians would be able to better classify the severity of itch and scratching caused by atopic dermatitis (AD) more objectively to optimise treatment for the patients, as opposed to the current subjective methods of assessments that are currently in use in hospitals and research settings. The validation data demonstrated an accuracy of 83% of the scratch prediction algorithm, while a separate 30 min validation trial had an accuracy of 99% in a controlled environment. In a pilot study with children (n = 6), SIGMA accurately detected 94.4% of scratching when the glove was donned. We believe that this simple device will empower dermatologists to more effectively measure and quantify itching and scratching in AD, and guide personalised treatment decisions.
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Affiliation(s)
- Cheuk-Yan Au
- Institute for Health Innovation & Technology (iHealthtech), National University of Singapore (NUS) MD6, 14 Medical Drive, #14-01, Singapore 117599, Singapore; (C.-Y.A.); (C.Y.); (J.C.Y.)
| | - Syen Yee Leow
- Department of Dermatology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore (M.J.A.K.)
| | - Chunxiao Yi
- Institute for Health Innovation & Technology (iHealthtech), National University of Singapore (NUS) MD6, 14 Medical Drive, #14-01, Singapore 117599, Singapore; (C.-Y.A.); (C.Y.); (J.C.Y.)
| | - Darrion Ang
- Institute for Health Innovation & Technology (iHealthtech), National University of Singapore (NUS) MD6, 14 Medical Drive, #14-01, Singapore 117599, Singapore; (C.-Y.A.); (C.Y.); (J.C.Y.)
| | - Joo Chuan Yeo
- Institute for Health Innovation & Technology (iHealthtech), National University of Singapore (NUS) MD6, 14 Medical Drive, #14-01, Singapore 117599, Singapore; (C.-Y.A.); (C.Y.); (J.C.Y.)
| | - Mark Jean Aan Koh
- Department of Dermatology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore (M.J.A.K.)
| | - Ali Asgar Saleem Bhagat
- Institute for Health Innovation & Technology (iHealthtech), National University of Singapore (NUS) MD6, 14 Medical Drive, #14-01, Singapore 117599, Singapore; (C.-Y.A.); (C.Y.); (J.C.Y.)
- Department of Biomedical Engineering, National University of Singapore (NUS), 4 Engineering Drive 3, Singapore 117583, Singapore
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3
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Kan SY, Arunachalam S, Ho S, Yin CC, Arkachaisri T, Aan Koh MJ. A case of neonatal lupus erythematosus presenting with extensive erosions at birth, healing with extensive scarring. JAAD Case Rep 2023; 42:35-37. [PMID: 37965190 PMCID: PMC10641549 DOI: 10.1016/j.jdcr.2023.09.017] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Affiliation(s)
- Sheau Yun Kan
- Department of Dermatology, KK Women’s & Children’s Hospital, Singapore
| | - Sridhar Arunachalam
- Department of Neonatal & Developmental Medicine, Singapore General Hospital, Singapore
| | - Selina Ho
- Infectious Disease service, KK Women’s & Children’s Hospital, Singapore
| | - Chong Chia Yin
- Infectious Disease service, KK Women’s & Children’s Hospital, Singapore
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4
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Tanugroho RR, Wee LWY, Koh MJA, Chong JH. Approach to clinically significant vascular anomalies in children. Singapore Med J 2023; 64:714-720. [PMID: 34808707 PMCID: PMC10775298 DOI: 10.11622/smedj.2021209] [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] [Received: 05/31/2021] [Accepted: 06/23/2021] [Indexed: 11/18/2022]
Abstract
Vascular anomalies consist of tumours or malformations made up of abnormal growth or collections of blood vessels that can result in functional or cosmetic problems. While many vascular anomalies are present at birth, some do not appear until later in life, making diagnosis more challenging. Although many vascular anomalies are benign, some are associated with serious complications and may involve multiple organ systems. This article highlights the important features of clinically significant vascular anomalies to help physicians promptly identify and refer these cases to a specialised multidisciplinary team for evaluation and management. The discussion includes the various presenting complaints of vascular anomalies in children, namely, rapidly growing birthmarks, painful lesions, seizures/neurological manifestations, bleeding diathesis, cardiac/airway abnormalities and part of an overgrowth syndrome.
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Affiliation(s)
| | | | | | - Jin Ho Chong
- Raffles Children’s Centre, Raffles Hospital, Singapore
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5
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Chin CYL, Chia SY, Koh MJA. A child with persistent exfoliative dermatitis. Pediatr Dermatol 2023; 40:1121-1123. [PMID: 37970692 DOI: 10.1111/pde.15316] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 03/26/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Cherlyn Yue Lin Chin
- Department of Dermatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Shi Yun Chia
- Department of Dermatology, KK Women's and Children's Hospital, Singapore, Singapore
- General Pediatrics Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore
| | - Mark Jean Aan Koh
- Department of Dermatology, KK Women's and Children's Hospital, Singapore, Singapore
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6
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Yin Yoong CS, Ning Quek CW, Foong YW, Aan Koh MJ. Dermatophytosis in Singapore children. Singapore Med J 2023; 0:367312. [PMID: 36695275 DOI: 10.4103/singaporemedj.smj-2020-279] [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: 01/08/2023]
Affiliation(s)
| | | | - Yee Wah Foong
- Dermatology Service, KK Women's and Children's Hospital, Singapore
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7
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Zhe Wong GH, Aan Koh MJ. Pityriasis alba secondary to prolonged use of face mask. Singapore Med J 2023; 0:367313. [PMID: 36695276 DOI: 10.4103/singaporemedj.smj-2021-005] [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: 01/09/2023]
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8
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Quek CWN, Wee LWY, Lie CJL, Foong YW, Koh MJA. Lipschütz ulcers in Asian children and adolescents. Int J Dermatol 2023; 62:e36-e37. [PMID: 36183303 DOI: 10.1111/ijd.16446] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/07/2022] [Accepted: 09/22/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Lynette Wei Yi Wee
- Department of Dermatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Cheryl Jia Ling Lie
- Department of Dermatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yee Wah Foong
- Department of Dermatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mark Jean Aan Koh
- Department of Dermatology, KK Women's and Children's Hospital, Singapore, Singapore
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9
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Ng PSM, Koh MJA. Degos disease in a child presenting with acute renal failure. Pediatr Dermatol 2022; 40:394-395. [PMID: 36443642 DOI: 10.1111/pde.15214] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022]
Abstract
Degos disease, also termed malignant atrophic papulosis, is a rare systemic vaso-occlusive disorder, seldom reported in the pediatric population. The pathognomonic skin lesion in Degos disease is a papule with an atrophic porcelain-white center with an erythematous, telangiectatic rim. The benign form of the disease remains limited to the skin, whereas, in others, it progresses to thrombotic vasculopathy in multiple organs including the gastrointestinal, cardiorespiratory, and central nervous systems, with a high mortality rate. We present a rare case of Degos disease in an adolescent female, presenting as acute renal failure secondary to thrombotic vasculopathy, with the characteristic skin lesion distinctively seen on dermoscopy.
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Affiliation(s)
- Pamela Si Min Ng
- Department of Pediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mark Jean Aan Koh
- Department of Dermatology, KK Women's and Children's Hospital, Singapore, Singapore
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10
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Zhao Z, Koh MJA. Cellular neurothekeoma occurring at the site of radiation therapy in a child with medulloblastoma. Pediatr Dermatol 2022; 39:488-490. [PMID: 35178793 DOI: 10.1111/pde.14941] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cellular neurothekeoma is a rare, benign cutaneous neoplasm. We report a case of cellular neurothekeoma arising on the mid-back of a 10-year-old boy within the previous radiation therapy field for medulloblastoma. Clinical features of cellular neurothekeoma in children are similar to those in adults, except that there have been no reports of local recurrence in children following surgical excision, and the presence of atypical histological features does not predict clinical behavior. Recognition of this entity in children is important to avoid misdiagnosis and overly aggressive treatments.
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Affiliation(s)
- Zitong Zhao
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
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11
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Ang YS, Wee LWY, Koh MJA. Systemic antibiotic prophylaxis for recurrent infective flares in children and adolescents with atopic dermatitis. Ann Acad Med Singap 2022; 51:113-114. [PMID: 35224608 DOI: 10.47102/annals-acadmedsg.2021324] [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: 06/14/2023]
Affiliation(s)
- Yi Shan Ang
- Department of Dermatology, KK Women's and Children's Hospital, Singapore
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12
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Lee EY, Wee CLP, Tan CH, Wee LWY, Lim CEE, Zhao X, Koh MJA, Yew YW, Goon ATJ. Pediatric patch testing in a multi-ethnic Asian population: A retrospective review. Pediatr Dermatol 2022; 39:69-76. [PMID: 34971009 DOI: 10.1111/pde.14904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/06/2021] [Accepted: 12/12/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Pediatric allergic contact dermatitis (ACD) is increasingly prevalent. Patch testing is the gold-standard diagnostic investigation. The aims of our study were to describe the clinical profile of pediatric patients with ACD in a multi-ethnic Asian population and identify the common contact allergens. METHODS This was a retrospective study involving children and adolescents aged 16 years or younger with clinically suspected ACD who underwent patch testing between January 2007 and March 2020 at two institutions in Singapore. Information pertaining to their demographics, atopy history, clinical presentation, and patch test results was analyzed. RESULTS A total of 252 patients were included. The mean age was 10.9 years (1.0-16.7 years). The majority were Chinese (79.8%) and girls (57.5%). Many (66.3%) had atopic dermatitis (AD), which was mild. The most common presentation was an acral eczematous rash. The sensitization rate was 50.0%. The most frequent reactions were to nickel sulfate (49.2%) and fragrance mix (19.1%). The overall rate of relevant positive patch tests was 72.5%. Patients with AD were less likely to have a reaction to fragrance mix (p = .019) and more likely to have a reaction to disperse blue (p = .041). Compared to younger children, adolescents were less likely to have a positive patch test (p = .008). Indians were also less likely to have a positive reaction (p = .004). CONCLUSION Metals and fragrances were the most common allergens causing childhood ACD in Singapore. Patients with AD were less likely to be sensitized to fragrances and more likely to be sensitized to disperse blue dye.
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Affiliation(s)
- Elis Yuexian Lee
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | | | - Chee Hian Tan
- Department of Dermatology, National Skin Centre, Singapore, Singapore
| | - Lynette Wei Yi Wee
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Charmaine En-En Lim
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Xiahong Zhao
- Research Department, National Skin Centre, Singapore, Singapore
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yik Weng Yew
- Department of Dermatology, National Skin Centre, Singapore, Singapore.,Research Department, National Skin Centre, Singapore, Singapore
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13
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Vohra S, Aan Koh MJ, Loong WW, Namuduri RP. Unusual lesion on the vulva of a postmenopausal woman. JAAD Case Rep 2021; 19:51-53. [PMID: 34917725 PMCID: PMC8669260 DOI: 10.1016/j.jdcr.2021.10.036] [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: 11/17/2022] Open
Affiliation(s)
- Suruchi Vohra
- Dermatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mark Jean Aan Koh
- Dermatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Wong Wai Loong
- Department of Gynaecological Oncology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Rama P Namuduri
- Department of Gynaecological Oncology, KK Women's and Children's Hospital, Singapore, Singapore
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14
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Wee LWY, Ling HY, Ho VPY, Foong AYW, Koh MJA. Juvenile xanthogranulomas in Asian children. Dermatol Ther 2021; 35:e15224. [PMID: 34820973 DOI: 10.1111/dth.15224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/29/2021] [Accepted: 11/19/2021] [Indexed: 01/04/2023]
Abstract
Juvenile xanthogranuloma (JXG) is the most common non-Langerhans cell histiocytic disorder. It can rarely be associated with systemic involvement. There is a paucity of literature on JXG in Asian children. We aim to describe the epidemiology, clinical features, systemic associations, histological features and outcome of a cohort of Asian children with JXG, and review the literature on the condition. We retrospectively reviewed the demographic, clinical and histological data of patients less than 16 years of age, diagnosed with JXG at our tertiary pediatric hospital between January 2002 and April 2019. A total of 147 children with JXG were identified, with a slight male preponderance of 53.1%. The median age of the onset was 15.5 months, with 69.4% presenting before 2 years of age. There was no racial predilection. The most frequently involved site was the head and neck region (44.2%). The majority of patients (76.2%) presented with a solitary lesion. Spontaneous resolution was documented in 57.7% of our patients with mean duration to resolution of 18.8 months. The proportion and speed of resolution did not differ in children with single or multiple lesions. No ophthalmologic complications were detected in our study cohort. JXG in children is generally limited to the skin and is rarely associated with systemic involvement, including the eye. Unless clinically indicated, the results from our study does not support routine screening for juvenile myelomonocytic leukemia, eye or systemic complications, even in the setting of multiple cutaneous JXGs.
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Affiliation(s)
- Lynette Wei Yi Wee
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Hua Yen Ling
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | | | - Alice Yee Wah Foong
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
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15
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Ng JQ, Chia SY, Koh MJA. Vesicular eruption in a teenager on oral isotretinoin for acne. Pediatr Dermatol 2021; 38:1318-1319. [PMID: 34750875 DOI: 10.1111/pde.14744] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jing Qi Ng
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Shi Yun Chia
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore.,General Pediatrics Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
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16
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Ng PSM, Wee LWY, Ho VPY, Tan WC, Bishnoi P, Alagappan U, Wong SMY, Gan EY, Quek BH, Shen L, Su B, Common JE, Koh MJA. Moisturisers from birth in at-risk infants of atopic dermatitis - a pragmatic randomised controlled trial. Australas J Dermatol 2021; 62:e539-e545. [PMID: 34424533 PMCID: PMC9291182 DOI: 10.1111/ajd.13703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 06/06/2021] [Revised: 07/24/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022]
Abstract
Background Atopic dermatitis (AD) is a common, chronic dermatosis, with onset of disease often manifesting in early infancy. Past studies evaluating the early use of moisturisers in the prevention of AD had mixed results. Objectives To compare the incidence of moderate or severe AD and total incidence of AD in a cohort of ‘at‐risk’ infants treated with moisturisers from the first 2 weeks of life, to a similar group without moisturisers. Methods We performed a single‐centre, prospective, parallel‐group, randomised study in infants with at least 2 first‐degree relatives with atopy. Subjects were randomised into either a treatment group with moisturisers or a control group without moisturisers. Participants were assessed at 2, 6, and 12 months for AD and if present, the severity was assessed using SCORAD index. We also compared the overall incidence of AD, trans‐epidermal water loss (TEWL), stratum corneum (SC) hydration, pH, and incidence of food and environmental sensitisation and allergies between both groups. Genotyping for loss‐of‐functions mutations in the FLG gene was conducted. Results A total of 200 subjects were recruited, with 100 subjects in each arm. There was no significant difference in incidence of moderate or severe AD, and total incidence of AD at 12 months between the treatment and control groups. There was a lower mean SCORAD in the treatment group than in the control group, but no significant difference in TEWL, SC hydration, and skin pH. No significant side‐effects were reported. Conclusions The early use of moisturisers in ‘at‐risk’ infants does not reduce the incidence of moderate‐to‐severe AD and overall incidence of AD in infancy.
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Affiliation(s)
- Pamela Si Min Ng
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | | | | | | | - Priya Bishnoi
- Dermatology Service, KK Women's and Children's Hospital, Singapore
| | - Uma Alagappan
- Dermatology Service, KK Women's and Children's Hospital, Singapore
| | | | - Emily Yiping Gan
- Dermatology Service, KK Women's and Children's Hospital, Singapore
| | - Bin Huey Quek
- Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - Liang Shen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Bing Su
- Research Center, KK Women's and Children's Hospital, Singapore
| | - John Ea Common
- Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR), Singapore
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17
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Wee LWY, Tan EC, Bishnoi P, Ng YZ, Lunny DP, Lim HW, Lee SP, Ong C, Yap TL, Mok YH, Low MY, Chu-Tian Chow C, Derrick L, Common JEA, Birgitte Lane E, Koh MJA. Epidermolysis bullosa with pyloric atresia associated with compound heterozygous ITGB4 pathogenic variants: Minimal skin involvement but severe mucocutaneous disease. Pediatr Dermatol 2021; 38:908-912. [PMID: 34152038 DOI: 10.1111/pde.14668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case of junctional epidermolysis bullosa with pyloric atresia (JEB-PA) with minimal skin involvement but severe protein-losing enteropathy and airway involvement. Genetic analysis revealed heterozygous mutations in the ITGB4 gene encoding integrin β4 protein. Parental testing confirmed inheritance of frameshift variant (c.794dupC) as maternal and splice site variant (c.1608C>T/p.Cys536Cys) as paternal. Immunofluorescence mapping of her skin revealed a subepidermal blister with decreased and frayed integrin β4 at both the floor and the roof of the blister, while the intestinal mucosa showed complete absence of integrin β4. We review the literature and discuss the differential expression of integrins in the skin and gastrointestinal tract, as well as the role of chronic inflammation in the pathogenesis of EB.
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Affiliation(s)
- Lynette Wei Yi Wee
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Ene Choo Tan
- Research Laboratory, KK Women's and Children's Hospital, Singapore, Singapore.,Genetics Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Priya Bishnoi
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yi Zhen Ng
- Institute of Medical Biology and Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Declan Patrick Lunny
- Institute of Medical Biology and Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Hwee-Woon Lim
- Research Laboratory, KK Women's and Children's Hospital, Singapore, Singapore
| | - Siew-Peng Lee
- Research Laboratory, KK Women's and Children's Hospital, Singapore, Singapore
| | - Christina Ong
- Paediatric Gastroenterology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Te Lu Yap
- Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yee Hui Mok
- Children's Intensive Care, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mei Yi Low
- Paediatric ENT, KK Women's and Children's Hospital, Singapore, Singapore
| | | | - Lian Derrick
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - John Edmund Armourer Common
- Institute of Medical Biology and Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Ellen Birgitte Lane
- Institute of Medical Biology and Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
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18
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Rr P, Douch C, Aan Koh MJ, Lai AHM, Lim CT, Hartley L, Thomas T, Yeo TH. Speckled brain lesions in Incontinentia Pigmenti patients with acquired brain syndromes. Eur J Paediatr Neurol 2021; 33:106-111. [PMID: 34133990 DOI: 10.1016/j.ejpn.2021.05.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/26/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022]
Abstract
Incontinentia Pigmenti (IP) is a neurocutaneous syndrome, with malformations of cortical development and neurodevelopmental delay in some patients. Neonates with IP may develop acute encephalopathy with multifocal ischemic brain lesions with a speckled pattern on diffusion-weighted magnetic resonance imaging (MRI). We observed a similar MRI pattern in 4 female patients with IP who presented with childhood acute encephalopathy syndromes. These patients, aged 9 days to 13 years old, had acute neonatal encephalitis, Influenza A virus related acute necrotizing encephalopathy (ANE) of childhood, Influenza B virus related acute encephalopathy with biphasic seizures and late restricted diffusion (AESD) and acute disseminated encephalitis (ADEM) with transverse myelitis (TM). These lesions could possibly reflect the white matter changes in IP patients with encephalopathy.
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Affiliation(s)
- Pravin Rr
- General Pediatrics, KK Women's & Children's Hospital, Singapore.
| | - Catherine Douch
- General Pediatrics, University College London Hospital, United Kingdom
| | | | - Angeline H M Lai
- Genetics Service, Department of Pediatrics, KK Women's & Children's Hospital, Singapore
| | - Cc Tchoyoson Lim
- Department of Neuroradiology, National Neuroscience Institute, Singapore
| | - Louise Hartley
- Pediatric Neurology, The Royal London Hospital, United Kingdom
| | - Terrence Thomas
- Pediatric Neurology Service, KK Women's & Children's Hospital, Singapore
| | - Tong Hong Yeo
- Pediatric Neurology Service, KK Women's & Children's Hospital, Singapore
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19
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Wong GHZ, Chia SY, Wei H, Rafi'ee K, Koh MJA, Tan EC. CARD14-associated papulosquamous eruption (CAPE) in a toddler responding to treatment with acitretin. Pediatr Dermatol 2021; 38:970-972. [PMID: 34075616 DOI: 10.1111/pde.14638] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CARD14-associated papulosquamous eruption (CAPE) is a rare autosomal dominant dermatosis that presents classically in early childhood with clinical features of both psoriasis and pityriasis rubra pilaris (PRP). The disease is known to be refractory to topical and systemic therapies classically used for psoriasis, with the majority of reported cases requiring treatment with biologics, such as ustekinumab and secukinumab. We present a toddler with a clinical presentation consistent with CAPE and found to have a novel heterozygous variant of the CARD14 gene. She was refractory to treatment with topical emollients and topical corticosteroids, but responsive to oral acitretin.
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Affiliation(s)
| | - Shi Yun Chia
- Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore.,Paediatrics Academic Clinical Programme, SingHealth Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Heming Wei
- Research Laboratory, KK Women's & Children's Hospital, Singapore, Singapore
| | - Khadijah Rafi'ee
- Research Laboratory, KK Women's & Children's Hospital, Singapore, Singapore
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore.,Paediatrics Academic Clinical Programme, SingHealth Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Ene Choo Tan
- Paediatrics Academic Clinical Programme, SingHealth Duke-NUS Graduate Medical School, Singapore, Singapore.,Research Laboratory, KK Women's & Children's Hospital, Singapore, Singapore
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20
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Chia SY, Wee LWY, Koh MJA. Dupilumab for children and adolescents with atopic dermatitis: An Asian perspective. Dermatol Ther 2021; 34:e14933. [PMID: 33751751 DOI: 10.1111/dth.14933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/30/2020] [Revised: 11/25/2020] [Accepted: 02/27/2021] [Indexed: 11/28/2022]
Abstract
Atopic dermatitis (AD) is a common, chronic, recurrent inflammatory skin disease. Poorly controlled AD can lead to reduced quality of life (QoL) and psychosocial impairment. Dupilumab is the first approved monoclonal antibody targeting type 2 inflammation, for adolescent and adult patients with moderate-to-severe AD. We performed a retrospective analysis of the efficacy and safety of dupilumab in a cohort of Asian children and adolescents with moderate-to-severe AD. Clinical response was documented with investigator global assessment (IGA) and eczema area and severity index (EASI) scores. Improvement in QoL was assessed using child dermatology life quality index (CDLQI) or Teenager's quality of life (T-QoL), and caregivers' QoL was assessed using dermatitis family impact (DFI) questionnaire. Twelve patients were recruited, aged between 6 to 18 years of age (mean 13.3 years), with mean duration of AD of 9.8 years. At baseline, the mean IGA score was four and the mean EASI was 48.2. The mean T-QoL and DFI scores at baseline were 18.7 and 19.6, respectively. After 12 to 16 weeks of treatment, the mean IGA score decreased to 2.2. The mean EASI decreased to 19.3 with mean reduction of 28.9. The mean T-QoL decreased to 7.5 with mean reduction of 11.2, and the mean DFI decreased to 8.6 with mean reduction of 11. Adverse events included mild conjunctivitis in two patients and paradoxical head and neck erythema in one patient. Our study supports dupilumab as an effective and safe treatment option for Asian children and adolescents with moderate-to-severe AD.
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Affiliation(s)
- Shi Yun Chia
- Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Lynette Wei Yi Wee
- Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
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21
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Ang YS, Koh MJA. Treatment of capillary malformations in capillary malformation-arteriovenous malformation syndrome with pulsed dye laser. J Cosmet Dermatol 2021; 20:3710-3711. [PMID: 33655684 DOI: 10.1111/jocd.14042] [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: 10/13/2020] [Revised: 02/02/2021] [Accepted: 02/18/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Yi Shan Ang
- Dermatology Service, KK Women's and Children's Hospital, Singapore City, Singapore
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore City, Singapore
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22
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Lee EY, Koh MJA. Acute generalized exanthematous pustulosis in children and adolescents in Singapore: A ten-year retrospective review. Pediatr Dermatol 2021; 38:424-430. [PMID: 33336363 DOI: 10.1111/pde.14482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/21/2020] [Accepted: 11/17/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Acute generalized exanthematous pustulosis (AGEP) is a rare, severe, cutaneous adverse reaction. Although most commonly caused by drugs, it can also be triggered by infections, especially in children. METHODS This is a retrospective study involving children and adolescents aged 16 years or younger, diagnosed with AGEP between January 2010 and March 2020 in our tertiary pediatric hospital. Information pertaining to the patient's demographics, clinical presentation and progress, biochemical, microbiological, and histopathological investigations, treatment, and outcomes was analyzed. RESULTS Eight patients were diagnosed with AGEP with mean age 8.2 years (range: 1.7-16.0 years). None of the patients had a personal or family history of psoriasis. Almost all patients had fever (n = 7, 87.5%). Although all 8 patients had intercurrent illness, 5 cases were attributed to infection, while the other 3 were likely precipitated by drugs. Abnormal hematological and biochemical parameters included a raised absolute neutrophil count (mean: 11.5 × 109 /L, range: 5.0-30.9 × 109 /L), C-reactive protein (mean: 52.5 mg/L, range: 5.0-143.7 mg/L), and erythrocyte sedimentation rate (mean: 38.6 mm/h, range: 6-64 mm/h). All patients developed post-pustular desquamation and subsequently recovered. The mean duration from onset to cessation of acute pustulation was 5.6 days (range: 3.0-10.0 days). One patient developed a recurrent episode of AGEP. CONCLUSION AGEP is rare and may be more commonly caused by infections in children. The condition is self-limiting with overall good outcomes in this age-group. In cases with concomitant infection and drug use, formal allergy testing should be arranged after resolution of the infection to confirm the underlying etiology.
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Affiliation(s)
- Elis Yuexian Lee
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
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23
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Lie CJL, Koh MJA, Ho VPY. Gray hair and fair skin in an infant with epilepsy. Pediatr Dermatol 2021; 38:280-282. [PMID: 33630363 DOI: 10.1111/pde.14435] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's & Children's Hospital, Singapore, Singapore
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24
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Wei H, Lai A, Tan ES, Koh MJA, Ng I, Ting TW, Thomas T, Cham B, Lim JY, Kam S, Goh CYJ, Lin G, Brett M, Chan D, Jamuar SS, Tan EC. Genetic landscape of congenital disorders in patients from Southeast Asia: results from sequencing using a gene panel for Mendelian phenotypes. Arch Dis Child 2021; 106:38-43. [PMID: 32978145 DOI: 10.1136/archdischild-2020-319177] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/24/2020] [Accepted: 08/30/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To test the utility and diagnostic yield of a medical-exome gene panel for identifying pathogenic variants in Mendelian disorders. METHODS Next-generation sequencing was performed with the TruSight One gene panel (targeting 4813 genes) followed by MiSeq sequencing on 216 patients who presented with suspected genetic disorders as assessed by their attending physicians. RESULTS There were 56 pathogenic and 36 likely pathogenic variants across 57 genes identified in 87 patients. Causal mutations were more likely to be truncating and from patients with a prior clinical diagnosis. Another 18 promising variants need further evaluation for more evidence to meet the requirement for potential upgrade to pathogenic. Forty-five of the 92 clinically significant variants were novel. CONCLUSION The 40.3% positive yield compares favourably with similar studies using either this panel or whole exome sequencing, demonstrating that large gene panels could be a good alternative to whole exome sequencing for quick genetic confirmation of Mendelian disorders.
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Affiliation(s)
- Heming Wei
- KK Research Centre, KK Women's & Children's Hospital, Singapore
| | - Angeline Lai
- Paediatric Academic Clinical Programme, SingHealth Duke-NUS Graduate Medical School, Singapore.,Genetics Service, KK Women's & Children's Hospital, Singapore
| | - Ee Shien Tan
- Paediatric Academic Clinical Programme, SingHealth Duke-NUS Graduate Medical School, Singapore.,Genetics Service, KK Women's & Children's Hospital, Singapore
| | - Mark Jean Aan Koh
- Paediatric Academic Clinical Programme, SingHealth Duke-NUS Graduate Medical School, Singapore.,Dermatology Service, KK Women's & Children's Hospital, Singapore
| | - Ivy Ng
- Paediatric Academic Clinical Programme, SingHealth Duke-NUS Graduate Medical School, Singapore.,Genetics Service, KK Women's and Children's Hospital, Singapore
| | - Teck Wah Ting
- Paediatric Academic Clinical Programme, SingHealth Duke-NUS Graduate Medical School, Singapore.,Genetics Service, KK Women's and Children's Hospital, Singapore
| | - Terrence Thomas
- Paediatric Academic Clinical Programme, SingHealth Duke-NUS Graduate Medical School, Singapore.,Neurology Service, KK Women's & Children's Hospital, Singapore
| | - Breana Cham
- Genetics Service, KK Women's & Children's Hospital, Singapore
| | - Jiin Ying Lim
- Genetics Service, KK Women's & Children's Hospital, Singapore
| | - Sylvia Kam
- Genetics Service, KK Women's & Children's Hospital, Singapore
| | | | - Grace Lin
- KK Research Centre, KK Women's & Children's Hospital, Singapore
| | - Maggie Brett
- KK Research Centre, KK Women's & Children's Hospital, Singapore
| | - Derrick Chan
- Paediatric Academic Clinical Programme, SingHealth Duke-NUS Graduate Medical School, Singapore.,Neurology Service, KK Women's & Children's Hospital, Singapore
| | - Saumya Shekhar Jamuar
- Paediatric Academic Clinical Programme, SingHealth Duke-NUS Graduate Medical School, Singapore.,Genetics Service, KK Women's & Children's Hospital, Singapore
| | - Ene-Choo Tan
- KK Research Centre, KK Women's & Children's Hospital, Singapore .,Paediatric Academic Clinical Programme, SingHealth Duke-NUS Graduate Medical School, Singapore
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25
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Quek CWN, Foong YW, Tan SK, Soh SY, Tan PL, Koh MJA. Leukemia cutis in a child with juvenile myelomonocytic leukemia presenting with Sweet syndrome-like lesions and a history of multiple juvenile xanthogranulomas. JAAD Case Rep 2020; 6:1138-1140. [PMID: 33134454 PMCID: PMC7591327 DOI: 10.1016/j.jdcr.2020.08.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/19/2022] Open
Affiliation(s)
- Chrystie Wan Ning Quek
- National University of Singapore Yong Loo Lin School of Medicine, Singapore
- Correspondence to: Chrystie Wan Ning Quek, IBDP, National University of Singapore Yong Loo Lin School of Medicine, 12 Science Drive 2, Singapore 117549.
| | - Yee Wah Foong
- Dermatology Service, KK Women's and Children's Hospital, Singapore
| | | | - Shui Yen Soh
- Haematology/Oncology Service, KK Women's and Children's Hospital, Singapore
| | - Poh Lin Tan
- Paediatrics Service, National University Hospital, Singapore
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26
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Namuduri RP, Lee LY, Aan Koh MJ. Combination of oral acitretin, antiretroviral therapy, human papillomavirus vaccine, and carbon dioxide laser ablation for the treatment of giant condyloma acuminatum of the vulva in a patient with AIDS. Dermatol Ther 2020; 33:e14253. [DOI: 10.1111/dth.14253] [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: 07/27/2020] [Revised: 08/09/2020] [Accepted: 08/21/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Rama P. Namuduri
- Department of Gynaecological Oncology KK Women's & Children's Hospital Singapore
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27
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Bao J, Foong YW, Chong JH, Aan Koh MJ. Systemic immunosuppressants for the treatment of atopic dermatitis in a cohort of Asian children. Dermatol Ther 2020; 33:e13981. [DOI: 10.1111/dth.13981] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/07/2020] [Accepted: 07/03/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Jianda Bao
- Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - Yee Wah Foong
- Dermatology Service KK Women's and Children's Hospital Singapore
| | - Jin Ho Chong
- Dermatology Service KK Women's and Children's Hospital Singapore
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28
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Soenjoyo KR, Chua BWB, Wee LWY, Koh MJA, Ang SB. Treatment of cutaneous viral warts in children: A review. Dermatol Ther 2020; 33:e14034. [PMID: 32683782 DOI: 10.1111/dth.14034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/06/2020] [Revised: 07/04/2020] [Accepted: 07/08/2020] [Indexed: 12/14/2022]
Abstract
Viral warts or verruca are very common skin infections in children. Although benign, lesions can be extensive, painful, bleed, or lead to cosmetic disfigurement. Although spontaneous resolution can occur, parents often bring their children for treatment, especially when they are symptomatic. Many publications have assessed the efficacy and safety of treatment of warts in adults. However, treatment in children can be challenging due to their immune responses and lower threshold for pain. We review the current literature on the methods, efficacy, and side effect profile of common treatment modalities for cutaneous viral warts in children. There is evidence that salicylic acid and cryotherapy are effective, and although cryotherapy is more effective, there is a higher risk of side effects such as pain and blistering. Combination treatment with salicylic acid and cryotherapy may reduce these side effects. Although there is limited data, other treatment options such as cantharidin, immunotherapy and other mechanical therapies, for example, carbon dioxide lasers, may also be considered, especially for recalcitrant lesions.
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Affiliation(s)
| | | | - Lynette Wei Yi Wee
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Seng Bin Ang
- Duke-NUS Medical School, Singapore, Singapore.,Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore.,Family Medicine Service, KK Women's and Children's Hospital, Singapore, Singapore
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29
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Lee EY, Koh MJA. A rare case of cutaneous Trichosporon asahii infection in an immunocompromised child. Pediatr Dermatol 2020; 37:962-963. [PMID: 32533725 DOI: 10.1111/pde.14251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/02/2020] [Revised: 05/06/2020] [Accepted: 05/21/2020] [Indexed: 11/29/2022]
Abstract
We present an 11-year-old girl who developed neutropenic fever and papulonodular lesions over her limbs and back following chemotherapy for relapsed acute myeloid leukemia. She was found to have cutaneous Trichosporon asahii infection, with no evidence of systemic infection, and responded to treatment with voriconazole. T. asahii infection is rare but often fatal and usually causes disseminated infections in immunocompromised patients. Cutaneous infection is relatively uncommon and rarely occurs in the pediatric population.
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Affiliation(s)
- Elis Yuexian Lee
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
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30
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Ling HY, Yee Wong SM, Yang J, Aan Koh MJ. A rare case of congenital red hair heterochromia of the scalp. JAAD Case Rep 2020; 6:700-701. [PMID: 32715053 PMCID: PMC7369455 DOI: 10.1016/j.jdcr.2020.05.028] [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: 11/28/2022] Open
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31
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Murrell DF, Lucky AW, Salas-Alanis JC, Woodley DT, Palisson F, Natsuga K, Nikolic M, Ramirez-Quizon M, Paller AS, Lara-Corrales I, Barzegar MA, Sprecher E, Has C, Laimer M, Bruckner AL, Bilgic A, Nanda A, Purvis D, Hovnanian A, Murat-Sušić S, Bauer J, Kern JS, Bodemer C, Martin LK, Mellerio J, Kowaleski C, Robertson SJ, Bruckner-Tuderman L, Pope E, Marinkovich MP, Tang JY, Su J, Uitto J, Eichenfield LF, Teng J, Aan Koh MJ, Lee SE, Khuu P, Rishel HI, Sommerlund M, Wiss K, Hsu CK, Chiu TW, Martinez AE. Multidisciplinary care of epidermolysis bullosa during the COVID-19 pandemic-Consensus: Recommendations by an international panel of experts. J Am Acad Dermatol 2020; 83:1222-1224. [PMID: 32682031 PMCID: PMC7363613 DOI: 10.1016/j.jaad.2020.06.1023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Dedee F Murrell
- Department of Dermatology, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia.
| | - Anne W Lucky
- Cincinnati Children's Epidermolysis Bullosa Center, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Julio C Salas-Alanis
- DebRA (Dystrophic Epidermolysis Bullosa Research Association) Mexico, Monterrey, Mexico
| | - David T Woodley
- Department of Dermatology, University of Southern California, Los Angeles, California
| | - Francis Palisson
- Dystrophic Epidermolysis Bullosa Research Association DebRA (Dystrophic Epidermolysis Bullosa Research Association) Chile; Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Ken Natsuga
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Milos Nikolic
- Deptartment of Dermatovenereology, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Mae Ramirez-Quizon
- Department of Dermatology, University of the Philippines, Philippines General Hospital, Manila, Philippines
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Children's Hospital, Northwestern University, Chicago, Illinois
| | - Irene Lara-Corrales
- Section of Dermatology, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Eli Sprecher
- Department of Dermatology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Cristina Has
- Department of Dermatology, Medical Center-University of Freiburg, Freiburg, Germany
| | - Martin Laimer
- EB Haus, Department of Dermatology, Paracelsus University, Salzburg, Austria
| | - Anna L Bruckner
- Pediatric Dermatology Department, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Asli Bilgic
- Department of Dermatology, Akdeniz University, Antalya, Turkey
| | - Arti Nanda
- Pediatric Dermatology Unit, As'ad Al-Hamad Dermatology Center, Kuwait
| | - Diana Purvis
- Department of Dermatology, Starship Children's Health, Auckland, New Zealand
| | - Alain Hovnanian
- Department of Genetics, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1163, Laboratory of Genetic Skin Diseases, Paris, France; Institut des Maladies Génétiques (IMAGINE), University of Paris, Paris, France
| | | | - Johannes Bauer
- EB Haus, Department of Dermatology, Paracelsus University, Salzburg, Austria
| | - Johannes S Kern
- Dermatology Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia
| | - Christine Bodemer
- Department of Dermatology, Necker Enfants Malades Hospital, University of Paris, Paris, France; Reference Centre for Genodermatoses and Rare Skin Diseases (MAGEC), Paris, France
| | - Linda K Martin
- Department of Dermatology, Sydney Children's Hospital, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Jemima Mellerio
- Adult Epidermolysis Bullosa Service, St John's Institute of Dermatology, St Thomas' Hospital, London, United Kingdom
| | - Cezary Kowaleski
- Department of Dermatology and Immunodermatology, University of Warsaw, Warsaw, Poland
| | - Susan J Robertson
- Dermatology Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Dermatology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | - Elena Pope
- Section of Dermatology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - M Peter Marinkovich
- Department of Dermatology, Stanford University Medical Center, Palo Alto, California
| | - Jean Y Tang
- Department of Dermatology, Stanford University Medical Center, Palo Alto, California
| | - John Su
- The University of Melbourne, Parkville, Victoria, Australia; Monash University, Eastern Health, Melbourne, Victoria, Australia
| | - Jouni Uitto
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, University of California, San Diego, California; Department of Pediatric Dermatology, Rady Children's Hospital, San Diego, California
| | - Joyce Teng
- Department of Dermatology, Stanford University Medical Center, Palo Alto, California
| | | | - Sang Eun Lee
- Department of Dermatology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Phuong Khuu
- Department of Dermatology, Stanford University Medical Center, Palo Alto, California
| | - Heather I Rishel
- Rishel Pediatric Dermatology, PC, Rishel Enterprises, LLC, San Francisco, California
| | - Mette Sommerlund
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Karen Wiss
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Chao-Kai Hsu
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tor Wo Chiu
- Chinese University of Hong Kong, Hong Kong, China
| | - Anna E Martinez
- Paediatric Dermatology Department, Great Ormond Street National Health Service Foundation Trust, London, United Kingdom
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32
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Olsson M, Bajpai R, Yew YW, Koh MJA, Thng S, Car J, Järbrink K. Associations between health-related quality of life and health care costs among children with atopic dermatitis and their caregivers: A cross-sectional study. Pediatr Dermatol 2020; 37:284-293. [PMID: 31863524 DOI: 10.1111/pde.14071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Atopic dermatitis is associated with a decreased health-related quality of life and contributes to substantial health care costs. It is important to understand what accelerates health care costs to inform various stakeholders, so they can effectively meet health care needs. This cross-sectional study aims to explore associations between health-related quality of life, health care costs, and cost-accelerating variables. METHODS Information on health-related quality of life (HRQoL) was collected through generic and disease-specific instruments from caregivers and children <16 years of age with a physician-confirmed diagnosis of atopic dermatitis. The economic impact of atopic dermatitis was evaluated by analyzing information on health service utilization and other health care costs related to managing the condition. RESULTS Children with high impact on health-related quality of life presented an annual health care cost of US$ 3787 compared with US$ 2548 for moderately impacted and US$ 2258 among children for which the condition had low impact. The severity of atopic dermatitis, disease duration, and a lower health-related quality of life was associated with greater health care costs. Analyses of subdomains of health-related quality of life revealed correlations between "mood" and "personal relationships" on one hand and caregivers' physical health and health care costs on the other hand. CONCLUSIONS Highly affected HRQoL is associated with increased health care costs and could be a valuable complement to traditional severity assessments. By using HRQoL instruments, burdens and symptoms beyond severity can be identified and addressed with interventions to increase HRQoL and subsequently reduce health care costs.
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Affiliation(s)
- Maja Olsson
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Queensland University of Technology, Brisbane, QLD, Australia
| | - Ram Bajpai
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | | | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Steven Thng
- National Skin Centre, Singapore, Singapore.,Skin Research Institute of Singapore, A*STAR. 8A Biomedical Grove, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Krister Järbrink
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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33
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Lee EY, Koh MJA, Foong AYW, Teh KL, Arkachaisri T. A penile rash in a child with arthritis. Pediatr Dermatol 2020; 37:202-203. [PMID: 31997443 DOI: 10.1111/pde.13932] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Elis Y Lee
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | | | - Alice Y W Foong
- Dermatology Service, KK Women's & Children's Hospital, Singapore
| | - Kai Liang Teh
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Thaschawee Arkachaisri
- Department of Paediatric Subspecialties, Rheumatology and Immunology Service, KK Women's and Children's Hospital, Singapore
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34
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Ho VPY, Koh MJA. Vulvar lymphangiectasia secondary to gastrointestinal tuberculosis infection in a teenager. Pediatr Dermatol 2020; 37:215-216. [PMID: 31618790 DOI: 10.1111/pde.13920] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a rare presentation of vulvar lymphangiectasia that developed secondary to gastrointestinal tuberculosis in a teenager, and its spontaneous resolution after anti-tuberculous treatment was completed.
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Affiliation(s)
- Valerie Pui Yoong Ho
- Dermatology Service, KK Women's and Children's Hospital, Singapore City, Singapore.,General Paediatrics Service, KK Women's and Children's Hospital, Singapore City, Singapore
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore City, Singapore
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Affiliation(s)
- Zi Xean Khoo
- Department of Paediatric Medicine, General Paediatrics Service, KK Women's and Children's Hospital, Singapore
| | - Jin Ho Chong
- Dermatology Service, KK Women's and Children's Hospital, Singapore
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36
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Xu X, van Galen LS, Koh MJA, Bajpai R, Thng S, Yew YW, Ho VPY, Alagappan U, Järbrink KSA, Car J. Factors influencing quality of life in children with atopic dermatitis and their caregivers: a cross-sectional study. Sci Rep 2019; 9:15990. [PMID: 31690745 PMCID: PMC6831568 DOI: 10.1038/s41598-019-51129-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 02/26/2019] [Accepted: 09/15/2019] [Indexed: 11/09/2022] Open
Abstract
Better understanding of atopic dermatitis' effect on quality of life could enhance current management and therapeutic strategies. Studies investigating factors related to the health-related quality of life (HRQOL) of children with atopic dermatitis and their caregivers are limited. This cross-sectional study included 559 children (<16 years) with atopic dermatitis and their caregivers. Disease severity was associated with infants' HRQOL (moderate: IRR: 1.42, 95% CI 1.20-1.67; severe: IRR: 1.72, 95% CI 1.32-2.24). Age and disease severity were associated with children's HRQOL (age: IRR: 0.99, 95% CI 0.98-1.00; moderate: IRR: 1.08, 95% CI 1.02-1.14). Quality of life subdomains itching/scratching, emotional distress and sleep disturbance were most reported and increased with higher disease severity. Both caregivers' mental and physical health were negatively affected by children's HRQOL (physical: IRR: 0.99, 95% CI 0.99-1.00; mental: IRR: 0.98, 95% CI 0.97-0.99). Sociodemographic characteristics (gender, ethnicity, educational attainment of carers, number of children) did not demonstrate significance in children's HRQOL model. In conclusion, current atopic dermatitis diagnostics and treatment have to be extended to the factors influencing both children' as their caregivers' quality of life and adapting management accordingly. Itching/scratching, emotional distress and sleep disturbance deserve attention. Sociodemographic characteristics in children's HRQOL models also merit attention in further research.
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Affiliation(s)
- Xiaomeng Xu
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Louise Sandra van Galen
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Section of Acute Medicine, Department of Internal Medicine, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Ram Bajpai
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | | - Yik Weng Yew
- National Skin Centre, Singapore, Singapore.,Skin Research Institute of Singapore, Singapore, Singapore
| | | | - Uma Alagappan
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Krister Sven Ake Järbrink
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
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37
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Wee LWY, Ling HY, Chong CY, Soe MN, Koh MJA. A rare case of purpuric rash caused by Saprochaete clavata in a pediatric patient with acute leukemia. Pediatr Dermatol 2019; 36:990-991. [PMID: 31423625 DOI: 10.1111/pde.13963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present a 13-year-old boy who developed invasive infection with Saprochaete clavata after induction chemotherapy for B-cell acute lymphoblastic leukemia, complicated by fungemia, septic shock and acute renal, and liver failure. He developed purpuric papulonodules over bilateral upper and lower limbs, which also grew S clavata on fungal culture.
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Affiliation(s)
- Lynette Wei Yi Wee
- Dermatology Service, KK Women's and Children's Hospital, Singapore City, Singapore
| | - Hua Yen Ling
- Dermatology Service, KK Women's and Children's Hospital, Singapore City, Singapore
| | - Chia Yin Chong
- Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore City, Singapore
| | - Mya Nwe Soe
- Haematology and Oncology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore City, Singapore
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore City, Singapore
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38
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van Galen LS, Xu X, Koh MJA, Thng S, Car J. Eczema apps conformance with clinical guidelines: a systematic assessment of functions, tools and content. Br J Dermatol 2019; 182:444-453. [PMID: 31179535 DOI: 10.1111/bjd.18152] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Eczema is a prevalent complex skin condition requiring active disease monitoring and personalized education. No studies have assessed the quality of apps that aim to support eczema self-management. OBJECTIVES To evaluate the quality and comprehensiveness of English, Chinese and Spanish self-management eczema smartphone apps for patients and/or their caregivers. METHODS A systematic assessment of eczema apps from July 2018 to November 2018. The assessment criteria were based on conformance with international eczema guidelines. The following domains were assessed: consistency and comprehensiveness of eczema-specific educational information; quality and comprehensiveness of eczema-specific tracking functions; compliance with health information best practice principles. RESULTS In total, 98 apps were assessed: 82 (84%) provided educational information; 38 (39%) tracking functions; and 13 (13%) both. We found that 34% (28/82) of apps provided misleading information, particularly regarding aspects of treatment and disease progression of eczema. Only 15% (12/82) provided international guideline supported information on pharmacological therapies and 16% (13/82) on nonpharmacological therapies. Among 38 apps with a tracking function, 82% (31/38) measured specific symptoms, disease severity or current skin condition and 89% (34/38) helped users to record medication usage including application of topicals. Environmental or dietary allergens were recorded by 34% (13/38). None of the included apps complied with all criteria for educational information, tracking functions or health information principles. CONCLUSIONS Eczema apps have not yet reached their potential. The large variance in quality of eczema apps highlights the need for quality assurance mechanisms for health apps and guidance for clinicians that would enable them to make personalized recommendations for patients and caregivers. What's already known about this topic? There is limited information about the quality of eczema self-management smartphone apps on the global market. What does this study add? This systematic assessment evaluated all English, Chinese and Spanish language apps that support eczema self-management. The majority did not conform with information in guidelines and insufficiently support evidence-based self-management. The large variance in the quality of eczema apps highlights the need for mechanisms to ensure app quality and to guide personalized app selection for patients, caregivers and doctors.
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Affiliation(s)
- L S van Galen
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Clinical Sciences Building, 11 Mandalay Road, Singapore, 308232, Singapore.,Section of Acute Medicine, Department of Internal Medicine, Amsterdam UMC location VUmc, the Netherlands
| | - X Xu
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Clinical Sciences Building, 11 Mandalay Road, Singapore, 308232, Singapore
| | - M J A Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore
| | - S Thng
- National Skin Centre, 1 Mandalay Road, 308205, Singapore
| | - J Car
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Clinical Sciences Building, 11 Mandalay Road, Singapore, 308232, Singapore.,Global Digital Health Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, 3rd floor Reynolds Building, St Dunstan's Road, London, W6 8RP, U.K
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39
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Chan D, Salas-Walinsundin WM, Yap FKP, Koh MJA. Calcium management challenges in a macrosomic child with subcutaneous fat necrosis. BMJ Case Rep 2019; 12:12/2/e227141. [PMID: 30787024 DOI: 10.1136/bcr-2018-227141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/04/2022] Open
Abstract
We present a case that illustrates the fluctuations in calcium levels to be expected while managing an infant with maternal gestational diabetes mellitus who also develops subcutaneous fat necrosis (SCFN). There is initial hypocalcaemia due to functional hypoparathyroidism, requiring judicious calcium replacement. But with increased extrarenal production of 1,25-dihydroxyvitamin D due to granulomatous inflammation of subcutaneous adipose tissue, hypercalcaemia ensues. With a self-limiting course, SCFN of the newborn has an excellent prognosis and resolves spontaneously. However, aberrations in serum calcium levels can manifest in life-threatening complications and must hence be closely monitored.
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Affiliation(s)
- Daniel Chan
- Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | | | | | - Mark Jean Aan Koh
- Paediatric Dermatology, KK Women's and Children's Hospital, Singapore
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40
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Loo BKG, Batilando MJ, Tan EC, Koh MJA. Compound heterozygous mutations with novel missense ABCA12 mutation in harlequin ichthyosis. BMJ Case Rep 2018; 2018:bcr-2017-222025. [PMID: 29298786 DOI: 10.1136/bcr-2017-222025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 11/04/2022] Open
Abstract
Harlequin ichthyosis (HI) is the most severe form of autosomal recessive congenital ichthyosis, presenting at birth with distinctive facial features and thick, plate-like scales over the entire body. The abnormal skin barrier predisposes the patient to multiple complications, including dehydration and sepsis. Mortality rates of babies with HI have been greatly reduced since the introduction of systemic retinoid therapy. Mutations in ABCA12 have been found to lead to HI. Most of these mutations are truncation or deletion mutations in the conserved region of the protein, leading to severe loss of ABCA12 function. We report a case of HI caused by a compound heterozygous mutation (a known single nucleotide deletion and a novel single nucleotide substitution) in the ABCA12 gene.
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Affiliation(s)
- Benny Kai Guo Loo
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | | | - Ene Choo Tan
- KK Research Centre, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mark Jean Aan Koh
- Department of Dermatology, KK Women's and Children's Hospital, Singapore, Singapore
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41
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Loo EXL, Sim JZT, Loy SL, Goh A, Chan YH, Tan KH, Yap F, Gluckman PD, Godfrey KM, Van Bever H, Lee BW, Chong YS, Shek LPC, Koh MJA, Ang SB. Associations between caesarean delivery and allergic outcomes: Results from the GUSTO study. Ann Allergy Asthma Immunol 2017; 118:636-638. [PMID: 28477794 DOI: 10.1016/j.anai.2017.02.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/15/2017] [Accepted: 02/20/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Evelyn Xiu Ling Loo
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | | | - See Ling Loy
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Anne Goh
- Allergy Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Fabian Yap
- Department of Endocrinology, KK Women's and Children's Hospital Singapore, Singapore
| | - Peter D Gluckman
- Growth, Development and Metabolism Programme, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore; Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Keith M Godfrey
- National Institute for Health Reseaerch, Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom; Medical Research Council Lifecourse Epidemiology Unit, Southampton, United Kingdom
| | - Hugo Van Bever
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yap Seng Chong
- Singapore Institute of Clinical Sciences and Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Lynette Pei-Chi Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital Singapore, Singapore
| | - Seng Bin Ang
- Dermatology Service, KK Women's and Children's Hospital Singapore, Singapore; Family Medicine Service, KK Women's and Children's Hospital Singapore, Singapore.
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42
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Cheok S, Yee F, Song Ma JY, Leow R, Ho MSL, Yew YW, Tay YK, Rebello SA, Luo N, Koh MJA. Prevalence and descriptive epidemiology of atopic dermatitis and its impact on quality of life in Singapore. Br J Dermatol 2017; 178:276-277. [PMID: 28415136 DOI: 10.1111/bjd.15587] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S Cheok
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - F Yee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - J Y Song Ma
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - R Leow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Y W Yew
- National Skin Center, Singapore
| | - Y K Tay
- Dermatology Department, Changi General Hospital, Singapore
| | - S A Rebello
- Saw Swee Hock School of Public Health, Singapore
| | - N Luo
- Saw Swee Hock School of Public Health, Singapore
| | - M J A Koh
- Dermatology Service, KK Women's & Children's Hospital, Singapore
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Abstract
Atopic dermatitis (AD) is a common chronic, pruritic skin disease in children. As the incidence of AD increases, especially in high-income countries, paediatricians may see an increasing number of recalcitrant AD cases in their practice. Although these cases are principally managed by paediatric dermatologists, it is important for paediatricians to be aware of the use and side effects of non-topical treatment like phototherapy and systemic agents as well as the evidence for alternative treatment, which caregivers may ask about. This review presents paediatric evidence for the practical use of phototherapy and certain oral immunosuppressants for paediatric AD including doses, duration of use and monitoring of adverse effects. The use of alternative therapy including traditional medicine, probiotics and the role of nutrition are also discussed. Narrow band ultraviolet B phototherapy is effective in recalcitrant paediatric AD. When phototherapy is ineffective or contraindicated, systemic drugs may be administered cautiously with close surveillance of side effects. The use of azathioprine, ciclosporin, methotrexate and mycophenolate mofetil is generally safe in the short term under close monitoring and can be effective alongside compliance to topical treatment. Alternative complementary treatment is not known to be effective. Holistic management including therapeutic patient education is important. Good quality paediatric studies for non-topical AD treatment are needed for definitive guidelines.
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Affiliation(s)
- Jin Ho Chong
- Dermatology service, KK Women's and Children's Hospital, Singapore.,Department of General Paediatrics, KK Women's and Children's Hospital, Singapore
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44
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Abstract
A 13-year-old boy underwent allogeneic hematopoietic stem cell transplantation (HSCT) for underlying acute lymphoblastic leukemia and achieved neutrophil engraftment 28 days after HSCT. He developed ichthyosis 6 weeks after HSCT and then keratotic follicular papules, palmoplantar keratoderma, and a seborrheic dermatitis-like eruption 18 weeks after HSCT. From skin biopsies he was diagnosed with eczematoid graft-versus host disease (GVHD), which showed spongiosis with scattered necrotic keratinocytes. He responded to oral and topical steroids and an increase in cyclosporine dose. Although uncommon, eczematoid GVHD must be considered in children who have undergone HSCT and then develop an atypical eczematous eruption, especially in the absence of a history of atopy.
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Affiliation(s)
- Jin Ho Chong
- Dermatology Service, KK Women's and Children's Hospital, Singapore
| | - Khawn Tawng
- Paediatric Haematology / Oncology, KK Women's and Children's Hospital, Singapore
| | - Hui Min Liew
- Dermatology Service, KK Women's and Children's Hospital, Singapore
| | - Shui Yen Soh
- Paediatric Haematology / Oncology, KK Women's and Children's Hospital, Singapore
| | - Ah Moy Tan
- Paediatric Haematology / Oncology, KK Women's and Children's Hospital, Singapore
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45
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Krishnan SG, Sim Tee NW, Tan AL, Tan AM, Aan Koh MJ, Chong CY, Thoon KC, Hui Tan NW. A case of cutaneous penicilliosis in a child with acute myeloid leukaemia. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sandhya G. Krishnan
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, 100 Bukit Timah Road, Singapore 229889
| | - Nancy Wen Sim Tee
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, 100 Bukit Timah Road, Singapore 229889
| | - Ai Ling Tan
- Department of Pathology, Singapore General Hospital, Singapore, Outram Road, Singapore 169608
| | - Ah Moy Tan
- Haematology and Oncology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, 100 Bukit Timah Road, Singapore 229889
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, 100 Bukit Timah Road, Singapore 229889
| | - Chia Yin Chong
- Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, 100 Bukit Timah Road, Singapore 229889
- Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore 169857
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, National University Health System Building (NUH), Singapore 119228
| | - Koh Cheng Thoon
- Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, 100 Bukit Timah Road, Singapore 229889
- Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore 169857
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, National University Health System Building (NUH), Singapore 119228
| | - Natalie Woon Hui Tan
- Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, 100 Bukit Timah Road, Singapore 229889
- Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore 169857
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, National University Health System Building (NUH), Singapore 119228
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46
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Koh WL, Tay YK, Koh MJA. Danazol-induced Stevens-Johnson syndrome in a patient with systemic lupus erythematosus. Dermatol Online J 2015; 21:13030/qt24v513b9. [PMID: 25612133] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 01/15/2015] [Indexed: 06/04/2023] Open
Abstract
A patient with Stevens-Johnson syndrome related to danazol is presented.
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Affiliation(s)
- W L Koh
- Changi General Hospital, Singapore.
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47
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48
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Abstract
Few studies have evaluated Asian children with mycosis fungoides (MF). We report a series of patients from a tertiary dermatologic institution in Singapore. A retrospective review was performed of patients younger than 16 years old diagnosed with MF between 2000 and 2008 at the National Skin Centre, Singapore. Forty-six patients were identified. At initial presentation, a provisional diagnosis of MF was made in 19 patients (41.3%), pityriasis lichenoides chronica (PLC) in 11 (23.9%) and postinflammatory hypopigmentation due to eczema or other causes in 11 (23.9%). After skin biopsy, the hypopigmented variant of MF was diagnosed in 42 patients (91.3%). There was one case each of PLC-like MF, pigmented purpuric dermatosis-like MF, classic MF, and solitary MF. Pityriasis lichenoides coexisted in three cases (6.5%). All except one patient presented with the early patch-plaque stage of disease (stage IA/B). The disease did not progress in any of our patients after a mean follow-up of 71.0 ± 52.5 months. Twenty-seven patients (58.7%) had complete disease clearance after a mean duration of 27.1 ± 28.1 months; 15 (49.7%) of 32 patients who received narrowband ultraviolet B treatment had complete clearance within an average of 8.9 ± 5.3 months, but 7 patients relapsed within 14.9 ± 14.8 months. One patient with solitary MF failed multiple treatment modalities before eventually achieving disease clearance with photodynamic therapy. Hypopigmented MF is the most common MF variant in Asian children. The diagnostic difficulty is in differentiating this from PLC, which may coexist with MF. Long-term prognosis is generally favorable.
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49
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How CH, Quah JHM, Koh MJA. Simply eczema. Singapore Med J 2013; 54:247-9; quiz 250. [PMID: 23716147 DOI: 10.11622/smedj.2013101] [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] [Indexed: 11/18/2022]
Abstract
Atopic eczema is a commonly encountered chronic skin condition in primary care. In this article, we share a holistic, structured approach, which is grounded on the chronic and atopic nature of the condition - planned reviews, patient empowerment, a written action plan for chronic and fare management, and trigger avoidance. Common pitfalls in management are insufficient emphases on scheduled reviews and patient empowerment, as well as neglect in the care of the loss of the epidermal barrier during acute flares.
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Affiliation(s)
- Choon How How
- SingHealth Polyclinics - Sengkang, Sengkang Community Hub, Singapore 545025.
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Chung WL, Ng SS, Koh MJA, Peh LH, Liu TT. A review of patients managed at a combined psychodermatology clinic: a Singapore experience. Singapore Med J 2012; 53:789-793. [PMID: 23268151] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Recognising and appropriately treating psychosomatic factors in dermatological conditions can have a significant positive impact on the outcomes of patients. Treatment of psychodermatological patients requires a multidisciplinary approach that involves dermatologists, psychiatrists and allied health professionals. METHODS This was a retrospective case series of patients seen in our psychodermatology liaison conferences from November 2009 to July 2011. We reviewed all the case notes and analysed data such as age, gender, dermatologic and psychiatric diagnoses, treatment and outcome. RESULTS The majority of patients in our cohort were diagnosed with either a psychophysiologic disorder or a primary psychiatric disorder. The most common diagnosis among patients with primary psychiatric disorder was delusions of parasitosis. Other common primary psychiatric disorders seen were trichotillomania and dermatitis artefacta. About a fifth of our patients had psychiatric disorders resulting from their underlying dermatological conditions. A third of our patients were lost to follow-up. CONCLUSION Managing patients with psychocutaneous disorders can be challenging, with many patients defaulting treatments. Psychodermatology clinics will benefit both patients and their caregivers. A collaborative approach using a consultation-liaison relationship between two medical departments in a friendly environment would result in more effective, integrated and holistic treatment strategies for such patients. Further studies should be conducted to determine how beneficial such services are to patients. With more experience, we hope to improve this service.
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Affiliation(s)
- Wan Ling Chung
- Department of Dermatology, Changi General Hospital,Singapore.
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