Sze Hon Chua

Mortality of bullous pemphigoid in Singapore: risk factors and causes of death in 359 patients seen at the National Skin Centre.

Bullous pemphigoid (BP) is the most common autoimmune‐mediated subepidermal blistering skin disease and is associated with significant morbidity and mortality.

Eosinophilic pustular folliculitis (Ofuji's disease) in Singapore: A review of 23 adult cases

The case records of 23 patients with classic eosinophilic pustular folliculitis (EPF), or Ofujis disease, seen at the National Skin Centre in Singapore, from 1990 to 2001 were reviewed. All patients had clinical and histopathological findings consistent with EPF. There were eight men and 15 women (ratio 1:1.6). The mean age at presentation was 35 years. There was a marked predilection for Chinese patients (87%), with a racial distribution of 20:2:1 of Chinese, Malay and Indian patients, respectively. The most frequent site of occurrence was the face, particularly over both cheeks. The majority of patients (90%) treated with oral indomethacin had a good response within 2–4 weeks. Relapses were frequent in 82.6% of patients and maintenance with indomethacin or ketoprofen was beneficial. Eosinophilic pustular folliculitis is a rare but important disease entity presenting with recurrent indurated erythematous papulopustules and plaques on the face. Increased awareness of this condition is important as it can mimic many other conditions presenting as red plaques on the face.

Prevention of Glucocorticoid-Induced Osteoporosis in Immunobullous Diseases With Alendronate A Randomized, Double-blind, Placebo-Controlled Study

OBJECTIVE To evaluate the efficacy and safety of oral alendronate sodium therapy once daily in preventing glucocorticoid-induced bone loss in patients with immunobullous skin diseases treated with long-term glucocorticoid therapy. DESIGN A 12-month randomized, double-blind, placebo-controlled trial. SETTING A tertiary referral dermatology center in Singapore. PARTICIPANTS Patients newly diagnosed as having an immunobullous disease and deemed to require at least 6 months of systemic glucocorticoid therapy. INTERVENTIONS The patients were randomized to receive either oral alendronate sodium (10 mg/d) or a matching placebo for 12 months. All patients also received concurrent calcium with vitamin D, 2 tablets daily. MAIN OUTCOME MEASURES Percent change in bone mineral density (BMD) at the lumbar spine and the femoral neck at 12 months. RESULTS A total of 29 patients (alendronate [n = 15], placebo [n = 14]) were evaluated. The percent change in BMD in the alendronate group was +3.7% and +3.5% at the lumbar spine and the femoral neck, respectively, whereas in the placebo group, it was -1.4% and -0.7% at the lumbar spine and the femoral neck, respectively. The increase in BMD observed in the alendronate group compared with the placebo group was statistically significant at both the lumbar spine (P = .01) and the femoral neck (P = .01). There was also a statistically significant decrease in serum heat-labile alkaline phosphatase levels after 12 months (-32.6%, P < .01) in the alendronate group but not in the placebo group. Adverse events were generally minor, and the frequency of occurrence did not differ significantly between both treatment groups (P = .59). CONCLUSIONS There were statistically significant increases in BMD at both the lumbar spine (P = .01) and the femoral neck (P = .01) with alendronate therapy. It is imperative to use bisphophonate therapy in patients with immunobullous disorders who are receiving oral corticosteroids because it largely prevents the morbidity associated with low BMD.

Oral tranexamic acid lightens refractory melasma.

Melasma is a common acquired hyperpigmentary disorder, particularly among Asians and Hispanics, but its exact pathomechanism is poorly understood. Tranexamic acid has been found to lighten melasma by interfering with the interaction of melanocytes and keratinocytes by inhibiting the plasminogen/plasmin system. The aim was to evaluate the therapeutic effects of oral tranexamic acid in the treatment of melasma refractory to topical skin‐lightening agents.

Reflectance confocal microscopy is a useful non-invasive tool in the in vivo diagnosis of pigmented basal cell carcinoma in Asians

The clinical differentiation between pigmented basal cell carcinoma (BCC) and other benign pigmented skin lesions can be challenging even with an additional dermoscopic evaluation, especially if the lesion is small. In vivo reflectance confocal microscopy (RCM) is an emerging, non‐invasive imaging tool that allows near‐microscopic evaluation of skin lesions. The features of RCM for pigmented BCC and seborrhoeic keratosis have previously been described. However, the use of RCM to differentiate between these clinically and dermoscopically challenging pigmented skin lesions among Asians has not yet been demonstrated.

Treatment of xanthelasma palpebrarum with a 1064-nm, Q-switched Nd:YAG laser

Background: Xanthelasma palpebrarum is the most common cutaneous xanthoma characterized by soft, yellow papules or plaques that arise on the periorbital skin. As these lesions can be cosmetically disfiguring, many patients seek medical help to remove these lesions. Objective: To determine the effectiveness and minimum number of treatment sessions with a 1064‐nm, Q‐switched neodymium‐doped yttrium aluminum garnet (Nd:YAG) laser for the treatment of xanthelasma. Methods: A retrospective review of patients with xanthelasma consecutively treated with Q‐switched Nd:YAG laser was conducted. Forty‐six patients with 103 lesions were identified from January 2012 through August 2015. Photographs taken of patients immediately before treatment and 4‐8 weeks after treatment were independently evaluated by 2 dermatologists. Results: After a single treatment session, 93.2% of lesions had some degree of clearance. All lesions had excellent‐to‐complete clearance after at least 4 treatment sessions. Patients usually required 4 treatment sessions for optimal results. Limitations: This was a retrospective study. Treatment parameters varied, follow‐up periods were not uniform, and response was not assessed with a validated scale. Conclusion: The Q‐switched Nd:YAG laser is effective and well tolerated in the treatment of xanthelasma in our study population.

A case series of imatinib-induced generalized hypopigmentation and progression of existing acquired dermal melanocytosis

Abstract Imatinib mesylate is a tyrosine kinase inhibitor used in the treatment of oncological conditions, including chronic myeloid leukemia and gastrointestinal stromal tumors. The most frequent dermatological side effect reported is pigmentary abnormalities. We report a case series of three Asian Chinese females with preexisting acquired dermal melanocytosis that progressed after initiation of imatinib treatment, and concurrently developed generalized hypopigmentation of the skin. All three patients had similar histological findings on skin biopsy. It is postulated that the KIT/SCF pathway has a central role in the pathogenetic mechanism. Therefore, it is important for physicians to be aware of this potential side effect of paradoxical pigmentation in patients treated with imatinib.

A retrospective review of the therapeutic response with remission in patients with newly diagnosed bullous pemphigoid

We reviewed the clinical characteristics and therapeutic response in cases of newly diagnosed bullous pemphigoid at the National Skin Centre between June 2009 and December 2010. Most (76%, n = 68/90) achieved clinical remission within 6 months of commencement of therapy. Oral mucosal involvement was identified as a risk factor associated with a prolonged duration of treatment beyond 6 months.