Consensus Guidelines in Usage of Biologics in Dermatology during COVID-19 Pandemic: Biologic Advisory Group Malaysia

@#The aim of this Biologic Advisory Group (BAG) Malaysia consensus guideline is to provide clinicians managing cutaneous diseases with biologics relevant parameters to consider prior to initiating or stopping or continuing any biologic treatment in the current landscape of the COVID-19 pandemic. Besides reviewing the medical literatures on COVID-19 and evidences related to other human coronavirus or influenza, expert opinions and clinical experiences are shared and debated in formulation of this biologic consensus guideline.

Skin eruption induced by dieting – an underdiagnosed skin disease in Malaysia

@#Prurigo pigmentosa is an inflammatory dermatosis characterized by a pruritic, symmetrically distributed erythematous papular or papulo-vesicular eruption on the trunk arranged in a reticulated pattern that resolves with hyperpigmentation. It is typically non-responsive to topical or systemic steroid therapy. The exact etiology is unknown, but it is more commonly described in the Far East countries. Dietary change is one of the predisposing factors. We report on nine young adult patients with prurigo pigmentosa, among whom five were on ketogenic diets prior to the onset of the eruptions. All cases resolved with oral doxycycline with no recurrence. We hope to improve the awareness of this uncommon skin condition among general practitioners and physicians so that disfiguring hyperpigmentation due to delayed diagnosis and treatment can be avoided.

Comparison of the efficacy and safety of Sungai Buloh Augmented Multiple Drug Therapy (SBA-MDT) and the World Health Organisation Multiple Drug Therapy (WHO-MDT) in the Treatment of Leprosy in Malaysia

Background Multiple drug therapy for leprosy has been in use in Malaysia since 1985. The SBAMDT is a modified WHO-MDT with an initial intensive phase and a longer duration of treatment. Objective The aim of the study is to compare the efficacy and safety of SBA-MDT against WHOMDT in the Treatment of Leprosy in Malaysia. Methodology A retrospective study was conducted between 1985 and 2009 in thirteen Malaysian dermatology centres. Data collected were analysed for comparison of relapse rates, compliance rates and adverse drug effects between the 2 regimes. Results A total of 1113 patients were included, of which 966 patients completed the SBA-MDT and 147 patients completed the WHO-MDT. Both the MDT regimes had a treatment failure rate of less than 2%. The relapse rate was 1.7% with SBA-MDT and 1.4% with WHO-MDT (p = 0.79). For multibacillary leprosy, the relapse rates were 0.9% with the former and 0 with the latter (p = 0.32). For paucibacillary leprosy, it was 3.1% and 5.0% respectively (p = 0.52). Patients on SBA-MDT had higher type 1 (16.1% vs. 8.8%, p = 0.03) and type 2 lepra reactions (19.2% vs. 6.1%, p < 0.001). Similarly, those on SBA-MDT also had higher rate of severe adverse drug reactions (11.1% vs. 5.6%, p = 0.01). Conclusion Both the SBA-MDT and the WHO-MDT regimes were effective in inducing clinical remission. Incidence of lepra reactions and severe adverse drug reactions were higher in patients with SBA-MDT.