Tien Guan Steven Thng

Investigating factors associated with depression of vitiligo patients in Singapore

AIMS To explore the depression level of a group of vitiligo patients in Singapore and to identify factors associated with depression. BACKGROUND Unlike most internal illness, skin disease is often immediately visible to others and therefore people suffers from dermatological conditions may suffer psychological consequences. DESIGN A descriptive survey was conducted during the period October 2009-August 2010 in Singapore; 145 vitiligo patients aged 21+  completed a structured questionnaire. METHODS Three main outcome variables were employed in the study: demographic characteristics, clinical and psychosocial outcomes. RESULTS Among the patients, 17·2% (n = 25) had been identified as depressed. Multiple logistic regression analyses were used to identify a model to predict vitiligo patients who will have depression. The results showed that females (p = 0·05), aged below 50 years old (p = 0·016), having 5+ years of illness (p = 0·021) and with low self-esteem (p = 0·002) and poor quality of life scores (p = 0·004) were significant risk factors for depression. CONCLUSION Providing a suitable health care consultation for vitiligo patients may reduces depressive symptoms and maintaining their psychological health may be crucial for preventing suffering from depressive symptoms. Apart from the findings, these conclusions resonate with recent Singapore guidance on managing depression in vitiligo patients. This stresses the importance of prevention, early detection and stepped care with a multifaceted approach to management. RELEVANCE TO CLINICAL PRACTICE It is important to regularly screen for depressive symptoms among vitiligo patients. Focusing on vitiligo patients with enhancing self-esteem and improving quality of life should help in both the prevention and recognition of onset of depression among vitiligo patients.

Investigating factors associated with quality of life of vitiligo patients in Singapore

Skin disease is often visible to others. People who have dermatological condition may also suffer from its psychological consequences. The purpose of this study is to explore the quality of life of patients with vitiligo and to identify factors associated with their quality of life. A descriptive correlational study was conducted with 222 patients with vitiligo recruited from two skin centres in Singapore from 2009 to 2011. Data were collected by a structured questionnaire. Three outcome variables were measured in the study: predisposal, clinical and psychological outcomes. Results showed that almost two-thirds of the participants reported vitiligo had moderate to extreme impact on their quality of life. Multiple regression analyses showed that patients who were depressed, had thyroid disease and had not used multiclear treatment were more likely to report poor quality of life. It is recommended that providing health care consultation for patients with vitiligo may help reduce depressive symptoms and maintain their psychological health, thus enhance their quality of life.

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.

Hybrid threshold optimization between global image and local regions in image segmentation for melasma severity assessment

Melasma image segmentation plays a fundamental role for computerized melasma severity assessment. A method of hybrid threshold optimization between a given image and its local regions is proposed and used for melasma image segmentation. An analytic optimal hybrid threshold solution is obtained by minimizing the deviation between the given image and its segmented outcome. This optimal hybrid threshold comprises both local and global information around image pixels and is used to develop an optimal hybrid thresholding segmentation method. The developed method is firstly evaluated based on synthetic images and subsequently used for melasma segmentation and severity assessment. Statistical evaluations of experimental results based on real-world melasma images show that the proposed method outperforms other state-of-the-art thresholding segmentation methods for melasma severity assessment.

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.

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 outcomes of vitiligo in Asian children

This retrospective study aimed to identify factors that predict treatment response in a cohort of Asian children with vitiligo. Shorter duration of vitiligo was associated with better repigmentation. Patients with focal vitiligo of short duration have a good chance of achieving repigmentation with topical agents alone.

The Scoring Aid: MASI and Modified MASI

There are currently several ways to quantify severity of melasma in patients. Quantitative methods using the Mexameter and chromameter are useful for point measurements of degree of darkness, but these instrumentations suffer from the inability to quantify the extent of melasma. Scoring aids, like the melasma severity scale (MSS), the melasma area and severity index (MASI) and the modified melasma area and severity index (mMASI), were developed to take into account both the darkness and extent of melasma. While these scoring systems are better measures of melasma severity, they are nevertheless fraught with problems as it requires a doctor to estimate the area and degree of darkness and as such results in intra-observer and inter-observer variability. Without a good, reproducible, standardized way of scoring melasma severity and response to treatment accurately, treatment outcomes cannot be standardized and as such, efficacy of various treatment modalities cannot be compared in meta-analyses. Of late, there are several efforts underway to utilize computer image analysis to accurately score melasma, using the principles of the mMASI. These systems seem to offer much promise in standardizing and accurately scoring melasma, enabling treatment options to be compared.

Diagnosis of Melasma in Brown Skin: Wood’s Lamp, Dermoscopy, and Confocal Microscopy

The diagnosis of melasma is usually made clinically and is rather straightforward due to its characteristic appearance. There are several distinct patterns based upon its distribution which includes centrofacial, malar, and mandibular pattern. Melasma has also been subdivided based on the different depth of melanin pigment into epidermal, dermal, mixed, and indeterminate types. The use of additional tools such as Wood’s lamp, dermoscopy, and reflectance confocal microscopy (RCM) may help to identify the depth of the pigment. These classifications aid in prognosis and predicting the therapeutic outcome. RCM is a new innovative tool which can also help in monitoring response to therapy.

Retrospective study on the characteristics and treatment of late-onset vitiligo

Background: Late-onset vitiligo, defined as being aged 50 years and above at the point of clinical onset, remains poorly characterized till now. Aim: This study aims to describe the clinical characteristics and treatment response of patients with late-onset vitiligo. Methods: We retrospectively reviewed the case records of all patients diagnosed with late-onset vitiligo, from January 1, 2010 to December 31, 2014. Information obtained included patient demographics, characteristics of vitiligo and treatment responses. Results: Of the 3128 patients diagnosed with vitiligo over the 5-year period, 461 (14.7%) had late-onset disease. The study had more females (n = 260, 56.4%) than males, with an average onset age of 59.4 ± 7.4 years. Majority of patients were Chinese (n = 308, 66.8%) and 45 (9.8%) patients had an associated autoimmune disease. Focal vitiligo, defined as the localized presence of depigmented patches, was most common (n = 209, 45.3%). Treatment response was evaluated in 359 patients, of which 216 received monotherapy (topical creams: n = 210, 97.2%; phototherapy: n = 6, 2.8%) and 143 received both modalities. Fifty six (15.6%) patients received oral steroids. Patients who were treated with both topical creams and phototherapy yielded better clinical responses compared to those on monotherapy (P < 0.001) with 56.6% (n = 81) of them achieving good epidermal repigmentation, defined as >50% return of pigmentation compared to baseline (vs. n = 66, 30.6% in the monotherapy group). The choice of phototherapy (targeted, narrowband ultraviolet B or psoralen + ultraviolet A) did not significantly affect clinical response (P = 0.774). Limitations: This study is limited by its retrospective nature, the nonstandardized documentation resulting in the inability to determine disease progression and associated metabolic comorbidities and also by the gradual loss to follow-up of patients. Conclusion: Late-onset vitiligo is not uncommon and tends to be of the focal vitiligo subtype. Nonsegmented vitiligo is more prevalent than segmental vitiligo. Combination therapy with topical medications and phototherapy is superior to monotherapy.