Emily Yiping Gan

Repigmentation in vitiligo: position paper of the Vitiligo Global Issues Consensus Conference

The Vitiligo Global Issues Consensus Conference (VGICC), through an international e‐Delphi consensus, concluded that ‘repigmentation’ and ‘maintenance of gained repigmentation’ are essential core outcome measures in future vitiligo trials. This VGICC position paper addresses these core topics in two sections and includes an atlas depicting vitiligo repigmentation patterns and color match. The first section delineates mechanisms and characteristics of vitiligo repigmentation, and the second section summarizes the outcomes of international meeting discussions and two e‐surveys on vitiligo repigmentation, which had been carried out over 3 yr. Treatment is defined as successful if repigmentation exceeds 80% and at least 80% of the gained repigmentation is maintained for over 6 months. No agreement was found on the best outcome measure for assessing target or global repigmentation, therefore highlighting the limitations of e‐surveys in addressing clinical measurements. Until there is a clear consensus, existing tools should be selected according to the specific needs of each study. A workshop will be conducted to address the remaining issues so as to achieve a consensus.

Clinical repigmentation patterns in paediatric vitiligo.

Repigmentation is an essential outcome measure in vitiligo. However, clinical studies describing vitiligo repigmentation patterns are lacking.

Pilot study of an automated method to determine Melasma Area and Severity Index.

Objective outcome measures for melasma severity are essential for the evaluation of severity as well as results of treatment. The modified Melasma Area and Severity Index (mMASI) score is a validated tool for assessing melasma severity but is often subject to inter‐observer variability.

Lymphomatoid papulosis: is a second lymphoma commoner among East Asians?

Background.  Lymphomatoid papulosis (LyP) is a low‐grade cutaneous lymphoma, which lies within the spectrum of primary cutaneous CD30‐positive lymphoproliferative disorders. Around 10–20% of LyP cases are associated with a second lymphoma.

Repigmentation of leucotrichia in vitiligo with noncultured cellular grafting

Background  Vitiligo in hair‐bearing areas is often associated with leucotrichia. Repigmentation of leucotrichia has been reported mainly with tissue and follicular hair grafts.

Melasma Image Segmentation Using Extreme Learning Machine

This paper introduces an image segmentation method based on the extreme learning machine (ELM) to detect melasma in human face images. In this work, skin texture features are extracted and fed into ELM classifier for segmentation. The results obtained by the proposed method show better segmentation performance visually than that obtained by a conventional threshold based image segmentation method. The proposed method could potentially lead to the development of a more reliable computerized melasma severity assessment system.

Isotretinoin is safe and efficacious in Asians with acne vulgaris

Abstract Background: Oral isotretinoin is effective for acne vulgaris but concerns remain regarding its adverse effects. Objectives: This study aims to evaluate the safety and efficacy of isotretinoin for acne vulgaris in Asian patients. Methods: We conducted a 4-year retrospective study on all patients with acne vulgaris treated with isotretinoin, between January 2005 and December 2008 at the National Skin Centre in Singapore. Medical records were reviewed for information on patient demographics, acne severity, isotretinoin dose, duration, adverse effects and outcome. Results:There were 2,255 patients, with a mean age of 22.5 years, male:female ratio of 2.5:1 and 82.3% being Chinese. The mean starting dose of isotretinoin was 0.4 mg/kg and on average, patients received 7.8 months of treatment at a mean dose of 0.5 mg/kg. Mean total cumulative dose was 95.6 mg/kg. Vast majority (93.9%) achieved complete remission or substantial improvement. Thirty-eight (2.2%) and 24 patients (2.7%) developed elevated serum levels of alanine and aspartate aminotransferases subsequent to treatment. There were 194 (12.1%) and 80 (4.8%) patients who developed hyperlipidaemia and hypertriglyceridaemia respectively. Isotretinoin was generally well-tolerated, with 6.4% (n = 145) discontinuing due to side-effects. Conclusions:This study reaffirms the overall safety and efficacy of oral isotretinoin in Asian patients with acne vulgaris.

Double Blind Placebo Controlled Trial to Evaluate of the Effectiveness of aDietary Supplement Rich in Carotenoids as Adjunct to Topical LighteningCream for the Treatment of Melasma: A Pilot Study

Objectives: To evaluate the efficacy of an oral supplement containing carotenoids as an adjunct to a topical cosmetic lightening cream for the treatment of melasma. Methods: 44 subjects with melasma were recruited into a double-blinded, randomized, placebo controlled trial over 84 days at the Singapore National Skin Centre, to receive either an oral dietary supplement containing carotenoids or a placebo. All were prescribed a commercially available cream. Patients were assessed at onset, day 54 and day 84 by the Modified Melasma area and Severity Index (mMASI), photographic documentation, melanin and erythema indexes using a Mexameter®. Results: 44 patients completed the study. The median mMASI score fell significantly in both groups (both p<0.001). There was a greater decrease seen in those who received the oral supplement group (-2.1 vs -1.8, p <0.379). The erythema score showed significant improvements in both groups, with greater improvement in the group on the oral supplement, compared to placebo (median difference = -30, p =0.018, vs median difference = -20, p =0.020). Conclusion: Oral supplements containing carotenoids are potential adjuncts in melasma treatment. 1.5 Limitations: Small sample size and short study duration limit the observations noted in this study. Further larger-scale studies are required.

A retrospective review of cutaneous metastases at the National Skin Centre Singapore

Cutaneous metastases occur in up to 10% of all visceral malignancies. This study aims to determine the clinico‐epidemiological characteristics of patients diagnosed with cutaneous metastases at a leading Asian tertiary dermatological centre.

Reaction-diffusion based level set method with local entropy thresholding for melasma image segmentation

This paper proposes a new method for melasma pigmentary area segmentation utilizing re action-diffusion based level set model (RDLSM) together with local entropy thresholding. In the adopted level set model, a diffusion term is used to regularize the level set function while a reaction term with anticipated sign property is used to force the zero level set towards desired locations. Then local entropy thresholding is applied to address the over-segmentation issue of RDLSM and to extract desired boundaries with higher overall local entropy. As a result, the melasma pigmentary areas and the normal skin areas can be better identified. Experimental results show that the proposed method performs well for melasma image segmentation, especially for cases with severe non-uniform illumination distribution.