Yung-Hian Leow

Malignancy in adult dermatomyositis

Background Dermatomyositis has been reported to be associated with malignancies in 15%–34% of patients in Western countries, but in as many as two‐thirds of patients in Singapore. The aim of this study was to determine whether a diagnostic measure could be helpful in the diagnosis of a malignancy in patients with dermatomyositis.

Adverse skin reactions to personal protective equipment against severe acute respiratory syndrome – a descriptive study in Singapore

Severe acute respiratory syndrome (SARS) was first recognized in February 2003. It is the first severe and readily transmissible new disease to emerge in the 21st century. Healthcare workers in affected countries were exposed to the regular use of personal protective equipment (PPE) such as the N95 mask, gloves, and gowns. Our aim was to study the prevalence of adverse skin reactions to PPE among healthcare workers in Singapore during the SARS outbreak. Healthcare staff in the National Skin Centre and Tan Tock Seng Hospital were surveyed using questionnaires. Of those asked to participate, 322 (94.7%) agreed. 14.3% of the respondents were doctors, 73.0% nurses, and 12.7% other ancillary staff. Mean age of respondents was 32.4 years, with the majority being women (85.7%) and Chinese (53.7%). 109 (35.5%) of the 307 staff who used masks regularly reported acne (59.6%), facial itch (51.4%), and rash (35.8%) from N95 mask use. 64 (21.4%) of the 299 who used gloves regularly reported dry skin (73.4%), itch (56.3%), and rash (37.5%). The use of PPE is associated with high rates of adverse skin reactions. There is a need to find suitable alternatives for affected staff and to encourage awareness among staff of the role of dermatologists in their care.

Correlation between laser Doppler perfusion imaging and visual scoring of patch test sites in subjects with experimentally induced allergic and irritant contact reactions

Purpose: To compare laser Doppler perfusion imaging (LDPI) measurements in experimentally induced allergic contact reactions and irritant contact reactions. The degree of correlation between visual scores and LDPI measurements was also studied.

Effect of occlusion on skin

Skin occlusion is a complex event which causes profound changes in the hydration status, epidermal lipids, DNA synthesis, microbioal flora and molecular and cellular processes. This article reviews the above dynamic changes on the skin.

Contact allergic potential of topical traditional Chinese medicaments in Singapore

Background: Western-based medication forms the basis of the health care system in Singapore. However, because Singapore is part of East Asia, there is still a high prevalence of use of topical traditional Chinese medicaments by the general population. Objective: This study was designed to determine the 10 most commonly used topical traditional Chinese medicaments by patients who were attending the Contact & Occupational Dermatoses Clinic. The final aim of the study was to put together a panel at the correct eliciting concentration for patch testing. Methods: Patients were interviewed and asked to identify the products that they had previously used from a panel of 74 medicaments. The 10 most commonly used topical traditional Chinese medicaments were then identified. Patients were then patch tested to these 10 preparations at concentrations varying from 1%, 5%, 10%, 20%, and 50% in each respective vehicle and as is. Results: No contact reaction was detected with five medicaments, but allergic contact reactions were detected with the other five preparations. These patients also had positive reactions to fragrance mix and/or balsam of Peru. Conclusions: Development of special panels for unique contact allergens in different regions with different social and cultural backgrounds is essential. Patients with positive reactions to balsam of Peru and fragrance mix should be advised against excessive use of topical traditional Chinese medicaments.

A preliminary study of gold sensitization in Singapore

Recent studies of sensitization to gold sodium thiosulfate seem to suggest a higher frequency of contact allergy to gold than previously thought (1–5). Gold sodium thiosulfate (GST) 0.5% pet. has therefore been added to the patch test standard series at the National Skin Centre, Singapore, since October 1996. 345 patients were patch tested to GST over the 6-month period October 1996 to March 1997. All patients, except one, were females. Their mean age was 38 years (range: 17–63). 6.4% (22) reacted positively to GST. However, only 3 female patients (0.86%) had reactions that were clinically relevant. All 3 patients had a current history of rash from gold jewellery. 2 of the 3 patients were also allergic to nickel and the other had a positive reaction to cobalt. Ornamental gold jewellery, such as rings and earrings (6), and gold-containing dental appliances, such as crowns (7–10), account for most cases of contact allergy to gold. Gold sodium thiosulfate 0.5% pet. has generally been regarded as the best screening test (11), though Bruze et al. (12) found that patch test reading should be done after 1–3 weeks, so as not to miss positive reactions. With the addition of GST 0.5% pet. to our standard series, we found a high sensitization rate of 6.4% to gold, but only 3 out of 22 patients with positive reactions had clinically relevant reactions, all of which could be traced to gold jewellery. We are not yet able to comment on the possible relevance of dental gold in our patients, but plan further study of this. References

Adjunctive usage of a non-comedogenic moisturizer with adapalene gel 0.1% improves local tolerance: a randomized, investigator-blinded, split-face study in healthy Asian subjects

Abstract Background: Adapalene gel 0.1% is an efficacious treatment for acne vulgaris in Asians. It is generally well tolerated, but may still cause cutaneous side effects among patients with sensitive skin. Objective: To assess the ability of a moisturizing lotion (Cetaphil®) in improving the local tolerance of adapalene. Methods: In this 4-week, randomized, investigator-blinded, split-face study among 30 healthy volunteers of Chinese origin, adapalene gel was applied once daily to the whole face and the moisturizing lotion was applied once daily to only one side of the face according to the randomization scheme. Results: At each study visit, both investigators and subjects reported better tolerance on the side of moisturizing lotion + adapalene gel than the side of adapalene gel only, with significant differences reported by the subjects during the first 2 weeks (p = 0.039 and 0.013, respectively). Global worst score, defined as the average of worst scores for erythema, desquamation, dryness, stinging/burning and pruritus, was significantly lower for the side of moisturizing lotion + adapalene gel than for the side of adapalene gel alone (0.43 ± 0.34 vs. 0.59 ± 0.44, p = 0.032). Conclusion: The adjunctive usage of an effective moisturizer improves local tolerance of adapalene gel and may contribute to better adherence.

Allergic contact dermatitis to epoxy resin in a hemodialysis cannula

A patient with chronic renal failure on hemodialysis presented with dermatitis, particularly over the arteriovenous fistulae sites on the forearm. Patch testing revealed a positive reaction to epoxy resin present in the glue that fixed the needle of the hemodialysis cannula.

Contact allergy trends in Singapore – a retrospective study of patch test data from 2009 to 2013

We retrospectively analysed patch test results of the National Skin Centre, Singapore, between 1 January 2009 and 31 December 2013. We included all patients with suspected allergic contact dermatitis who were tested with a modified European baseline series. Patch testing was performed by the use of Finn Chambers® on Scanpor® tape, with allergens from Chemotechnique Diagnostics (Vellinge, Sweden), and exposure on the back for 48 h. Reading of the tests was performed on day (D) 3 and D7, according to the recommendations of the ICDRG (1).

Acrylate-induced hand dermatitis in the manufacture of contact lenses

After 9 months of work in a factory manufacturing disposable contact lenses, a 36-year-old Chinese man presented with a 4-month history of a work-related, recurrent, bilateral dermatitis affecting the tips of his fingers and thumbs. Clinical examination showed scaly, eczematous plaques limited to the left thumb, index, and middle fingertips as well as the right index and middle finger tips. Personal protective equipment included safety boots, latex gloves, and goggles. The patient was patch tested with National Skin Centre baseline and acrylate series (Chemotechnique® Diagnostics, Sweden) with Finn® chambers on Scanpor® tape as well as to the constituent monomers of the contact lenses (in 1% and 2% pet.) and his own gloves. After 2D application, readings were taken on D3 and D7 using International Contact Dermatitis Research Group criteria (1). Details of the patch test results are shown in Table 1. Table 1. Acrylate and glove patch test results