Guideline for the diagnosis, treatment and long-term management of cutaneous lupus erythematosus.

Cutaneous lupus erythematosus (CLE) is an inflammatory, autoimmune disease encompassing a broad spectrum of subtypes including acute, subacute, chronic and intermittent CLE. Among these, chronic CLE can be further classified into several subclasses of lupus erythematosus (LE) such as discoid LE, verrucous LE, LE profundus, chilblain LE and Blaschko linear LE. To provide all dermatologists and rheumatologists with a practical guideline for the diagnosis, treatment and long-term management of CLE, this evidence- and consensus-based guideline was developed following the checklist established by the international Reporting Items for Practice Guidelines in Healthcare (RIGHT) Working Group and was registered at the International Practice Guideline Registry Platform. With the joint efforts of the Asian Dermatological Association (ADA), the Asian Academy of Dermatology and Venereology (AADV) and the Lupus Erythematosus Research Center of Chinese Society of Dermatology (CSD), a total of 25 dermatologists, 7 rheumatologists, one research scientist on lupus and 2 methodologists, from 16 countries/regions in Asia, America and Europe, participated in the development of this guideline. All recommendations were agreed on by at least 80% of the 32 voting physicians. As a consensus, diagnosis of CLE is mainly based on the evaluation of clinical and histopathological manifestations, with an exclusion of SLE by assessment of systemic involvement. For localized CLE lesions, topical corticosteroids and topical calcineurin inhibitors are first-line treatment. For widespread or severe CLE lesions and (or) cases resistant to topical treatment, systemic treatment including antimalarials and (or) short-term corticosteroids can be added. Notably, antimalarials are the first-line systemic treatment for all types of CLE, and can also be used in pregnant patients and pediatric patients. Second-line choices include thalidomide, retinoids, dapsone and MTX, whereas MMF is third-line treatment. Finally, pulsed-dye laser or surgery can be added as fourth-line treatment for localized, refractory lesions of CCLE in cosmetically unacceptable areas, whereas belimumab may be used as fourth-line treatment for widespread CLE lesions in patients with active SLE, or recurrence of ACLE during tapering of corticosteroids. As for management of the disease, patient education and a long-term follow-up are necessary. Disease activity, damage of skin and other organs, quality of life, comorbidities and possible adverse events are suggested to be assessed in every follow-up visit, when appropriate.

A clinician's reference guide for the management of atopic dermatitis in Asians

BACKGROUND: Atopic dermatitis (AD) is a common skin condition among Asians. Recent studies have shown that Asian AD has a unique clinical and immunologic phenotype compared with European/American AD. OBJECTIVE: The Asian Academy of Dermatology and Venereology Expert Panel on Atopic Dermatitis developed this reference guide to provide a holistic and evidence-based approach in managing AD among Asians. METHODS: Electronic searches were performed to retrieve relevant systematic reviews and guidelines on AD. Recommendations were appraised for level of evidence and strength of recommendation based on the U.K. National Institute for Health and Care Excellence and Scottish Intercollegiate Guidelines Network guidelines. These practice points were based on the consensus recommendations discussed during the Asia Pacific Meeting of Experts in Dermatology held in Bali, Indonesia in October 2016 and April 2017. RESULTS: The Expert Panel recommends an approach to treatment based on disease severity. The use of moisturizers is recommended across all levels of AD severity, while topical steroids are recommended only for flares not controlled by conventional skin care and moisturizers. Causes of waning efficacy must be explored before using topical corticosteroids of higher potency. Topical calcineurin inhibitors are recommended for patients who have become recalcitrant to steroid, in chronic uninterrupted use, and when there is steroid atrophy, or when there is a need to treat sensitive areas and pediatric patients. Systemic steroids have a limited role in AD treatment and should be avoided if possible. Educational programs that allow a patient-centered approach in AD management are recommended as an adjunct to conventional therapies. Recommendations on the use of phototherapy, systemic drugs, and emerging treatments are also included. CONCLUSION: The management of AD among Asians requires a holistic approach, integrating evidence-based treatments while considering accessibility and cultural acceptability.

Peri-urban aquatic plant culture and skin disease in Phnom Penh, Cambodia.

A cross-sectional study with follow-up was done in five communities involved in aquaculture in peri-urban Phnom Penh, Cambodia, to assess the association between skin disease, particularly dermatitis and occupational wastewater exposure. From 200 selected households 650 household members aged > or = 15 years were visited and examined dermatologically three times in July 2004, January and May 2005. Overall dermatitis prevalence was 6.1%. However, all cases (116) were found in the two wastewater villages involved in aquatic plant culture. Risk factor analysis restricted to the two wastewater villages showed that involvement in wastewater-fed aquatic plant production increased the risk of dermatitis in the univariable analysis but not in the multivariable analysis. Among family members involved in wastewater-fed aquatic plant production a longer duration of daily wastewater contact did not increase the risk of dermatitis in the multivariable analysis. Wet season, older age and having a history of skin problems in the three months prior to each survey were associated significantly with dermatitis. Very few aquaculture workers applied personal protection and the factor had no significant effect on dermatitis. The present study did not show a consistent association between occupational exposure to wastewater and dermatitis, unlike similar Vietnamese studies.

Occurrence of arsenicosis in a rural village of Cambodia.

Ninety-seven subjects belonging to 40 families in a village in Cambodia were examined in a health camp where all the cases with skin disease assembled. These people had evidences of chronic arsenic exposure from reports of testing of water samples and of hair and/or nail studied. Seventy cases were diagnosed to be suffering from arsenicosis (Clinically and laboratory confirmed according to WHO criteria) as all these cases had evidences of pigmentation and/or keratosis characteristic of arsenicosis and history of exposure of arsenic contaminated water and/or elevated level of arsenic in hair and/or in nail. Highest number of cases belonged to age group of 31 to 45 yrs, both the sexes are more or less affected equally. Evidence of both pigmentation and keratosis were found in 60 cases (85.7%) while only pigmentation and only keratosis was found in 6 (8.5%) and 4 (5.7%) cases respectively. It was interesting to find 37.04% of children below the age of 16 years had skin lesions of arsenicosis. The youngest child having definite evidence of keratosis and pigmentation was aged 8 years, though two children aged 4 and 5 yrs had feature of redness and mild thickening of the palms. The minimum and maximum arsenic values detected in the nails were 1.06 and 69.48 mg/Kg respectively and the minimum and maximum arsenic values in hair were 0.92 and 25.6 mg/Kg respectively. No correlation was observed between arsenic concentration in drinking water and arsenic level in nail and hair. This is the first report of clinical and laboratory confirmed cases of arsenicosis in Cambodia.