Antonio Chuh

Does age or gender influence quality of life in children with atopic dermatitis

Background.  Quality of life (QoL) is impaired in children with atopic dermatitis (AD) but the various aspects of QoL may not be equally affected.

Atypical presentations of pityriasis rosea: case presentations

Atypical cases of pityriasis rosea (PR) are fairly common and less readily recognized than typical eruptions. We present four patients for whom we believe atypical PR is the most likely diagnosis. A 33‐year‐old man had purpuric lesions bilaterally on the legs with classical rash on the trunk. A 28‐year‐old woman had intensely pruritic and urticarial lesions. A 10‐year‐old girl had hundreds of small papular lesions 1–3 mm in size. A pregnant woman aged 26 had oral haemorrhagic ulcers with classical PR eruption on her trunk. The oral ulcers erupted and remitted at the same time as the generalized eruption. We reviewed the literature and proposed a classification based on rash morphology, rash size, rash distribution, number of lesions, site of lesions, severity of symptoms and course of the eruption. We believe that it is difficult to make a clear division to define typical and atypical PR, and that it is important not to ascribe any unusual or atypical skin eruption with PR unless other dermatoses have been excluded.

Acne prevalence and beyond: acne disability and its predictive factors among Chinese late adolescents in Hong Kong

Background.  Data are lacking on the prevalence of acne, its effects on quality of life (QOL) and the treatment usage among Chinese patients in late adolescence.

Pityriasis rosea--an update.

Recent controversies on the etiology, diagnosis and treatment have led to increased interest in pityriasis rosea (PR). We review these aspects of the disease. PR is universal. The incidence is around 0.68 per 100 dermatological patients, or 172.2 per 100,000 person-years. The prevalence in people aged between 10 and 29 years is 0.6%. The male to female ratio is around 1:1.43. Evidence on seasonal variation is conflicting, but there is no evidence that the incidence is dependent on mean air temperature, mean total rainfall, or mean relative humidity. Spatial-temporal and temporal clustering of cases of PR has been reported. The association of PR with human herpesvirus-7 infection is still controversial. Owing to the extreme high sensitivities of sequence-based detection methods such as polymerase chain reaction, novel criteria should be applied to evaluate the evidence. There is no evidence that PR is associated with other viral or bacterial infections. The role of autoimmunity in PR warrants further investigations. Many patients with PR have one or more atypical features. Application of validated diagnostic criteria may be helpful for atypical cases. The efficacy of macrolides, including erythromycin, in PR is still under evaluation. There is no evidence that antiviral agents are effective. The efficacies of ultraviolet radiotherapy and systemic corticosteroids are not well established. In managing a patient with PR, we should concentrate more on how the eruption is affecting the quality of life, i.e. the illness, rather than the extent and severity of the eruption, i.e. the disease.

The association of smoking and acne in men in Hong Kong and in India: A retrospective case-control study in primary care settings

Previous studies on the association of smoking with acne vulgaris have reported conflicting results. The objective of this study was to investigate such an association. Our setting was three primary care practices in Hong Kong and one primary care practice in India. Patient characteristics in all four practices are similar. All medical records in these practices incorporate a section in which the smoking habits of each patient is routinely documented. We searched our database and retrieved 632 records of patients with acne seen in the previous 5 years. We also retrieved 632 records of age‐ and sex‐matched controls. Fifty‐three out of 379 male patients with acne and 25 out of 379 male controls were smokers (P = 0.001; OR, 2.3; 95% CI, 1.4–3.8). Six out of 253 female patients with acne and three out of 253 female controls were smokers (OR, 2.0; 95% CI, 0.5–9.4). We conclude that smoking is likely to bear a positive correlation with acne for men. Our numbers are too small for a definite conclusion to be drawn for females.

The detection of human herpesvirus-8 DNA in plasma and peripheral blood mononuclear cells in adult patients with pityriasis rosea by polymerase chain reaction

Background  Herpesvirus‐like particles have been reported to be detectable by electron microscopy in lesional biopsy of patients with pityriasis rosea (PR). We report a study investigating the association of PR with human herpesvirus‐8 (HHV‐8) infection.

The Diagnostic Criteria of Gianotti-Crosti Syndrome: Are They Applicable to Children in India?

Abstract:  In order to evaluate the applicability of the diagnostic criteria to children with Gianotti‐Crosti syndrome (GCS) in India we retrieved all clinical records of children with a definite diagnosis of this syndrome seen over 30 months in a private dermatology practice. The controls were children for whom Gianotti‐Crosti had been suspected but the final diagnosis was not this syndrome, and children in whom it was not suspected but who were diagnosed with any of the differential diagnoses of the syndrome. We documented the presence or absence of the positive and negative clinical features for all patients and controls. The clinical records of 23 children with GCS and 74 controls were retrieved. The three positive clinical features – 1) papules or papulovesicles 1–10 mm in diameter on at least three of the following four sites: cheeks, buttocks, extensor surfaces of the forearms, extensor surfaces of legs; 2) being symmetrical; 3) lasting for at least 10 days – were sensitive and positively correlated with GCS. Both negative clinical features – extensive truncal lesions and scaly lesions – are negatively correlated with this syndrome. All 23 children with GCS and none of the controls fulfilled the set of diagnostic criteria. We concluded that the Gianotti‐Crosti diagnostic criteria are applicable to affected children in India.

Diagnosis of Pediculosis pubis: a novel application of digital epiluminescence dermatoscopy

© 2007 The Authors 837 JEADV 2007, 21, 822–849 Journal compilation

Gianotti-Crosti syndrome, pityriasis rosea, asymmetrical periflexural exanthem, unilateral mediothoracic exanthem, eruptive pseudoangiomatosis, and papular-purpuric gloves and socks syndrome: a brief review and arguments for diagnostic criteria

Several exanthems including Gianotti-Crosti syndrome, pityriasis rosea, asymmetrical periflexural exanthem, eruptive pseudoangiomatosis, and papular-purpuric gloves and socks syndrome are suspected to be caused by viruses. These viruses are potentially dangerous. Gianotti-Crosti syndrome is related to hepatitis B virus infection which is the commonest cause of hepatocellular carcinoma, and Epstein-Barr virus infection which is related to nasopharyngeal carcinoma. Pityriasis rosea has been suspected to be related to human herpesvirus 7 and 8 infections, with the significance of the former still largely unknown, and the latter being a known cause of Kaposis sarcoma. Papular-purpuric gloves and socks syndrome is significantly associated with human B19 erythrovirus infection which can lead to aplastic anemia in individuals with congenital hemoglobinopathies, and when transmitted to pregnant women, can cause spontaneous abortions and congenital anomalies. With viral DNA sequence detection technologies, false positive results are common. We can no longer apply Kochs postulates to establish cause-effect relationships. Biological properties of some viruses including lifelong latent infection, asymptomatic shedding, and endogenous reactivation render virological results on various body tissues difficult to interpret. We might not be able to confirm or refute viral causes for these rashes in the near future. Owing to the relatively small number of patients, virological and epidemiology studies, and treatment trials usually recruit few study and control subjects. This leads to low statistical powers and thus results have little clinical significance. Moreover, studies with few patients are less likely to be accepted by mainstream dermatology journals, leading to publication bias. Aggregation of data by meta-analyses on many studies each with a small number of patients can theoretically elevate the power of the results. Techniques are also in place to compensate for publication bias. However, these are not currently feasible owing to different inclusion and exclusion criteria in clinical studies and treatment trials. The diagnoses of these rashes are based on clinical assessment. Investigations only serve to exclude important differential diagnoses. A wide spectrum of clinical features is seen, and clinical features can vary across different populations. The terminologies used to define these rashes are confusing, and even more so are the atypical forms and variants. Previously reported virological and epidemiological results for these rashes are conflicting in many aspects. The cause of such incongruence is unknown, but low homogeneity during diagnosis and subject recruitment might be one of the factors leading to these incongruent results. The establishment and proper validation of diagnostic criteria will facilitate clinical diagnosis, hasten recruitment into clinical studies, and allow results of different studies to be directly compared with each another. Meta-analyses and systematic reviews would be more valid. Diagnostic criteria also streamline clinical audits and surveillance of these diseases from community perspectives. However, over-dependence on diagnostic criteria in the face of conflicting clinical features is a potential pitfall. Clinical acumen and the experience of the clinicians cannot be replaced by diagnostic criteria. Diagnostic criteria should be validated and re-validated in response to the ever-changing manifestations of these intriguing rashes. We advocate the establishment and validation of diagnostic criteria of these rashes. We also encourage the ongoing conduction of studies with a small number of patients. However, for a wider purpose, these studies should recruit homogenous patient groups with a view towards future data aggregation.

An investigation of the association between diet and occurrence of acne: a rational approach from a traditional Chinese medicine perspective

Background.  The association between diet and acne vulgaris has long been suggested but remains unproven in western medicine. In contrast, the diet–acne relationship is considered important in traditional Chinese medicine (TCM).