Correlation of IL36RN and CARD14 mutations with clinical manifestations and laboratory findings in patients with generalised pustular psoriasis.

Background Generalized pustular psoriasis (GPP) is a chronic disease associated with genetic factors related to mutations of the interleukin 36 receptor antagonist gene (IL36RN) and the caspase recruitment domain 14 gene (CARD14). However, the relevance of these mutations to the clinical features and severity of GPP remains unclear. Aims Our objective was to correlate the presence of IL36RN and CARD14 mutations with the clinical and laboratory findings in patients with GPP. Methods This cross-sectional descriptive study was conducted in 64 subjects with GPP. Clinical manifestations were recorded and the severity was graded as mild, moderate, or severe. Routine laboratory tests were performed and blood samples were collected for Sanger sequencing. The clinical data of patients were compared among the different mutation groups. Results The two main variants of IL36RN were c.115+6T > C (p.Arg10ArgfsX1) and c.227C > T (p.Pro76Leu). The major CARD14 mutations were c.2458C > T (p.Arg820Trp), c.1641C > T (p.Arg547Ser), and c.1753G > A transitions. Provocative factors were uncommon in the group with both IL36RN and CARD14 mutations. Drugs (unspecified), especially herbals, were the most common triggers. A history of psoriasis was frequent in patients with only CARD14 mutations, but fever was uncommon. The c.1641C > T mutation was associated with leukocytosis > 15000/mm3 and the c.1753G > A mutation was associated with hypoalbuminemia <3.8g/dL. Both the c.115+6T > C and c.227C > T variants of IL36RN were associated with fever ≥38.5°C while the c.115+6T > C variant was also associated with geographic tongue. No gene mutations were associated with the total severity and severity grades. Limitations Four patients without the two major IL36RN mutations were excluded from the study. Conclusion The presence of IL36RN and CARD14 mutations were associated with a history of psoriasis, various provocative factors, fever, leukocytosis, hypoalbuminemia, and geographic tongue. Further studies to explore the role of these mutations in therapeutic efficacy and disease outcomes are necessary.

In Vitro Antibiotic Resistance in Bacterial Infected Eczema at Ho Chi Minh City Hospital of Dermatology.

BACKGROUND: Infected eczema is one of the most common complications of eczema. The progression and treatment of infected eczema have become more complex and difficulty due to the antibiotic resistance of bacteria and the abuse of antibiotics in treatment. AIM: Our research was conducted with the aim of investigating the severity of in vitro antibiotic resistance in patients with bacterially infected eczema at Ho Chi Minh City Hospital of Dermatology. METHODS: We studied 40 cases of patients, suffering from atopic dermatitis, contact dermatitis, vesicular palmoplantar eczema, with positive results of infected eczema. RESULTS: S. aureus accounted for 82.5%, followed by S. epidermidis (15%), P. aeruginosa (12.5%), S. pyogenes (5%) accounted for a small percentage. E. coli (2.5%) and M. morganii (2.5%) accounted for the lowest percentage. Both MSSA and MRSA were completely resistant to penicillin. MRSA is completely resistant to penicillin, erythromycin, and cefuroxime, highly resistant to clindamycin (82.35%). Our research showed that Pseudomonas aeruginosa was not resistant to a variety of antibiotics. It was completely resistant to tetracycline, trimethoprim/sulfamethoxazole (100%). Most bacteria are highly sensitive to linezolid, vancomycin as other studies in the world shown. There are also rifampicins, pristinamycin. Hence, it`s prioritised to be used for only patients with eczema infected with multidrug-resistant bacteria. CONCLUSION: Penicillin is not recommended for the treatment for infected eczema. Linezolid, vancomycin has a high sensitivity to bacteria including multidrug-resistant bacteria like MRSA.

Efficacy of Oral Isotretinoin in Combination with Desloratadine in the Treatment of Common Vulgaris Acne in Vietnamese Patients.

AIM: To evaluate the efficacy of oral isotretinoin used alone and in combination with desloratadine in the treatment of moderate acne vulgaris. METHODS: A comparative clinical trial was undertaken to evaluate the efficacy of oral isotretinoin alone and in combination with desloratadine in the treatment of 62 moderate acne vulgaris patients. Patients were randomised into two groups with 31 patients in each group. Each studied group's patient took 20 mg isotretinoin and 5 mg desloratadine per day. In the control group, patients took only 20 mg isotretinoin per day. The treatment time was 16 weeks. The evaluation and follow-up were done at week 2, 4, 8, 12 and 16 of the treatment. RESULTS: The studied group had a better curative rate than the control group (45.2% versus 22.6%). The average number of inflammatory lesions in the studied group was significantly lower than the control group (0.19 versus 0.94). The mean GAGS score of the studied group was significantly lower than the control group (3.71 versus 6.52). Acne outbreaks rate of the studied group was lower than the control group (in week 2: 22.6% versus 45.2% and in week 4: 16.1% versus 38.7%, respectively). The rate of itchy was lower in the studied group. CONCLUSION: In the treatment of moderate acne vulgaris, oral isotretinoin in combination with desloratadine is more effective and has fewer side effects than using isotretinoin alone.

Efficacy of Narrow - Band UVB Phototherapy versus PUVA Chemophototherapy for Psoriasis in Vietnamese Patients.

BACKGROUND: Psoralen UVA (PUVA) and narrow-band UVB (NBUVB) chemophototherapy are treatment options for psoriasis. AIM: To compare the effectiveness of NBUVB with PUVA in Vietnamese psoriasis patients. METHODS: We conducted a non-randomized trial on 60 patients with plaque-type psoriasis (30 NBUVB, 30 PUVA). Both regimens were thrice-weekly. The extent of lesion was assessed by the Psoriasis Area Severity Index (PASI). Clearance was defined as a ≥ 75% reduction in a follow-up PASI score from baseline. Patients with clearance were followed-up until 6 months after stopping treatment. Relapse was defined as 50% or more of the original extent. RESULTS: The proportion of patients achieving PASI75 was comparable (76.7% in NBUVB versus 80% in PUVA; p > 0.05). Patients in both groups had a similar number of sessions to achieve clearance but patients in the PUVA group exposed to a significantly higher cumulative UV dose. After six months, the relapse rate was higher in the NBUVB group compared with in the PUVA group (p > 0.05). CONCLUSION: Thrice weekly NBUVB is as effective as thrice weekly PUVA in treating psoriasis for Vietnamese patients.

Antifungal Susceptibility of Dermatophytes Isolated From Cutaneous Fungal Infections: The Vietnamese Experience.

AIM: Evaluate the resistance of dermatophytes to systemic antifungal drugs in the Vietnamese population. METHODS: We enrolled 101 patients with cutaneous dermatophytosis at the Dermato-Venereology hospital in HCMC from August 2016 to March 2017. All the specimens were subjected to direct examination (10% KOH mount) and culture on Sabouraud dextrose agar. In vitro antifungal sensitivity testing was done on species isolated from a culture with broth microdilution method. RESULTS: Direct microscopy was positive for dermatophytes in all patients. However this pathogen was found in fungal cultures in only 61.38% of patients. The main causative agent isolated was Trichophyton spp. (90.3%), followed by Microsporum spp. (8%) and Epidermophyton spp. (1.7%). Trichophyton spp. Has shown resistance to fluconazole, griseofulvin, ketoconazole, and itraconazole in 92.9%, 46.4%, 5.4% and 1.8% of strains, respectively. All Microsporum spp. Strains were found resistant to fluconazole and griseofulvin while resistance to ketoconazole was demonstrated in only 20% of strains and none of them was resistant to itraconazole. Epidermophyton spp strains were all resistant to fluconazole, griseofulvin, ketoconazole while none of them was resistant to itraconazole. CONCLUSION: Based upon our results, Itraconazole shows the greatest probability of efficacy in the treatment of cutaneous dermatophytosis in Vietnamese patients.

Superantigens of Staphylococcus Aureus Colonization in Atopic Dermatitis and Treatment Efficacy of Oral Cefuroxim in Vietnamese Patients.

BACKGROUND: Atopic dermatitis (AD) is a common, chronic, relapsing, genetically determined inflammatory skin disorder. Staphylococcus aureus (S. aureus) plays an important role in the pathogenesis of AD. Atopic skin is susceptible to infection with S. aureus. AIM: This study was aimed to compare the skin S. aureus colonisation status and its secretion of superantigens in adult AD and healthy subjects and to evaluate the efficacy of two treatment regimens (oral cefuroxime plus topical betamethasone dipropionate 0.05% versus topical betamethasone dipropionate 0.05%) in AD patients. METHODS: A group of 128 AD and 40 healthy subjects were recruited in this study and treatment efficacy was assessed by the SCORAD score. RESULTS: S. aureus was found in skin lesions in 83.8% of AD patients while only 37.5% of healthy subjects possessed this kind of bacteria in the external nares (p < 0.001). Superantigen production was more common in S. aureus strains isolated from AD than the control group (58.6% versus 6.6%, p = 0.0006) and staphylococcal enterotoxin B was predominant (88.89%). 68 AD patients who had positive cultures with S. aureus were included in a clinical therapeutic trial. The isolated bacteria were all sensitive to cefuroxime. Patients were randomised to receive either oral cefuroxime 500 mg b.i.d. Plus topical betamethasone dipropionate 0.05% twice daily for 2 weeks (so-called group 1, 36 patients) or only topical betamethasone dipropionate 0.05% twice daily for 2 weeks (so-called group 2, 32 patients). The mean SCORAD scores of group 1 at baseline and after 1 and 2 weeks of treatment were 44.61, 26.69 and 16.61, respectively. The corresponding values for group 2 were 43.03, 32.53 and 23.41, respectively. CONCLUSION: The reduction in SCORAD scores was significantly higher in group 1 than group 2 in comparison to the baseline value of each study group (p = 0.003 after 1 week and p < 0.001 at the end of treatment).

The Decline of PUVA Therapy in Vietnam: Effective Treatment of Narrow Band UVB in Vietnamese Vitiligo Patients.

AIM: To examine the efficacy and safety of Narrowband ultraviolet B (NB-UVB) in Vietnamese vitiligo patients. METHODS: We recruited thirty-one patients (14 males, 17 females), aged from 7 to 67 years, with both segmental vitiligo (SV) and non-segmental vitiligo (NSV), treated three times weekly with NB-UVB. The starting dose for adults from 15 years old and children less than 15 years old was 200 mJ/cm2 and 150 mJ/cm2, respectively, with 50 mJ/cm2 and 20 mJ/cm2 dose increments at each subsequent visit, respectively, until mild erythema lasting less than 24 hrs reported by patient, given for a period of 6 months. Response to therapy was assessed based on VASI score changes. RESULTS: Based upon our results, 38.7% (12/31) of patients achieved a very good response of more than 50% VASI changes, 41.9% (13/31) obtained a good response (VASI changed from 25 to 50%). Total good and very good response to therapy significantly increased with prolonged treatment, increasing from 19.4% to 64.5% and 80.6% after 2, 4 and 6 months, respectively. Localised NSV patients obtained good and very good response significantly more frequently than generalised NSV (55.6% versus 18.2%). Adverse effects were minimal, of which one case developed herpes simplex, and 4 cases reported mild photo burn reaction which completely disappeared after adjusting the dose. CONCLUSION: NB-UVB therapy is an effective and safe tool in the management of Vietnamese vitiligo patients.

The Efficacy of a Two-Fold Increase of H1-Antihistamine in the Treatment of Chronic Urticaria - the Vietnamese Experience.

BACKGROUND: Chronic urticaria, a mast cell-driven condition, is common, debilitating and hard to treat. H1-antihistamines are the first line treatment of chronic urticaria, but often patients do not get satisfactory relief with the recommended dose. European guidelines recommend increased antihistamine doses up to four-fold. AIM: We conducted this study to evaluate the efficacy of increased H1-antihistamine doses up to two-fold in Vietnamese chronic urticaria patients. METHODS: One hundred and two patients with chronic urticaria were recruited for treatment with levocetirizine (n = 52) or fexofenadine (n = 50). Treatment started at the conventional daily dose of 5 mg levocetirizine or 180 mg fexofenadine for 2 weeks and then increased to 10 mg levocetirizine or 360 mg fexofenadine for 2 weeks if patients did not have an improvement in symptoms. At week 0, week 2 and week 4 wheal, pruritus, size of the wheal, total symptom scores, and associated side-effects were assessed. RESULTS: With the conventional dose, the total symptom scores after week 2 decreased significantly in both groups compared to baseline figures, i.e. 7.4 vs 2.3 for levocetirizine group and 8.0 vs 2.6 for fexofenadine group (p < 0.05). However, there were still 26 patients in each group who did not have improvements. Of these 26 patients, after having a two-fold increase of the conventional dose, 11.5% and 38.5% became symptom-free at week 4 in levocetirizine group and fexofenadine group, respectively. At week 4 in both groups, the total symptom scores had significantly decreased when compared with those at week 2 (2.8 ± 1.5 versus 4.7 ± 1.6 in levocetirizine group; 2.1 ± 1.9 versus 5.1 ± 1.4 in fexofenadine group). In both groups, there was no difference in the rate of negative side effects between the conventional dose and the double dose. CONCLUSION: This study showed that increasing the dosages of levocetirizine and fexofenadine by two-fold improved chronic urticaria symptoms without increasing the rate of negative side effects.

The Effectiveness of Oral Mini-Pulse Methylprednisolonein - the Treatment of Alopecia Areata in Vietnam.

BACKGROUND: Systemic corticosteroid is used to treat alopecia areata, but it is associated with side effects. Mini-pulse therapy is thought to be effective but able to reduce side effects. AIM: The study aimed to evaluate the effectiveness of oral mini-pulse methylprednisolone in the treatment of alopecia areata. METHODS: Patients received methylprednisolone 16 mg orally for 2 consecutive days every week. RESULTS: After 3 months, among patients, 40% recovered well, and 55.6% recovered fairly. After 6 months, 82.2% recovered well, 17.8% recovered fairly. No adverse events were detected, and the recurrence rate was low (2.2%). CONCLUSION: Oral mini-pulse methylprednisolone therapy is an effective and safe therapeutic option for alopecia areata without side effects, and the time of the treatment is short.

The Relationship between HLA-B27, HLA-Cw06, HLA-DR7 and Psoriatic Arthritis in Vietnamese Patients: Disease Progression and Therapeutic Burden.

We conducted a prospective, cross-sectional study at Ho Chi Minh City Hospital of Dermato Venereology from January 2016 to March 2017 in 40 psoriatic arthritis (PsA) patients to evaluate the disease progression and therapeutic burden about the HLA patterns. Based upon our results, PsA with HLA-B27 (+) had a threat of severe arthritis. PsA with HLA-Cw06 (+) had a higher risk of earlier onset and shorter duration for plaque psoriasis to transform into PsA. HLA-DR7 (+) in PsA delayed the time for conversion from plaque psoriasis into PsA. These findings are quite similar to other studies in the literature.