Subject(s)
Asian People , Cost-Benefit Analysis , Microscopy, Confocal , Skin Neoplasms , Humans , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Skin Neoplasms/epidemiology , Microscopy, Confocal/methods , Microscopy, Confocal/economics , Female , Male , Melanoma/diagnosis , Middle Aged , Cohort Studies , Aged , Carcinoma, Basal Cell/diagnosis , Carcinoma, Basal Cell/epidemiology , Carcinoma, Basal Cell/economics , Sensitivity and Specificity , Adult , Carcinoma, Squamous Cell/diagnosisSubject(s)
Ultraviolet Therapy , Vitiligo , Humans , Vitiligo/radiotherapy , Treatment Outcome , Combined Modality Therapy , PhototherapySubject(s)
Asian , Platelet-Rich Plasma , Humans , Alopecia/diagnosis , Alopecia/therapy , Treatment OutcomeSubject(s)
Hypopigmentation , Vitiligo , Humans , Self-Assessment , Severity of Illness Index , Vitiligo/diagnosisSubject(s)
Dermatologic Agents , Ultraviolet Therapy , Vitiligo/therapy , alpha-MSH/analogs & derivatives , Asian People , Combined Modality Therapy , Double-Blind Method , Drug Implants , Humans , Time Factors , Treatment Outcome , Ultraviolet Therapy/adverse effects , Ultraviolet Therapy/methods , alpha-MSH/adverse effects , alpha-MSH/therapeutic useSubject(s)
Imaging, Three-Dimensional , Mass Screening/methods , Photoacoustic Techniques/methods , Skin Neoplasms/diagnostic imaging , Tomography/methods , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Preoperative Period , Prospective Studies , Skin/diagnostic imaging , Skin/pathology , Skin Neoplasms/pathology , Skin Neoplasms/surgeryABSTRACT
BACKGROUND/OBJECTIVES: Controversy persists as to whether lichen planus pigmentosus and ashy dermatosis are separate clinical entities. This study was conducted to examine the clinicopathological features and treatment outcome of the two conditions. METHODS: A retrospective medical chart review of all patients who were diagnosed with lichen planus pigmentosus or ashy dermatosis was conducted. The information collected included the participants' age at onset, site of onset, duration of disease, presence of precipitating factors, distribution of disease, pigmentation and presence of symptoms. In patients from whom a biopsy was taken the histopathological reports were included. RESULTS: Altogether 26 patients with ashy dermatosis and 29 with lichen planus pigmentosus were included in the study. Compared with ashy dermatosis, lichen planus pigmentosus had a more localised distribution with a preponderance for facial involvement, compared with the truncal preponderance in ashy dermatosis. Ashy dermatosis tended to have a more stable clinical course than lichen planus pigmentosus, which was more likely to wax and wane. The utility of histopathology in differentiating between the two conditions is low. CONCLUSION: Ashy dermatosis and lichen planus pigmentosus, as defined in this study, appear to be two separate clinical entities with distinguishable clinical features and natural histories.
Subject(s)
Hyperpigmentation/drug therapy , Lichen Planus/drug therapy , Adolescent , Adult , Aged , Child , Disease Progression , Face , Female , Humans , Hyperpigmentation/ethnology , Hyperpigmentation/pathology , Lichen Planus/ethnology , Lichen Planus/pathology , Male , Middle Aged , Retrospective Studies , Torso , Treatment Outcome , Young AdultABSTRACT
Introduction: Melasma is a common pigmentary disorder with a multifactorial etiology that can hinder its management. The aqueous extract of the fern Polypodium leucotomos (PLE), Fernblock® (IFC, Madrid, Spain), has demonstrated antioxidant and photoprotective activities and has been used for the treatment of several pigmentary disorders. The aim of this study was to evaluate the efficacy and safety of oral PLE in the treatment of melasma in Asian patients. Methods: Forty healthy adult patients with clinical diagnoses of melasma who were receiving treatment with topical 4% hydroquinone cream and sunscreen with a sun protection factor (SPF) of 50+ were recruited for inclusion in this study from the National Skin Centre in Singapore. They were randomized to receive either oral PLE supplementation or placebo for 12 weeks. Patients were assessed at baseline, Day 28, Day 56, and Day 84 using the modified Melasma Area and Severity Index (mMASI); melanin and erythema indexes; VISIA® photography (Canfield Scientific, Parsippany, New Jersey, USA); and the Melasma Quality of Life (MelasQoL) questionnaire. Adverse events were recorded. Results: Following four, eight, and 12 weeks of treatment, there were statistically significant differences between the mMASI scores of both groups as compared with the baseline scores (p≤0.01). mMASI scores of the PLE group at eight and 12 weeks were also significantly lower than those of the placebo group (p≤0.05). At the end of the study, a significant improvement was reached in both groups (both p≤0.01), with no significant differences between them. The scores of the melanin and erythema indices displayed a slight improvement in both groups, without significant differences among them. MelasQoL score showed an improvement in the PLE group versus the placebo group. Our results demonstrate that the PLE aqueous extract product significantly improves and accelerates the outcome reached with hydroquinone and sunscreen almost from the first month of treatment in comparison with the placebo. There were no significant side effects reported. Conclusions: The oral PLE aqueous extract product appears to be a safe and effective adjunctive treatment for melasma in combination with topical hydroquinone and sunscreen.
ABSTRACT
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.
Subject(s)
Calcineurin Inhibitors/therapeutic use , Glucocorticoids/therapeutic use , Phototherapy/methods , Prednisolone/therapeutic use , Vitiligo/therapy , Administration, Topical , Asian People , Child , Child, Preschool , Combined Modality Therapy , Female , Humans , Male , Retrospective Studies , Skin Pigmentation/drug effects , Treatment OutcomeABSTRACT
Currently, imaging technologies that enable dermsurgeons to visualize non-melanoma skin cancers (NMSC) in vivo preoperatively are lacking, resulting in excessive or incomplete removal. Multispectral optoacoustic tomography (MSOT) is a volumetric imaging tool to differentiate tissue chromophores and exogenous contrast agents, based on differences in their spectral signatures and used for high-resolution imaging of functional and molecular contrast at centimeter scale depth. We performed MSOT imaging with two- and three-dimensional handheld scanners on 21 Asian patients with NMSC. The tumors and their oxygenation parameters could be distinguished from normal skin endogenously. The lesion dimensions and depths were extracted from the spectral melanin component with three-dimensional spatial resolution up to 80 µm. The intraclass correlation coefficient correlating tumor dimension measurements between MSOT and ex vivo histology of excised tumors, showed good correlation. Real-time 3D imaging was found to provide information on lesion morphology and its underlying neovasculature, indicators of the tumor's aggressiveness.
ABSTRACT
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.
Subject(s)
Vitiligo/diagnosis , Vitiligo/therapy , Age of Onset , Aged , Aged, 80 and over , Combined Modality Therapy/methods , Dermatologic Agents/administration & dosage , Female , Follow-Up Studies , Humans , Male , Middle Aged , Phototherapy/methods , Retrospective Studies , Steroids/administration & dosage , Treatment Outcome , Ultraviolet Therapy/methodsABSTRACT
BACKGROUND: 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. OBJECTIVES: We aimed to evaluate the usefulness of non-invasive RCM to differentiate between clinically and dermoscopically challenging pigmented skin lesions among Asians in a series of 11 lesions. METHODS: Nine patients with 11 clinically and dermoscopically difficult to distinguish pigmented skin lesions were evaluated by RCM to differentiate between pigmented BCC and benign lesions. In all cases, a histological confirmation of the RCM diagnosis was obtained. RESULTS: The clinical or dermoscopical characteristics were non-specific in all 10 cases. RCM detected features of pigmented BCC in nine patients and seborrhoeic keratosis in one patient. These were all confirmed by histological examination. CONCLUSIONS: This case series shows the value of non-invasive in vivoâ RCM imaging in the differentiation of malignant and benign pigmented lesions. Early diagnosis of small, pigmented BCC allows earlier excision with better prognosis. Future biopsies of benign lesions in cosmetic areas could also be avoided.
Subject(s)
Asian People , Carcinoma, Basal Cell/diagnostic imaging , Keratosis, Seborrheic/diagnostic imaging , Skin Neoplasms/diagnostic imaging , Aged , Aged, 80 and over , Carcinoma, Basal Cell/pathology , Diagnosis, Differential , Female , Humans , Intravital Microscopy , Male , Microscopy, Confocal/methods , Middle Aged , Skin Neoplasms/pathologyABSTRACT
BACKGROUND: Progressive macular hypomelanosis is an acquired disorder characterized by hypopigmented macules mostly on the trunk and upper extremities. Although many treatment modalities have been proposed for this condition with variable success rates, there are few reports comparing their efficacy and relapse rates. AIM: To compare the efficacy and relapse rates of different treatment modalities for progressive macular hypomelanosis. METHODS: Case records of patients diagnosed with progressive macular hypomelanosis and treated in National Skin Centre for a six year period between 2008 and 2014 were reviewed. Patient demographics, distribution of hypopigmented macules, treatment efficacy and relapse rates were noted. RESULTS: A total of 108 patients were seen for progressive macular hypomelanosis over the study period; of these, 40 opted for no treatment but were followed up. Thirty-six were treated with topical antimicrobials and 32 with phototherapy. Of those untreated, 23% recovered spontaneously while 38% in the antimicrobial group and 90% in the phototherapy had remission of their hypopigmentation. After 2 years of follow-up, relapse occurred only in the phototherapy group. LIMITATIONS: The main limitation is the retrospective design whereby diagnosis is dependent on the attending dermatologist. CONCLUSIONS: Narrow-band ultraviolet B therapy appears to be the most effective treatment for progressive macular hypomelanosis but also has the highest potential for relapse. Response rates for antimicrobial therapy are lower and slower, but patients who responded did not relapse. A combination of topical/systemic antimicrobials with narrow-band ultraviolet B therapy might be the best option to hasten recovery and minimize relapse.
Subject(s)
Anti-Infective Agents/administration & dosage , Disease Progression , Hypopigmentation/diagnosis , Hypopigmentation/therapy , Macula Lutea/pathology , Phototherapy/trends , Administration, Topical , Adolescent , Adult , Female , Follow-Up Studies , Humans , Macula Lutea/drug effects , Male , Recurrence , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
BACKGROUND AND OBJECTIVES: Post-acne scarring is a common and well-known sequelae of acne vulgaris. We aim to study the impact of post-acne scarring on the quality of life (QOL) among young adults in Singapore. SETTINGS AND DESIGN: This was a non-interventional prospective study. MATERIALS AND METHODS: Patients aged 21-40 years with atrophic and hypertrophic acne scars who attended the National Skin Centre, Singapore were recruited in the study. They answered a simple questionnaire and the clinical severity of their acne scars were assessed by the doctor. STATISTICAL ANALYSIS USED: Descriptive analyses using absolute and percentage frequencies were performed on all data. The test of significance was two-sided and was set at 5% (P ≤ 0.05). Differential analyses were conducted using the parametric, independent two-sample t-test and non-parametric Mann-Whitney U-test. The statistical assessments were performed using SPSS version 18.0. RESULTS: A total of 100 patients were studied. The mean patients' subjective self-scoring on the severity of their post-acne scars was 5.78/10 and the mean Dermatology Life Quality Index (DLQI) for post-acne scars was 5.61. Many (36%, n = 36) were self-conscious of their acne scars and 24%, (n = 24) felt that their acne scars was affecting their social activities. CONCLUSIONS: Our study showed that post-acne scars have a significant negative effect on the QOL of young adults. It highlights the need to increase public awareness of acne vulgaris and its sequelae through education programs and advocating early treatment to reduce the risk of scarring.
ABSTRACT
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.