Basal cell carcinoma trends in Thailand: A 10-year retrospective study of demographic, clinical and histopathological features.

Basal cell carcinoma (BCC) is the most common skin cancer with globally increasing incidence. To date, the information regarding BCC in Thailand is limited. Our aim was to evaluate the demographic, clinical, histopathological trends of BCC and other contributing factors. We retrospectively reviewed the demographic, clinical and histological data of all BCC outpatients from January 2009 to December 2018. From 278 BCC patients recruited to this study, most of them (71.6%) were older than 60 years old. The most common histological subtype was nodular BCC (63.3%). A statistically significant association was observed between histological variant and location of the tumor; H and M area were associated with nodular BCC; L area was related to superficial subtype (P<0.001). Misdiagnosis of BCC was observed in 53 cases, mostly as melanocytic nevus (30.2%), and about quarter (26.4%) was made by board-certified dermatologists. Nodular BCC is significantly associated with H and M area, while superficial subtype is related to L location. Quarter of the patients already have large tumors at their first presentation. Misdiagnosis of BCC is not uncommon.

Legal vs. illegal injectable fillers: The adverse effects comparison study.

BACKGROUND: Over the past decades, soft-tissue filler injections have become an essential part of cosmetic practice worldwide. Due to the increasing demand, unlicensed practitioners venture in performing this minimally invasive procedure, injecting illegal fillers that pose serious complications. OBJECTIVES: To compare the adverse effects of legal and illegal soft-tissue fillers injected by licensed and unlicensed practitioners. MATERIALS AND METHODS: A 10-year retrospective, descriptive, single-center study conducted at the outpatient dermatology department and skin laser center at Siriraj Hospital from January 2009 to December 2019. Patients were identified as having treatment-related complications. Their demographic data, clinical history, and injection history were reviewed. RESULTS: Forty patients with mean age of 37 years old were included in the study. Thirty-five of them (87.5%) were female. Illegal soft-tissue fillers were used in 28 patients (70%) and were performed by unlicensed practitioners (18 cases, 64.3%, P = .001). Adverse effects from illegal fillers (26 cases, 92.9%) developed longer than legal fillers (7 cases, 58.3%) (P = .017). Symptoms significantly lasted longer in patients injected with illegal fillers, 10 (0.07-288) weeks, as compared to patients injected with legal fillers 0.75 (0.14-72) weeks (P = .01). Injections from illegal fillers resulted to foreign body reaction (22 cases, 78.6%) and infections (6 cases, 21.4%). Vascular complications were identified in legal fillers injections (5 cases, 41.7%). CONCLUSIONS: The incidence of adverse effects and complications from soft-tissue filler injections are superior when performed by novice injectors and unlicensed practitioners using illegal fillers. Proper training of filler injections, selection of appropriate fillers, and early recognition of adverse effects are critically important to the success of treatments.

WILLINGNESS TO PAY, QUALITY OF LIFE, AND KNOWLEDGE ON HERPES ZOSTER AMONG THAI PATIENTS PRIOR ZOSTER VACCINE ERA.

Herpes zoster is a devastating condition affecting patients' wellbeing. Policy on zoster vaccine in developing countries needs more data on the disease burden. This study was designed to assess willingness to pay, quality of life, and the patients' knowledge on herpes zoster disease. All of the patients were asked to complete questionnaires about the willingness to pay for zoster treatment using the Dermatology Life Quality Index (DLQI) questionnaires in Thai version and basic knowledge about herpes zoster. The demographic and clinical data were all recorded. Eighty-two from one hundred and eighteen patients in this study were female (69.5%), and the mean (SD) age was 57.6 (14.9) years. The median of their willingness to pay for zoster treatment was THB500 (range of THB50-10,000) or only 4.2% of median income per month. The mean of total DLQI score (SD) was 10.7 (6.2), which indicated moderate to severe impact on quality of life. From multiple linear regression analysis, three factors were related to inferior patients' quality of life including facial involvement (regression coefficients, b=4.789, p=0.001), presence of zoster complications (b=5.018, p=0.001) and advanced pain score (b=0.883, p<0.001). Moreover, more than half of them still had mistaken knowledge about the disease.

Onychomycosis: A study of self-recognition by patients and quality of life.

BACKGROUND: Onychomycosis accounts for approximately half of all nail disorders and is usually asymptomatic. OBJECTIVES: To evaluate patients' recognition of fungal nail disease, concomitant fungal skin diseases, complications, and quality of life. METHODS: Patients from the fungal nail clinic were enrolled between May 2011 and April 2012. Patients' awareness of diseased nails was evaluated and the Dermatology Life Quality Index (DLQI) questionnaire was used to evaluate the impact of dermatologic disease on quality of life. RESULTS: A total of 110 patients with onychomycosis were enrolled in the study, of which 64 (58.2%) were female and the mean age was  60.8 years. The number of patients who were able to recognize the presence of onychomycosis was 71 (64.5%), while 32 (29.1%) and 7 (6.4%) were diagnosed by a dermatologist and other physicians, respectively. Multivariate analysis showed that patient recognition of the disease was significantly associated with female sex and young age. The mean DLQI score was  3.6. LIMITATION: Patient recall bias including the duration of fungal nail infection, long-term past history and previous treatment was a limitation of this study that affected DLQI scores. CONCLUSION: About half of onychomycosis patients, especially elderly males, could not recognize the disease by themselves. It is important for physicians to educate patients with risk factors for onychomycosis to recognize this condition early to prevent concomitant infection and complications, and to improve patients' well-being.