Ocular toxicity of chloroquine among Thai patients.

BACKGROUND: Chloroquine has been prescribed for the treatment of various diseases. The most serious side-effect of chloroquine is retinopathy. The frequency of occurrence of retinopathy varies from 0.001 to 40% depending on the criteria used. The purpose of this study was to evaluate the incidence of ocular toxicity from chloroquine treatment among Thai patients. METHODS: A retrospective study was carried out in patients treated with chloroquine at Ramathibodi Hospital over the past 10 years (1987-1997). Patients eligible for review were followed by ophthalmic examination by an ophthalmologist for at least 6 months after starting treatment. RESULTS: One hundred and fifty-five patients were studied. Nineteen were men and 136 were women. They ranged in age from 10 to 70 years. Most patients received 250 mg of chloroquine per day. The duration of treatment varied from 6 months to 14 years, and the cumulative dose of chloroquine ranged from 26 to 1771 g. Fourteen patients (9%) had only corneal deposition, while 22 (14.2%) developed retinopathy. There were no correlations between corneal deposits or retinopathy and age, sex, duration of treatment, or cumulative dose of chloroquine. CONCLUSIONS: The present study confirms the finding reported by Mackenzie (Am J Med 1983; 75 (Suppl 1A): 40-45) that retinopathy is not related to the duration of treatment and cumulative dose of chloroquine. Based on our finding that retinopathy can be detected as early as 9 months after starting chloroquine therapy, we recommend routine ophthalmic examination before treatment and every 6 months thereafter.

Hormonal profiles and prevalence of polycystic ovary syndrome in women with acne.

One of the important etiologic factors in acne is an increase in sebaceous gland activity, which is androgen dependent. Acne is a common manifestation of hyperandrogenemia. Therefore, acne may not only cause cosmetic concern but may also be a sign of underlying disease. In females, the most common cause of hyperandrogenemia is polycystic ovary syndrome (PCOS). The purpose of this study was to determine the hormonal profiles of women with acne and the prevalence of PCOS in women attending the dermatological clinic with acne problems. The diagnostic criteria of PCOS were clinical findings of menstrual disturbances and hyperandrogenism (acne, seborrhea, hirsutism), pelvic ultrasound imaging of PCO (multiple subcapsular ovarian cysts 2-8 mm. in diameter, with dense echogenic stroma), and an elevated luteinizing hormone (LH) to follicle stimulating hormone (FSH) ratio. There were 51 women with acne; 20 regularly menstruating volunteers without acne served as a control group. PCOS was found in 19 out of 51 patients with acne (37.3%) and none of the control group. Twenty acne patients had abnormal menstruation (39.2%). Acne cases had higher mean levels of serum total testosterone (T), free T, dehydroepiandrosterone sulfate (DHEAS) and prolactin (PRL). No statistically significant difference was observed for LH, FSH or sex hormone binding globulin (SHBG). Because of this high prevalence of PCOS in women with acne, all women presenting with acne should be asked about their menstrual pattern and examined for other signs of hyperandrogenemia. Hormonal profile determination as well as pelvic ultrasonography for ovarian visualization should be performed to confirm the diagnosis of PCOS in female acne patients who have menstrual disturbances.

Clinical and histopathological features of secondary syphilis.

Fifty-four patients with secondary syphilis were studied in regard to the clinical manifestations, response to treatment and histopathology of the skin lesions. The correlation between the skin lesions and histopathology, between the duration of skin lesions and VDRL titer, between type of skin lesions and VDRL titer were also determined. The clinical manifestations varied from macular, maculopapular, papular, papulosquamous and urticarial lesions. The hair loss usually occurred on the scalp, but the eyebrows or even total body hair loss could occur. The response to treatment was good, only one patient relapsed. The histopathology was related to the clinical manifestations, there was sparse inflammatory cell infiltration in the dermis in macular lesions, but more dense infiltration as well as more epidermal change in papular and papulosquamous lesions. There were significant correlation between the duration of skin lesions and VDRL titer, but no correlation between types of skin lesions and VDRL titer.

Topical steroid induced chronic demodicidosis.

We report a 39-year-old female patient who developed pruritic erythematous telangiectatic patches with scaly follicular papules on the neck and upper chest for 4 years. Ten per cent potassium hydroxide preparation of skin scrapings revealed Demodex folliculorum. Histology showed three Demodex mites in one of the hair follicles. She was treated with a topical steroid without improvement. The skin lesions and Demodex mite disappeared after a single application of 1 per cent gamma benzene hexachloride but twice daily application of 1 per cent gamma benzene hexachloride for 2 weeks was needed to prevent recurrence.

Predictive patch testing of "Medigloves" on humans using the repeated insult technique.

The predictive patch tests using the repeated insult technique with pieces of ETO sterilized "Medigloves" on 200 human subjects showed negative allergic reactions in all cases. Therefore, the sensitizing potential of "Medigloves" is quite low, if any. Mild to severe forms of miliaria rubra were occasionally observed in about one fourth of the subjects during the induction and challenge periods since the weather was quite warm and humid. However, three subjects who developed more pronounced miliaria rubra on the skin underneath rubber-glove squares were selected for provocative use tests. The results were negative in all cases. A subject who showed a false-positive allergic reaction also showed negative results in a provocative use test and in patch tests with standard rubber chemicals and pieces of "Medigloves" from various batches. Occlusive patch tests for 72 hours with Mediglove pieces from the same batch used in the initial test challenge phase were repeatedly negative when performed during the cool time of the year. In tropical countries, predictive closed patch tests employing solid occlusive materials should be done during cool weather in order to prevent or minimize the occurrence of miliaria. In hot weather, this is a common source of false positive reactions.

Cutaneous leukocytoclastic vasculitis: clinical and laboratory features of 45 patients seen in Ramathibodi Hospital.

Forty-five patients with histologically proved cutaneous leukocytoclastic vasculitis were studied with regard to the clinical features, laboratory findings and etiology. There were 12 males and 33 females, with an age range of 13 to 64 years. The most common skin lesions were palpable purpura which appeared mostly on the lower part of the legs. Renal involvement was the most common systemic manifestation, which occurred in 45 per cent of the patients. Abdominal pain occurred in 42 per cent of the male patients while none of the female patients had this symptom. Arthralgia occurred in 20 per cent of the patients. The most common laboratory abnormalities were elevation of ESR, which was significantly more common in females than in males (P = 0.047). The possible etiology of leukocytoclastic vasculitis was identified in 5 patients, these included streptococcal infection in 2 patients, in the other patients the possible causes were penicillin hypersensitivity, systemic lupus erythematosus and livedoid vasculitis, respectively.

Congenital self-healing reticulohistiocytosis: report of a patient with a strikingly large tumor mass.

A newborn male Thai infant had numerous brownish red nodules of various sizes scattered over both palms and soles, left thigh, abdomen, chin, and left upper eyelid. An extremely large tumor mass was present on the right sole. Many lesions showed spontaneous ulceration. No extracutaneous involvement was found. All lesions involuted spontaneously within two to three months, some with scar formation. Histology showed large numbers of mononucleated and multinucleated histiocytic cell infiltrations, 10% of which contained Birbeck's granules. Areas of necrosis and calcification were also seen in the largest tumor. No recurrence was observed after follow-up for three years.

Prospective study of cutaneous drug reactions.

One hundred and seventy-five patients with cutaneous drug reactions were studied with regard to age, sex, possible causative drugs and clinical course of the reactions. The age of the patients ranged from 3 to 78 years old, with the common occurrence between the age of 20 to 30 years. Females outnumbered males at a proportion of 1.8:1. The maculopapular rash was the most common reaction, which accounted for 42.9 per cent of the patients. Fixed drug eruption and Stevens-Johnson syndrome were the second and third common occurrences. The eruptions were attributed to 45 drugs, the three most common causative drugs were ampicillin, penicillin and trimethoprim-sulphamethoxazole. Ampicillin was the most common drug that caused maculopapular rash whereas tetracycline and trimethoprim-sulphamethoxazole were responsible for fixed drug eruption and Stevens-Johnson syndrome respectively. The drug eruption occurred within a few minutes to 3 weeks of beginning therapy. The eruptions lasted from 3 to 30 days depending on the type of reactions.

Short-course multi-drug therapy for leprosy patients.

Short-course multi-drug therapy for leprosy patients was evaluated in terms of effectiveness, recurrence rate and side effects. Of the 108 patients studied, 48.1 per cent defaulted. This MDT appeared to be quite effective in controlling leprosy. The medication could be stopped at 6 months in 83 per cent of the paucibacillary patients. The medication was continued further in 17 per cent of paucibacillary patients because of persistent skin lesions clinically and histopathologically. Recurrence occurred in 2.3 per cent of the paucibacillary patients. The effect of this regimen for multibacillary patient is difficult to evaluate because of the small number of patients studied. Side effects of this regimen occurred in 5.4 per cent of the patients. Leprosy reaction occurred in two patients with borderline lepromatous leprosy.

Nail involvement in histiocytosis X. A 12-year retrospective study.

A retrospective study of nail involvement was made in 15 cases of histiocytosis X (HX). These included seven cases of Letterer-Siwe (LS) disease, four cases of Hand-Schüller-Christian disease, and four cases of eosinophilic granuloma seen at Ramathibodi Hospital, Bangkok, Thailand, during the years 1970 to 1981. Nail involvement was found in three patients with LS disease, two of whom showed fingernail and toenail dystrophy with onycholysis and subungual hyperkeratosis. Paronychial erythema and swelling with small pustules underneath some nails were seen in both of the latter patients. The remaining patient showed subungual purpura of all fingernails and toenails with slight thickening of some fingernails. The nail changes in one patient responded well to cytotoxic therapy but recurred when the disease progressed. Nail involvement seems to be one of the unfavorable prognostic signs in HX.