C. L. Goh

The prevalence and clinical characteristics of pruritus among patients with extensive psoriasis

Background Many patients with psoriasis are known to suffer from itch. However, the data available regarding itch and its characteristics in psoriasis are sparse. Objectives To examine the prevalence of pruritus and various related clinical characteristics in 101 patients with extensive psoriasis. Methods A structured questionnaire was used. Results Generalized pruritus was a feature of psoriasis in 84% of the patients. In 77% of these it appeared on a daily basis. It involved all areas of the body, had prolonged duration and appeared mainly in the evening and at night. The pruritus significantly affected quality of life. Important daily factors that were found to exacerbate the itch were ambient heat (81%), skin dryness (80%), sweating (65%) and stress (55%). Important factors that were found to ameliorate itch were sleep (57%) and cold showers (55%). The pruritus was found to be unresponsive to most available antipruritics, including phototherapy. Itch intensity as reflected by a visual analogue scale did not correlate with Psoriasis Area and Severity Index scores; however, a highly significant correlation was obtained between the affective descriptors and itch intensity in the worst itch states (r = 0·6, P < 0·001). Conclusions Pruritus is a common feature of psoriasis and affects quality of life.

The prevalence and descriptive epidemiology of atopic dermatitis in Singapore school children

Summary Background  Atopic dermatitis is a common disease that appears to be increasing in frequency during recent decades. Most of the studies are based on the Western population, and there are few data in the Asian population.

Basal cell carcinoma, squamous cell carcinoma and melanoma of the skin: analysis of the Singapore Cancer Registry data 1968–97

Summary Background There has been an alarming recent increase in skin cancer incidence among fair‐skinned populations. Information from Asian populations is less readily available.

Clinical characteristics of pruritus in chronic idiopathic urticaria

Summary Background Although pruritus is a predominant symptom of chronic idiopathic urticaria (CIU) its clinical characteristics have not been explored.

Efficacies of a barrier cream and an afterwork emollient cream against cutting fluid dermatitis in metalworkers: a prospective study

We compared the point prevalence of cutting fluid dermatitis and transepidermal water vapour loss (TEWL) changes in groups of new machinists who (a) used a barrier cream; (b) used an afterwork emollient cream; and (c) did not use any cream (controls) over a 6‐month period. All machinists handled cutting fluid (neat mineral oil) during their work. There was no significant difference in the prevalence of cutting fluid dermatitis in the 3 groups throughout the study period. The prevalence of cutting fluid dermatitis in all groups increased rapidly during the first 6 weeks and thereafter remained steady throughout the remainder of the study period. The prevalence of cutting fluid dermatitis was slightly lower in machinists using afterwork emollient cream compared to those using barrier cream and controls (not significant). The differences in the mean TEWL changes during the study period among the 3 groups were also not statistically significant. The mean TEWL values in the 3 groups increased rapidly during the first 6 weeks of exposure to cutting fluids and thereafter remained fairly constant throughout the remainder of the study period. Barrier cream and afterwork emollient cream did not appear to have any significant effect against either cutting fluid dermatitis or TEWL changes in machinists exposed to cutting fluid. However, afterwork emollient cream appeared clinically to help reduce the prevalence of cutting fluid irritation.

Factors influencing pain outcome in herpes zoster: an observational study with valaciclovir

Aim of the study An observational study with valaciclovir was conducted to assess clinical outcome in herpes zoster, especially pain and associated neurological signs and symptoms in relation to a series of demographic and disease characteristics discernible at presentation. The safety and acceptability of valaciclovir for treatment of zoster was assessed in a wide variety of primary care and clinic referral settings.

A comparison of the combined effect of cryotherapy and corticosteroid injections versus corticosteroids and cryotherapy alone on keloids: a controlled study

BACKGROUND: Treatment modalities for keloids, which are commonly found in Asians, include intralesional corticosteroid injections and cryotherapy as well as a combination of these two modalities. Few studies have been performed in a controlled fashion to evaluate the efficacy of these treatments. OBJECTIVE: A controlled study, to evaluate the combined effect of intralesional corticosteroid injection with cryotherapy vs. intralesional corticosteroid or cryotherapy alone. METHODS: Ten patients completed the study: eight patients had at least three keloids and two had two keloids. Patients were treated for at least three sessions 4 weeks apart. The outcome of the lesions was compared between the treatments regarding the thickness of the lesion using a caliper and phoKeywords: tographic assessment, and the presence of itch and pain before and after treatment using a visual analogue scale. RESULTS: In terms of thickness, the keloids responded significantly better to combined cryotherapy and triamcinolone vs. triamcinolone alone or cryotherapy alone ( P < 0.001). Pain intensity was significantly lowered with all treatment modalities; however, itch was lowered only with the combined treatment and intralesional corticosteroid alone. No significant side effects were noted with any of the treatments and no re-occurrence of keloids was noted with the combined therapy. CONCLUSION: Combined injection of intralesional steroids with cryotherapy appears to be superior to other current modalities.BACKGROUND Treatment modalities for keloids, which are commonly found in Asians, include intralesional corticosteroid injections and cryotherapy as well as a combination of these two modalities. Few studies have been performed in a controlled fashion to evaluate the efficacy of these treatments. OBJECTIVE A controlled study, to evaluate the combined effect of intralesional corticosteroid injection with cryotherapy vs. intralesional corticosteroid or cryotherapy alone. METHODS Ten patients completed the study: eight patients had at least three keloids and two had two keloids. Patients were treated for at least three sessions 4 weeks apart. The outcome of the lesions was compared between the treatments regarding the thickness of the lesion using a caliper and photographic assessment, and the presence of itch and pain before and after treatment using a visual analogue scale. RESULTS In terms of thickness, the keloids responded significantly better to combined cryotherapy and triamcinolone vs. triamcinolone alone or cryotherapy alone (P < 0.001). Pain intensity was significantly lowered with all treatment modalities; however, itch was lowered only with the combined treatment and intralesional corticosteroid alone. No significant side effects were noted with any of the treatments and no re-occurrence of keloids was noted with the combined therapy. CONCLUSION Combined injection of intralesional steroids with cryotherapy appears to be superior to other current modalities.

Contact sensitivity to topical antimicrobials. (II). Sensitizing potentials of some topical antimicrobials.

A predictive study comparing the sensitizing potentials of some topical antimicrobials, using a modified Beuhlers technique, showed that over‐the‐counter (OTC) antimicrobials were more sensitizing than prescribed topical antibiotics, Among OTC antimicrobials, proflavine was the most potent sensitizer (4/10 guinea pigs); parachlorometaxylenol, benzalkonium chloride and propamidine isethionate moderate sensitizers (2/10 guinea pigs); iodine a weak sensitizer (1/10 guinea pigs); and chlorhexidine and cetrimide very weak sensitizer (0/10) guinea pigs). Among prescribed topical antibiotics, ncomycin was a moderate sensitizer (2/10 guinea pigs); gentamycin and chloramphenicol weak sensitizers (1/10 guinea pigs); kanamycin, clioqunol, polymyxin B, bacitracin, tetracycline, sodium fusidate and fusidic acid very weak sensitizers (0/10 guinea pigs), There was good correlation between sensitizing potentials in animal studies and clinical experience of contact allergy to these topical antimicrobials.

Changing trends in the epidemiology of contact dermatitis in Singapore

All patients seen in the Contact Dermatitis Clinic of the National Skin Centre, Singapore (and the former Middle Road Hospital) between January 1986 and December 1990 were analysed retrospectively. 5557 patients comprising 2934 (47.4%) males and 2923 (52.6%) females were patch tested, 3154 (56.8%) patients had 1 or more positive reactions. The majority of the patients wore Chinese (78.0%), followed by Malays (11.5%), Indians (8.1%) and other minority races (2.4%). The majority of positive reactions belonged to the 21.40 age group. The incidence of Positivity decreased after 61) years. The commonest allergens responsible were nickel (17.7%), fragrance (13.3%); neomycin (6.9%), colophony (6.6%)and proflavine (6.5%). Both neomycin mid proflavine were commonly used as over‐the‐counter medicaments. Compared loan earlier report in 1988, there were differences in the incidence of contact sensitivity to some allergens. Potassium dichromate. which used to be a common allergen, was less common. Some allergens (carba‐mix, naphthyl‐mix, caine‐mix and PCMX) have been removed from our standard series as they were uncommon causes of contact allergy. Thimerosal and Amerchol L‐101 were added in their place.

Comparative study of TRUE test and finn chamber patch test techniques in Singapore

This is a report on a comparative study of the reactivity of TRUE test and Finn Chamber patch test techniques. 413 patients attending a contact dermatitis clinic in Singapore were simultaneously patch tested with panels 1 and 2 of the TRUE test standard series and with corresponding allergens (Hermal. Hamburg) using Finn Chambers. The left/right application of the TRUE test and Finn Chambers was randomized. The concordance of positive patch test reactions to the 2 test techniques was studied The number of patient with positive ructions was 38% and 42% for TRUE Test and Finn Chamber techniques, respectively (n.s.). The overall concordance of positive patch test reactions was 64%, (209/328) 13% (42/128) of positive reactions appeared on TRUE Test only and 24% (77% 328) on Finn Chamber only. When only relevant positive reactions were considered, the concordance fate was 67%; 11 6% Of positive reactions appeared on TRUE Test only and 21% on Finn Chamber only. Positive reactions to p‐phenylenediamine (PPD) and neomycin were more frequent with the Finn Chamber technique than with TRUE Test, i e., false negative reactions to PPD and neomyein were more likely to occur with TRUE Test. It appeared that the TRUE Test and Finn Chamber techniques were comparable when used for patch testing However false negative and false positive patch test reactions can occur when using either technique.