Efficacy of Adding Oral Simvastatin to Topical Therapy for Treatment of Psoriasis: The Vietnamese Experience.

BACKGROUND: Psoriasis, the prevalence of which ranges from 2% to 3% of the general population, has been recently recognised as not only a chronic inflammatory skin disorder but also an immunometabolic systemic disease. Dyslipidemia is one of the most important comorbidities of psoriasis. Statins, frequently used as anti-hyperlipidemic agents, may be beneficial in the treatment of several autoimmune diseases, including psoriasis, due to their anti-inflammatory and immunomodulatory characteristics. Hence, we hypothesised that using this medication was not only beneficial for reducing hyperlipidemia but also improving psoriatic conditions. AIM: We conducted a study to determine the prevalence of dyslipidemia in psoriatic patients as well as whether the addition of statins (simvastatin prescribed forms) to standard topical antipsoriatic treatment can improve skin lesions in psoriatic patients. METHODS: A group of 128 psoriatic patients and 128 healthy controls who were matched with the patients regarding ethnicity, age, and sex were enrolled, and their lipid concentrations were determined. Furthermore, sixty patients were randomly selected from the former group and divided into two treatment subgroups to evaluate the effect of statins on the severity of psoriasis using the PASI score. RESULTS: We found that the rate of dyslipidemia in the patient group was significantly higher than in the healthy group (53.9% versus 21.9%, p < 0.001), particularly the triglyceride concentration (1.86 ± 1.17 versus 1.43 ± 0.79 mg/dL, p < 0.001). Also, the PASI score reduction in the simvastatin-treated subgroup was significantly different from that in the placebo-treated one after eight weeks of therapy (8.63 ± 4.78 versus 5.34 ± 3.59, p < 0.01). CONCLUSION: This study showed that simvastatin might play a role in controlling hyperlipidemia and in turn decrease the PASI score in psoriatic patients.

Antifungal Susceptibility of Dermatophytes Isolated From Cutaneous Fungal Infections: The Vietnamese Experience.

AIM: Evaluate the resistance of dermatophytes to systemic antifungal drugs in the Vietnamese population. METHODS: We enrolled 101 patients with cutaneous dermatophytosis at the Dermato-Venereology hospital in HCMC from August 2016 to March 2017. All the specimens were subjected to direct examination (10% KOH mount) and culture on Sabouraud dextrose agar. In vitro antifungal sensitivity testing was done on species isolated from a culture with broth microdilution method. RESULTS: Direct microscopy was positive for dermatophytes in all patients. However this pathogen was found in fungal cultures in only 61.38% of patients. The main causative agent isolated was Trichophyton spp. (90.3%), followed by Microsporum spp. (8%) and Epidermophyton spp. (1.7%). Trichophyton spp. Has shown resistance to fluconazole, griseofulvin, ketoconazole, and itraconazole in 92.9%, 46.4%, 5.4% and 1.8% of strains, respectively. All Microsporum spp. Strains were found resistant to fluconazole and griseofulvin while resistance to ketoconazole was demonstrated in only 20% of strains and none of them was resistant to itraconazole. Epidermophyton spp strains were all resistant to fluconazole, griseofulvin, ketoconazole while none of them was resistant to itraconazole. CONCLUSION: Based upon our results, Itraconazole shows the greatest probability of efficacy in the treatment of cutaneous dermatophytosis in Vietnamese patients.

In Vitro Antibiotic Resistance in Bacterial Infected Eczema at Ho Chi Minh City Hospital of Dermatology.

BACKGROUND: Infected eczema is one of the most common complications of eczema. The progression and treatment of infected eczema have become more complex and difficulty due to the antibiotic resistance of bacteria and the abuse of antibiotics in treatment. AIM: Our research was conducted with the aim of investigating the severity of in vitro antibiotic resistance in patients with bacterially infected eczema at Ho Chi Minh City Hospital of Dermatology. METHODS: We studied 40 cases of patients, suffering from atopic dermatitis, contact dermatitis, vesicular palmoplantar eczema, with positive results of infected eczema. RESULTS: S. aureus accounted for 82.5%, followed by S. epidermidis (15%), P. aeruginosa (12.5%), S. pyogenes (5%) accounted for a small percentage. E. coli (2.5%) and M. morganii (2.5%) accounted for the lowest percentage. Both MSSA and MRSA were completely resistant to penicillin. MRSA is completely resistant to penicillin, erythromycin, and cefuroxime, highly resistant to clindamycin (82.35%). Our research showed that Pseudomonas aeruginosa was not resistant to a variety of antibiotics. It was completely resistant to tetracycline, trimethoprim/sulfamethoxazole (100%). Most bacteria are highly sensitive to linezolid, vancomycin as other studies in the world shown. There are also rifampicins, pristinamycin. Hence, it`s prioritised to be used for only patients with eczema infected with multidrug-resistant bacteria. CONCLUSION: Penicillin is not recommended for the treatment for infected eczema. Linezolid, vancomycin has a high sensitivity to bacteria including multidrug-resistant bacteria like MRSA.

Distribution of Malassezia Species from Scales of Patient with Pityriasis Versicolor by Culture in Vietnam.

BACKGROUND: The detection of pathogenic fungus is an important step and key to assessing the sensitivity of the antifungal drugs, and therefore choosing an effective treatment method. AIM: To identify Malassezia species from scales of a patient with pityriasis versicolor. METHODS: Three hundred patients with pityriasis versicolor who were positive with direct examination, were isolated by culture. RESULTS: Identification of Malassezia species by culture: the growth rate was 90.3%; the detection rate was 97.0%, including 11 species: M. globosa (42.4%), M. dermatitis (17.3%), M. furfur (14.4%). M. globosa was the most prevalent species in the 20-29 group 36.5%, in hyphae and yeast cells (42.2%). CONCLUSION: M. globosa is the main cause of pityriasis versicolor in Vietnam.

Successful Treatment of Facial Atrophic Acne Scars by Fractional Radiofrequency Microneedle in Vietnamese Patients.

AIM: This study aimed to evaluate the effect of the fractional Radiofrequency microneedle treatment for facial atrophic acne scars. METHODS: A group of 52 patients were recruited for the study. Goodman & Baron's acne scar grading system was used for assessment at their first visit and the end of 3 months after the last treatment session. RESULTS: The results displayed that 73.1% of patients have the improvement of the Goodman scar level after four times of treatment. The Goodman and Baron scar point mean was reduced from 16 ± 7.6 to 5.6 ± 5.0 (p < 0.01). Post-inflammatory hyperpigmentation was experienced in 5 patients (9.6%). CONCLUSION: The microneedle fractional Radiofrequency is an effective treatment method of facial atrophic acne scars, with minor side effects and a short downtime.

Anatomical Evaluation for Successful Dye Laser Treatment of Port Wine Stain in Vietnamese Patients.

AIM: To assess the efficacy in the treatment of port wine stain in the head and neck by using (Vbeam perfecta®). METHODS: Forty-two port wine stain patients were recruited at the National Hospital of Dermatology and Venereology, Hanoi, Vietnam. RESULTS: We reported an excellent response (43.8%) (76%-100% lightening), a good response (18.8%) (51%-75% lightening), fair improvement (18.8%) (26%-50% lightening), and no response (18.8%) (0%-25% lightening). CONCLUSION: In conclusion, pulsed dye laser is an excellent technique to remove port wine stains on the face and neck.

Efficacy of Oral Itraconazole in the Treatment of Seborrheic Dermatitis in Vietnamese Adults Patients.

AIM: This longitudinal study aims to evaluate the efficacy of oral itraconazole in the treatment of seborrheic dermatitis in Vietnamese patients. METHODS: Thirty patients were enrolled at National Hospital of Dermatology and Venereology, Hanoi, Vietnam and were treated with oral itraconazole (200 mg daily in 14 days followed by 200 mg weekly in 4 weeks). The clinical severity was assessed by a four-parameter scoring system. All patients completed the six-week regimen with good adherence. RESULTS: At the week 2nd, 70% of the patients had moderate to severe diseases. At the week 6th, 63.4% of the patients achieve clearance of the lesions, and none had severe disease. No side effects were reported. CONCLUSION: Oral itraconazole can be an option for seborrheic dermatitis because of good efficacy, safety profile and adherence.

The Efficacy and Safety of Hyaluronic Acid Microinjection for Skin Rejuvenation in Vietnam.

BACKGROUND: Aging is an increasing concern of modern society, particularly facial ageing. In recent years, the microinjection technique has increasingly been emphasised as a skin rejuvenation strategy. Hyaluronic acid (HA) plays an important role in the hydration of the extracellular space and can thus improve skin hydration, firmness and viscoelastic properties. AIM: To evaluate the efficacy and safety of HA microinjection in skin rejuvenation. METHODS: We enrolled thirty participants underwent three sessions of HA microinjection involving multiple injections in the face or back of the hands at 2-week intervals. The aesthetic outcomes were assessed at baseline and after 2, 4 and 8 weeks. Clinical evaluation was based on the Global Aesthetic Improvement Scale (GAIS) and the Wrinkle Severity Rating Scale (WSRS). RESULTS: Evaluation of photographs from 2, 4 and 8 weeks revealed significant clinical improvement in the brightness, texture and wrinkling of the skin. Analysis of the GAIS and WSRS scores revealed statistically significant results after 2 months. CONCLUSION: Most of the participants felt satisfied with the treatment (93.3%).

Efficacy of 10% Potassium Hydroxide Solution Versus 10% Salicylic Acid Ointment in Treatment of Molluscum Contagiosum - the Low - Cost Dermatologic Therapy in Vietnam.

BACKGROUND: Molluscum contagiosum is a common viral disease primarily affecting children. AIM: The objective is to compare the efficacy of 10% potassium hydroxide (KOH) solution versus 10% salicylic pomade in the treatment of molluscum contagiosum. METHODS: Clinical trials on 70 patients were randomised into 2 groups: 39 patients treated with 10% KOH solution and 31 patients treated with 10% salicylic pomade. The evaluation was based on the complete clearance of lesions, side effects and complications of the drug. RESULTS: The clearance of all lesions after 2, 4, 6, 8 weeks of treatment in both groups were 7.7%; 23.1%; 53.8%; 79.5% and 0%; 3.2%, 9.7% 22.6%, respectively (p < 0.05). Side effects were seen in both groups include burning (76.9% versus 19.4%; p < 0.05); redness (59% versus 14%; p < 0.01); desquamation (12.8% versus 19.3%; p < 0.05). CONCLUSION: The efficacy of KOH solution in the treatment of MC was better than that of salicylic pomade and both products are safe, effective, and easy to apply at home.

Efficacy of BAFF in Monitoring Treatment Response in Early Vietnamese Systemic Sclerosis Patients.

BACKGROUND: B-cell activating factor (BAFF) is considered to have a role in the pathogenesis of systemic sclerosis (SSc). AIM: We conducted a longitudinal study on early SSc patients to determine the change in BAFF serum level after treatment and its association with organ involvements. METHODS: A total of 46 patients (32 diffuse, 14 limited) were recruited, among which 35 patients (24 diffuse, 11 limited) completed 12-month follow-up. RESULTS: Higher pretreatment BAFF levels were observed in patients with positive anti-topoisomerase antibody (ATA) (2252.1 ± 899.7 pg/ml versus 1475.5 ± 697.6 pg/ml in ATA-negative patients; p = 0.01) and muscular involvement (2741.9 ± 1039.9 pg/ml versus 1897.2 ± 762.9 pg/ml in patients without muscular involvement; p = 0.005). Lower levels were observed in patients with interstitial lung disease (ILD) (1926.7 ± 757.9 pg/ml versus 2721.6 ± 1131.4 pg/ml in non-ILD patients; p = 0.01). After treatment, BAFF level reduced significantly in diffuse SSc patients (1652.2 ± 892.7 pg/ml versus 2147.6 ± 945.5 pg/ml before treatment; p = 0.03). CONCLUSION: Patients with worsening outcome had the highest pretreatment BAFF level and was associated with increased BAFF level after treatment. BAFF can be used to predict and monitor patients' response to therapy.

Efficacy of Azole Antifungal in Treatment of Pityriasis Versicolor.

AIM: Compare itraconazole alone, fluconazole combined with ketoconazole and ketoconazole in the treatment of patients with pityriasis versicolor. MATERIAL AND METHODS: A group of 240 pityriasis versicolor patients (confirmed with KOH and culture) were classified into 3 groups: Fluconazole 300 mg a week and 2% ketoconazole foam twice a week for 2 weeks (Category I), Itraconazole 200 mg daily for one week (category II); Ketoconazole 2% foam daily for 2 weeks (Category 3). Clinical (colour of macule, scale, pruritus) and mycological assessment were done after 4 weeks of therapy. RESULTS: After 4 weeks of treatment, clinical cure was observed in 62.4% (Category I), 36.3% (Category II) and 37.5% (Category III). CONCLUSION: It was reported in our study that the most effective regimen for PV patients is fluconazole 300 mg per week combined with ketoconazole 2% twice a week for 2 weeks.

The Effectiveness of Local Surgical Technique in Treatment of Axillary Bromhidrosis.

BACKGROUND: Up to now, surgical excision of apocrine glands still has been a method that yields high treatment results and low rate of odour recurrent for patients, but many people worry about some serious complications that have been observed postoperatively, such as hematoma and skin necrosis. These prolong wound healing, leading to unsightly scars in the axillary fossae. AIM: We conducted this research to investigate the effects and complications of our surgical technique for axillary bromhidrosis. METHODS: Forty-three patients with axillary bromhidrosis were treated. An elliptical incision was made at a central portion of the area marked, with both tips of the ellipse along the axillary crease. The elliptical skin with the subcutaneous tissue was removed en lock. The adjacent skin was undermined to the periphery of the hair-bearing area with straight scissors. The undermined subcutaneous tissue was removed with curved scissors, and the skin was defatted to become a full-thickness skin flap. Any suspected hemorrhagic spots were immediately coagulated electrosurgically. Appropriate drains were placed, and the treated area was covered with thick gauze to each axilla. Arm movement was strictly controlled in the first 3 days post-operatively. RESULTS: Thirty-one patients have been followed up and evaluated for 6 months. 56 out of 62 axillae (90.3%) showed good to excellent results for malodor elimination. All patients reported a reduction in axillary sweating. There were two axillae of skin necrosis and three axillae of hematoma, with one patient receiving an anticoagulant from a cardiologist after the first day of surgery, to treat heart valve disease. The Dermatology Life Quality Index (DLQI) score decreased significantly, and the quality of life improved after the operation. CONCLUSION: Our technique is a simple surgical procedure and easy to perform helping to achieve results for high malodor elimination, with almost no serious complications. Patient's life quality improved significantly after the operation.

Improving Treatment Outcome of Pemphigus Vulgaris on Vietnamese Patients by Using Desmoglein Elisa Test.

BACKGROUND: Pemphigus Vulgaris (PV) is a chronic disease, is characterized by the presence of flacid bullous in skin and mucosa. There are 2 main autoantibodies against desmoglein3 (Dsg3) and desmoglein1 (Dsg1). AIM: The aims of this study were to evaluate the before and after treatment outcome with corticosteroid, using Desmoglein ELISA test. METHOD: Forty patients with Pemphigus include 36 PV and 4 PF (28 women, 12 women) were enrolled. The titers of Dsg in pemphigus patients by using ELISA test were done before and 1-month treatment. RESULTS: Both anti-Dsg1 and anti-Dsg3 levels were significantly reduced after treatment (P < 0.05). The severity of skin lesions was correlated with anti-Dsg1 antibody level and the severity of oral lesions was significantly correlated with anti-Dsg 3 antibody levels (p < 0.05). CONCLUSION: It is recommended that we can predict and improve the outcome of treatment by using Desmoglein ELISA test.

Efficacy and Safety of Methotrexate in Combination with Mini Pulse Doses of Methylprednisolone in Severe Alopecia Areata. The Vietnamese Experience.

BACKGROUND: Treatment of severe alopecia areata remains very difficult, especially in alopecia areata totalis and alopecia areata universalis. Methotrexate is known to be effective in the treatment of severe and chronic autoimmune disorders. OBJECTIVE: To assess the effectiveness and safety of MTX in combination with mini pulse dose of methylprednisolone in the treatment of severe alopecia areata. PATIENTS AND METHODS: The open, uncontrolled study compared pre-treatment and after-treatment. Thirty-eight patients (age 16-64) with severity AA (SALT score > 50 %) visiting National hospital of Dermatology and Venereology from April-2004 to September-2015 were enrolled. All patients received oral methylprednisolone 24mg/day for 3 consecutive days of a week in combination with oral MTX 7,5 mg weekly. This regimen is maintained up to 12 weeks and follow-up until to 6 months. RESULTS: After 6 months, 60.5% of patients show complete hair growth (good response) and 18.4% shows the medium response. There is a significant SALT score reduction: mean baseline SALT score 84.39 ± 17.03 compared to mean post-treatment SALT score 24.19 ± 29.42. Good clinical improvement noted in after 3 months. We do not observe any side- effects related to oral MTX and oral methylprednisolone, and no patients had to withdrawal treatment due to side- effects. CONCLUSION: Combination Methotrexate and mini pulse dose of methylprednisolone are effective and safe in treatment severity alopecia areata.

Using Patch Testing to Improve Therapeutic Outcome in the Treatment of Hand Eczema in Vietnamese Patients.

BACKGROUND: Hand eczema is a common chronic and relapsing skin disease with various clinical features. Hand eczema aetiology can be allergic contact dermatitis (ACD), irritant contact dermatitis (ICD), atopic dermatitis (AD) and unknown or combination causes. If the causative agents are not detected treatment of hand eczema will be a failure. A patch test can be useful to detect causative agents in suspected allergic contact hand eczema. Then patients will avoid contacting them. This results in the improvement of hand eczema. In Vietnam, patch test has not been used before, so we conduct this study. AIM: To identify causative allergens by using patch test with 28 standard allergens in consecutive patients. METHODS: A group of 300 HE patients from the National Hospital of Dermatology and Venereology (NHDV) in Vietnam were enrolled in this study. They were divided into 4 groups-ACD, ICD, AD and unknown aetiology. The patient was patch tested with 28 standard allergens to identify the causative agents. RESULTS: Among the 300 HE enrolled patients, ACD accounted for 72.7%, AD and ICD had the same rate of 12.7%. 39.3% of the patients had a positive patch test. Reaction to nickel sulfate was the most common (10.3%), followed by potassium dichromate (9.7%), cobalt (4%) and fragrance mix (3.1%). About one-third of the cases had relevant clinical reactions correlated with the contact agents and clinical history. Males reacted to cement, thiuram mix and formaldehyde more than females, while females reacted to a nickel more than males. CONCLUSIONS: Hand eczema has variable clinical features and diverse aetiology. ACD is an important cause of hand eczema that can be managed with a patch test to detect causative allergens. Nearly 40% of HE cases had positive patch test. Relevant patch test reactions were seen in one-third of the patients. We propose using patch test detect causative agents in suspected allergic contact hand eczema. Then patients will avoid contacting them. This results in the improvement of hand eczema.

Efficacy of Surgical Excision for Nevus Sebaceous - Vietnamese Experience.

BACKGROUND: Nevus Sebaceous (NS) is hamartoma predominantly composed of sebaceous glands and is classified as a type of epidermal nevus. In most case, clinical manifestation of NS is typical, so histopathology examination is important only in atypical lesions for its risk of malignancy. Clinical symptoms are plaques or papules (100%), appearing in the head area (100%) with smooth surface (65.8%), usually with hair loss (60.7%). The histopathology is mostly characterized by the image of sebaceous gland hyperplasia (100%), no hair follicles (60.7%) or immature follicles (14.3%). AIM: The aim of our study is describing clinical and histopathological manifestation, make diagnosis and evaluate the best therapy. METHODS: Our study recruited 38 patients with NS, 3 patients (7.9%) with atypical aspects. All patients were treated by surgical excision. RESULTS: Complications as hair loss and infections were reported in 36.8% patients. No patients had recurrence after one year of treatment. CONCLUSION: Based upon our experience, surgery is cheap, simple, associated with high aesthetics effectiveness and low recurrence rate, proposing as the first choice for treatment of NS.

Efficacy of Oral Isotretinoin in Combination with Desloratadine in the Treatment of Common Vulgaris Acne in Vietnamese Patients.

AIM: To evaluate the efficacy of oral isotretinoin used alone and in combination with desloratadine in the treatment of moderate acne vulgaris. METHODS: A comparative clinical trial was undertaken to evaluate the efficacy of oral isotretinoin alone and in combination with desloratadine in the treatment of 62 moderate acne vulgaris patients. Patients were randomised into two groups with 31 patients in each group. Each studied group's patient took 20 mg isotretinoin and 5 mg desloratadine per day. In the control group, patients took only 20 mg isotretinoin per day. The treatment time was 16 weeks. The evaluation and follow-up were done at week 2, 4, 8, 12 and 16 of the treatment. RESULTS: The studied group had a better curative rate than the control group (45.2% versus 22.6%). The average number of inflammatory lesions in the studied group was significantly lower than the control group (0.19 versus 0.94). The mean GAGS score of the studied group was significantly lower than the control group (3.71 versus 6.52). Acne outbreaks rate of the studied group was lower than the control group (in week 2: 22.6% versus 45.2% and in week 4: 16.1% versus 38.7%, respectively). The rate of itchy was lower in the studied group. CONCLUSION: In the treatment of moderate acne vulgaris, oral isotretinoin in combination with desloratadine is more effective and has fewer side effects than using isotretinoin alone.

The Effectiveness of Narrow Band Uvb (Nb-Uvb) In the Treatment of Pityriasis Lichenoides Chronica (PLC) In Vietnam.

AIM: This prospective clinical study presents the experiences with NB-UVB monotherapy in the treatment of PLC on Vietnamese patients. METHODS: We enrolled at National Hospital of Dermatology and Venereology (NHDV), Vietnam, 29 PLC patients with generalised disease involving at least 60% of the total body surface (based on Nine's Rule) and/or failed to respond to other modalities of treatment. Patients were treated with NB-UVB followed the guideline of the psoriatic treatment of AAD-2010, three times weekly. RESULTS: A complete response (CR) was seen in 24 out of 29 PLC patients (82.8%) with a mean cumulative dose of 9760.5 mJ/cm2 after a mean treatment period of 4.6 weeks (13.8 ± 7.4 exposures). Mild side effects were observed: 69% erythema minimum, 55.2% irritation related to dry skin. No severe side effects were seen during the study. No relapses occurred in 24 CR patients within a mean period of 3 months after the last treatment. CONCLUSION: NB-UVB therapy is an effective and safe option for the treatment and management of PLC.

Efficacy of Narrow - Band UVB Phototherapy versus PUVA Chemophototherapy for Psoriasis in Vietnamese Patients.

BACKGROUND: Psoralen UVA (PUVA) and narrow-band UVB (NBUVB) chemophototherapy are treatment options for psoriasis. AIM: To compare the effectiveness of NBUVB with PUVA in Vietnamese psoriasis patients. METHODS: We conducted a non-randomized trial on 60 patients with plaque-type psoriasis (30 NBUVB, 30 PUVA). Both regimens were thrice-weekly. The extent of lesion was assessed by the Psoriasis Area Severity Index (PASI). Clearance was defined as a ≥ 75% reduction in a follow-up PASI score from baseline. Patients with clearance were followed-up until 6 months after stopping treatment. Relapse was defined as 50% or more of the original extent. RESULTS: The proportion of patients achieving PASI75 was comparable (76.7% in NBUVB versus 80% in PUVA; p > 0.05). Patients in both groups had a similar number of sessions to achieve clearance but patients in the PUVA group exposed to a significantly higher cumulative UV dose. After six months, the relapse rate was higher in the NBUVB group compared with in the PUVA group (p > 0.05). CONCLUSION: Thrice weekly NBUVB is as effective as thrice weekly PUVA in treating psoriasis for Vietnamese patients.

Effectiveness, Safety and Tolerance of Methotrexate in Vietnamese Psoriatic Arthritis Patients.

AIM: To access the effectiveness, safety and tolerance of methotrexate (MTX) in psoriatic arthritis (PsA) treatment. METHODS: We recruit 37 patients, admitted at HCMC Hospital of Dermato-Venereology from 1/2016 to 3/2017, with MTX dosage ranging from 10 mg to 15 mg per week. RESULTS: Skin lesion response after 12 weeks improved PASI 50: 40.5%, PASI 75: 24.3%. Disease activity score decreased after 12 weeks with ∆DAS28 = -1.43 + 0.79, 37.8% PsA achieved complete remission. Nausea and vomiting were 8.1%. These symptoms were mild and transient. We did not stop MTX usage. The rate of elevating SGPT 2-3 times as much as the upper limit of the normal range was 2.7%. CONCLUSION: We finally demonstrated that the rate of treatment response in Vietnam is the same as demonstrated by foreign authors in other countries.