Clinical characteristics of Thai patients with psoriasis.

OBJECTIVE: To reveal the clinical manifestations, aggravating factors, factor associated with severity, and treatment of psoriasis in Thai patients. MATERIAL AND METHOD: The data of psoriasis patients who had been visited Dermatologic outpatient clinic, Siriraj Hospital between July 2002 and July 2008 were retrospectively reviewed. RESULTS: One thousand eighty two patients were studied. The male to female ratio was 1.2:1 and the peak age of onset was in the 40 to 49 year-old age group. The most common aggravating factor was stress (50%), followed by trauma (39%) and weather condition (35%). The majority of patients had plaque type (72.8%). Male gender, smoking, alcohol intake, and nail abnormalities were related to severe psoriasis (PASI > 10). CONCLUSION: The present study demonstrated the demographic data of Thai psoriasis patients in a large number of population. These data would be beneficial for national public health development of Thailand in order to provide the better care for Thai psoriasis patients.

Prevalence and clinical features of Thai patients with bullous pemphigoid.

BACKGROUND: Bullous pemphigoid (BP) is a rare, subepidermal autoimmune blistering disease. Studies from different regions show discrepancies in clinical features and courses. OBJECTIVES: To reveal clinical characteristics, investigations and clinical outcomes of Thai patients with BP and to evaluate the association of BP with malignancy, diabetes mellitus and neurologic diseases. METHODS: Patients diagnosed as BP who had visited the autoimmune skin clinic at Siriraj Hospital between 1991 and 2009 were retrospectively studied. RESULTS: Fifty-eight patients were enrolled. Mean age of onset was 69.3 years. The female to male ratio was 2.7:1. Fifteen percent of the patients had mucosal involvement and 38.9% showed peripheral blood eosinophilia. The sensitivity of the direct and indirect immunofluorescence test in the diagnosis of BP was 95.7% and 73.5%, respectively. The frequency of diabetes mellitus in BP patients was significantly higher than that in the general population (p < 0.001). BP patients had a significantly higher chance of having neurologic diseases compared with other autoimmune vesiculobullous disease patients (adjusted odd ratios 4, 95% confidence interval 1.2-13.3). Disease control was achieved in 89.7% of the patients. One-year and three-year 6.4% remission rate was and 66.3%, respectively. CONCLUSIONS: BP usually occurred in the seventh and eighth decade of life and affected females more than males. BP is associated with diabetes mellitus and neurologic diseases. Corticosteroids are the mainstay of the treatment. Two-thirds of patients are likely to be in remission within three years.

Clinical features and course of pemphigus in Thai patients.

BACKGROUND: Pemphigus is a rare, organ-specific autoimmune disease. The epidemiology and clinical course vary between reports from different countries. OBJECTIVE: To evaluate clinical manifestations, investigation and clinical course of Thai patients with pemphigus. METHODS: Demographic data, clinical presentations, laboratory investigations and treatment outcomes in 124 pemphigus patients who had attended the specialized autoimmune skin clinic at Siriraj Hospital during the period from January 1991 to December 2009 were retrospectively studied. RESULTS: Of the 124 pemphigus patients, 79% were diagnosed with pemphigus vulgaris (PV) and 15.3% with pemphigus foliaceus (PF). The male to female ratio was approximately 1:2 in both groups. The mean age of onset was 45.4 years in PV patients and 57.4 years in PF patients. Oral mucosal involvement at the onset of disease was presented in 37.8% of PV patients. The sensitivity and specificity of DIF in the diagnosis of pemphigus was 97.8% and 98.3% while that of IIF was 94.7% and 98.4%. Disease control was achieved in 93.9% of PV patients and 94.7% of PF patients. Remission (off therapy) was achieved in 31.6% of patients in both groups. CONCLUSIONS: PV is the most common subtype of pemphigus in Thailand and usually affects females more than males. The disease usually occurs in the fifth decade of life and mucosal involvement is common. Immunofluorescence studies yields very high sensitivity and specificity. Corticosteroids are the mainstay of treatment. The majority of patients attain disease control and one-third of them achieve remission (off therapy).

Clinicopathological Significance among Patients with In vivo Epidermal Nuclear Staining by Direct Immunofluorescence Study.

CONTEXT: In vivo epidermal nuclear staining (ENS) can be found in patients with autoimmune connective tissue diseases (CNTDs) and other diseases. AIMS: The aim of this study was to reveal the underlying diseases and direct immunofluorescence (DIF) characters of patients with in vivo ENS and association of in vivo ENS with circulating autoantibodies. SETTINGS AND DESIGN: A retrospective analysis was conducted involving skin biopsy specimens submitted for DIF study at the Dermatoimmunology Laboratory at Siriraj Hospital between 2002 and 2012. SUBJECTS AND METHODS: The findings of DIF study, clinical manifestations, and diagnosis of patients who had positive ENS were investigated. STATISTICAL ANALYSIS USED: The SPSS software version 18.0. Descriptive statistics were used to report demographic data, clinical characteristics, and laboratory investigation results. Moreover, Chi-squared test or Fisher's exact test were used to compare the categorical variables. RESULTS: One hundred and thirty-eight out of 3735 submitted specimens (3.7%) showed positive ENS. The most common diagnosis was CNTD (79%) followed by vasculitis (10.1%). Lupus erythematosus was the most common diagnosis among CNTD (78%). No association between levels of serum antinuclear antibodies (ANA) titer and intensity of ENS (P = 0.660). However, we found that patients with positive in vivo ANA had lower prevalence of systemic involvement. CONCLUSIONS: Although lupus erythematosus was the most common diagnosis among patients with in vivo ENS, the presence of ENS does not indicate any specific diagnosis. However, patients with ENS tend to have less systemic involvement.

Latex glove-related symptoms among health care workers: a self-report questionnaire-based survey.

BACKGROUND: The use of latex gloves by health care workers (HCWs) can lead to multiple symptoms: eczema, contact urticaria, rhinitis, conjunctivitis, asthma, and anaphylaxis. OBJECTIVES: The objectives of this study were to reveal the prevalence of latex glove-related symptoms of HCWs at Siriraj Hospital and to determine risk factors associated with those symptoms associated with the use of latex gloves. METHODS: Self-administered questionnaires were sent to 6880 HCWs who were working at Siriraj Hospital and using latex rubber gloves in their duty. RESULTS: The questionnaire response rate was 65.8%. Of 4529 respondents, the male-to-female ratio was 1:8.6 and the mean age was 34.3 years. The majority of respondents were nurses (83%). The prevalence of glove-related symptoms among the HCWs is 13.3%. Glove-related cutaneous and noncutaneous symptoms were found in 11.3% and 5.9% of the respondents. CONCLUSIONS: The hospital housekeepers emerged as the job with the significantly higher prevalence rate of glove-related symptoms than that of the other job categories. Factors associated with glove-related cutaneous symptoms are frequency and duration of glove use, history of atopy, and history of allergy to fruit cross-reacting with latex. The quantity of glove use, history of atopy, and allergy to fruits cross-reacting with latex are risk factors for the occurrence of glove-related noncutaneous symptoms.

Polymorphic eruption of pregnancy presented with targetoid lesions: a report of two cases.

BACKGROUND: Skin lesions in pregnant women could be caused by physiologic or pathologic changes. Polymorphic eruption of pregnancy (PEP), which manifests as various types of skin lesions, is the most common pregnancy dermatosis. Thus, PEP could mimic other skin diseases related to unfavorable maternal and fetal outcomes. MAIN OBSERVATIONS: Two PEP patients with targetoid lesions are presented here. One of them was a primigravida, whereas the other was a secundigravida. Both patients had singleton pregnancies and skin rash which started during the third trimester. The lesions began on the abdomen and then spread to the trunk and extremities. The face, palms, soles, and mucosa were not affected. Pruritus was observed but no other systemic symptoms were reported. Both patients delivered healthy, term infants without complications. CONCLUSION: Targetoid lesions in PEP are an uncommon presentation, and the differential diagnosis of PEP along with other dermatoses should be considered. However, the prognosis for this type of PEP is not different from that for classic PEP.