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'Pai Syndrome' with anterior alveolar polyp: A variant of a rare clinical entity

Debnath KK, Kanapaty Y, Yong DJ, Chandran S, Bakri A

Med J Malaysia, 2019 Jun;74(3):229-230.
PMID: 31256179

'Pai syndrome' (PS) is a rare congenital syndrome. Presented here, a new-born baby-girl who exhibited the characteristic features of having a midline nasal (septal) polyp, an anterior alveolar process polyp, and a pericallosal lipoma associated with corpus callosum dysgenesis of the brain. Both polyps were lined with stratified-squamous epithelium. The overall features were largely consistent with those described by Pai et al., in 1987. A midline cleft-lip (with or without cleft-alveolus) is one of the most common features of the syndrome which was however absent in this case. Instead, an anterior alveolar polyp is present, which is relatively rare.

Matched MeSH terms: Skin Diseases
Fulltext A Prospective Survey of Skin Manifestations in Children With Inborn Errors of Immunity From a National Registry Over 17 Years

Al-Herz W, Zainal M, Nanda A

Front Immunol, 2021;12:751469.
PMID: 34659256 DOI: 10.3389/fimmu.2021.751469

Background and Objectives: Reports on skin manifestations in inborn errors of immunity (IEI) are based on retrospective analysis, small series, or isolated case reports. The present prospective study aimed to determine the spectrum of skin manifestations in children with IEI and their relevance to specific molecular defects.
Materials and Methods: The data were obtained from the Kuwait National Primary Immunodeficiency Disorders Registry during the period of 2004-2020.
Results: A total of 313 pediatric cases of IEI, 71% diagnosed at molecular level, were registered with a cumulative follow-up period of 29,734 months. Skin manifestations were seen in 40.3% of the patients, and they were among the presenting manifestations in 33%. Patients with skin manifestations were older at both onset and diagnosis ages of IEI symptoms, but this was statistically significant for the latter only. The diagnosis delay was significantly longer in patients with skin manifestations. There was a statistically significant association between having skin manifestations and IEI category, being more common in patients with complement deficiencies, combined immunodeficiencies, and diseases of immune dysregulation. There was no statistically significant association between having skin manifestations and both gender and survival. Skin infections were the most frequent manifestations followed by eczema and autoimmune associations. Among IEI with more than 10 cases, skin lesions were a consistent finding in dedicator of cytokinesis 8 (DOCK8) deficiency, hyper IgE syndrome, ataxia-telangiectasia, and recombination activation gene (RAG)1 deficiency.
Conclusions: Skin manifestations are common in IEI patients, and they had significant diagnosis delay and referral to specialists. Improvement of awareness about IEI is needed among pediatricians and dermatologists.

Matched MeSH terms: Skin Diseases/epidemiology*
Fulltext A case of pustular psoriasis in a young boy

Meera Kuppusamy, Tarita Taib

Journal of Clinical and Health Sciences, 2017;2:39-42.

We report a case of a 13-year-old boy who presented with acute onset of generalised erythematous skin and patchy areas of pustules for one week duration. He was well until one month ago when he started having small scaly plaques on his scalp and extensors of his legs. During the acute episode, he also had joint pain and bilateral conjunctivitis. Skin biopsy confirmed pustular psoriasis. He developed leucocytosis and transaminitis during the acute phase of the pustular eruption while on acitretin, which was then withheld. Subsequently, treatment with oral cyclosporine induced remission of his skin and joint disease. The case is hereby reported because of rarity of presentation and clinical features. Oral cyclosporine should be considered in patients with generalised pustular psoriasis complicated with transaminitis.

Matched MeSH terms: Skin Diseases, Vesiculobullous
Fulltext A case of pustular psoriasis in a young boy

Meera Kuppusamy, Tarita Taib

Journal of Clinical and Health Sciences, 2017;2(1):39-42.
MyJurnal

We report a case of a 13-year-old boy who presented with acute onset of generalised erythematous skin and patchy areas of pustules for one week duration. He was well until one month ago when he started having small scaly plaques on his scalp and extensors of his legs. During the acute episode, he also had joint pain and bilateral conjunctivitis. Skin biopsy confirmed pustular psoriasis. He developed leucocytosis and transaminitis during the acute phase of the pustular eruption while on acitretin, which was then withheld. Subsequently, treatment with oral cyclosporine induced remission of his skin and joint disease. The case is hereby reported because of rarity of presentation and clinical features. Oral cyclosporine should be considered in patients with generalised pustular psoriasis complicated with transaminitis.

Matched MeSH terms: Skin Diseases, Vesiculobullous
Fulltext A pilot school health survey to study the incidence of common disorders in primary school children and the role of teachers in the school health service

Ayyamani UD

Med J Malaysia, 1986 Mar;41(1):4-11.
PMID: 3796347

Selected students were subjected to a general health appraisal including vision and hearing tests by teachers, nurses and finally a medical officer. The findings of all three examiners were then compared taking the results of the medical officer as the indicator of accuracy. The findings of the survey indicated that the problems of school children were similar to those reported by other workers and by MCH Division of the Ministry of Health namely dental caries, head lice, malnutrition, skin infections and visual disability. Other problems like skeletal deformity and abnormalities of heart, lung, speech and behaviour were extremely uncommon and formed only 1.5% of the total. Teachers and nurses performed extremely well in relation to the doctor with 93% and 95.8% concurrence respectively in detecting these abnormalities. Teachers were also requested to give a feedback on their view of and role in the SHS as well as problems faced in following the school health card. The majority perceived the SHS as a joint effort between the Ministry of Health and Education and agreed that they had a role to play in the SHS. Many teachers also indicated a willingness to carry out the various tasks in the SHS. The main problem in filling the school health card seemed to be in getting relevant details from parents though over 50% of teachers complained that there were too many details to fill. The role of teachers in the SHS is discussed in the light of the findings of the study and recommendations are made.

Matched MeSH terms: Skin Diseases, Infectious
Fulltext A rare case of a subcutaneous phaeomycotic cyst with a brief review of literature

Manoharan M, Shanmugam N, Veeriyan S

Malays J Med Sci, 2011 Apr;18(2):78-81.
PMID: 22135592

Phaeohyphomycosis consists of a heterogeneous group of fungal infections caused by more than 80 genera and species. Subcutaneous infection usually follows traumatic implantation of a fungus by a wooden splinter that the fungus inh abits as a saprophyte. The growth of the fungus forms verrucous plaques or a painless subcutaneous abscess. We report a subcutaneous cyst (phaeomycotic cyst) in the leg of a 60-year-old woman that developed after a thorn prick at that site. With the provisional diagnosis of an epidermoid cyst, she was treated with a simple excision of the cyst. However, histopathological examination of the cyst revealed the typical features of fungus, and a definitive diagnosis of a phaeomycotic cyst was made. As the infective aetiology was not considered clinically, the specimen was not sent for microbiological culture, and hence the exact species was not identified. As the lesion was localised, simple excision was sufficient treatment, and no recurrence was observed during 12 months of follow-up.

Matched MeSH terms: Skin Diseases
A retrospective survey of mucocutaneous manifestations of HIV infection in Malaysia: analysis of 182 cases

Jing W

J Dermatol, 2000 Apr;27(4):225-32.
PMID: 10824485

A retrospective analysis of 182 HIV positive Malaysians was done in two centers, the University Hospital Kuala Lumpur (UHKL) and the General Hospital Kuala Lumpur (GHKL) from March 1997 to February 1998. Demographic and clinical data were analyzed. The analysis showed that 130 out of 182 patients had mucocutaneous disorders (71.4%). In the study there were 125 males (96.2%) and 5 females (3.8%). The majority of the patients were in the age group from 20 to 50 years. The patients who presented with mucocutaneous disease also had low CD4+ T lymphocyte counts, and most of them had AIDS defining illnesses. The number of cases with generalized hyperpigmentation was very high (35.7%), followed by papular eruptions (29.1%) and xerosis (27.5%). Seborrheic dermatitis was seen in 19.2% of the cases and psoriasis in 7.7%. The most common infections were oral candida 35.7%, tinea corporis and onychomycosis 9.9%, and herpes infection 4.3%. However, mucocutaneous manifestations of Kaposi's sarcoma were rare. The results suggested that mucocutaneous findings are useful clinical predictors of HIV infection or a sign of the presence of advanced HIV infection.

Matched MeSH terms: Skin Diseases/etiology; Skin Diseases/epidemiology*; Skin Diseases/pathology
A simple pharmacopoeia for out-station skin clinics

Pettit JHS

Trop Doct, 1977 Jul;7(3):107-10.
PMID: 142324
Matched MeSH terms: Skin Diseases/drug therapy*
A sinister rash in a lady with breast malignancy

Tan WF, Voo SYM

Med J Malaysia, 2021 03;76(2):275-277.
PMID: 33742647

Cutaneous metastasis may be the first presentation of an undiagnosed malignancy or a relapse of a previously treated malignancy. We describe a case of a 64-year-old lady with cutaneous metastases from breast carcinoma, who presented with two uncommon rash morphology-carcinoma erysipeloides (CE) and annular erythema. Histopathological examination showed infiltration of neoplastic cells in the dermal lymphatics and staging CT showed distant metastases. She is currently on palliative chemotherapy. A high index of suspicion and early referral to a dermatologist is crucial for early diagnosis for a patient who presents with an inflammatory skin lesion that is refractory to treatment, particularly if the patient has a previous history of malignancy.

Matched MeSH terms: Skin Diseases, Genetic
A study of haemolytic streptococci isolated from outpatients in dermatological clinics

Murai T, Inazumi Y, Nishiwaki M, Noda Y, Hino H

Kansenshogaku Zasshi, 1991 Aug;65(8):960-9.
PMID: 1919131

A total of 44 patients suspected of streptococcal infections were studied in outpatient clinics in Tokyo during the one year from December 1988 to December 1989. Employing bacteriological culturing and serodiagnosis, the following results were obtained. 1) There were 9 cases of impetigo and 15 cases of erysipelas with typical clinical manifestations and age distributions. 2) It seemed that some of the skin infections were caused by group A streptococci whose M-types were different from those of upper respiratory infections typically occurring in Japan. 3) The type distribution of group A streptococci found were quite similar to those isolated in Thailand or Malaysia. 4) There were found group A streptococci exhibiting unique combinations of T- and M-types, such as T11 and M9, T11 and M62 or T13-49 and MOD8 (Provisional type). 5) As for serodiagnostic method, ADNB (anti-deoxyribonuclease B) titer reflected infection by group A streptococcus only, while ASK (anti-streptokinase) and ASO (anti-streptolysin O) reflected not only group A streptococcal infections but group G infections as well.

Matched MeSH terms: Skin Diseases, Infectious/microbiology*
A subcutaneous retro-auricular abscess in a Dyak boy in Sarawak, probably caused by a trematode of the genus Poikilorchis, Fain and Vandepitte, 1957

LIE KJ, WILLIAMS HI, MIYAZAKI I, WONG SK

Med J Malaya, 1962 Sep;17:37-40.
PMID: 13930508
Matched MeSH terms: Skin Diseases*
Fulltext A woman with persistent fever and a skin lesion

Tai KS, Das Gupta E

Aust J Gen Pract, 2018 08;47(8):535-536.
PMID: 30114881
Matched MeSH terms: Skin Diseases
Fulltext Acute Wound Healing Potential of Marine Worm, Diopatra claparedii Grube, 1878 Aqueous Extract on Sprague Dawley Rats

Che Soh N', Rapi HS, Mohd Azam NS, Santhanam RK, Assaw S, Haron MN, et al.

Evid Based Complement Alternat Med, 2020;2020:6688084.
PMID: 33488747 DOI: 10.1155/2020/6688084

Diopatra claparedii which is colloquially known as Ruat Sarung can be found along the west coast of Peninsular Malaysia. The species has a unique ability to regenerate anterior and posterior segments upon self-amputation or injury, thus having potential as a wound healing promoter. In this study, the wound healing potential of D. claparedii aqueous extract on acute wound model in rats was revealed for the first time. Various concentrations (0.1%, 0.5%, and 1.0% w/w) of D. claparedii ointment were formulated and tested on Sprague Dawley rats through topical application on full-thickness skin wounds for 14 days. The wound healing effects were investigated via behaviour observation, wound contraction, and histopathological analysis. Quality assessment was performed via skin irritation test, microbial contamination test (MCT), and heavy metal detection. The study also included test for antibacterial activities and detection of bioactive compounds in D. claparedii. One percent of D. claparedii ointment showed rapid wound healing potential with good soothing effects and more collagen deposition in comparison to the commercial wound healing ointments such as acriflavine (0.1% w/v) and traditional ointment gamat (sea cucumber extract) (15.0% w/v). No local skin irritation, microbial contamination, and insignificant concentration of heavy metals were observed, which indicate its safe application. Moreover, the aqueous extract of D. claparedii exhibited antibacterial activities against Escherichia coli and Pseudomonas aeruginosa with minimum inhibitory concentration (MIC) value at 0.4 g/ml. 1H NMR analysis of the aqueous extract of D. claparedii revealed some metabolites that might be responsible for its wound healing properties such as amino acids, halogenated aromatics, organic acids, vitamins, and others. Altogether, these results suggested that the aqueous extract of D. claparedii could be utilised as an alternative natural wound healing promoter.

Matched MeSH terms: Skin Diseases
Fulltext An Adaptive Deep Learning Framework for Dynamic Image Classification in the Internet of Things Environment

Jameel SM, Hashmani MA, Rehman M, Budiman A

Sensors (Basel), 2020 Oct 14;20(20).
PMID: 33066579 DOI: 10.3390/s20205811

In the modern era of digitization, the analysis in the Internet of Things (IoT) environment demands a brisk amalgamation of domains such as high-dimension (images) data sensing technologies, robust internet connection (4 G or 5 G) and dynamic (adaptive) deep learning approaches. This is required for a broad range of indispensable intelligent applications, like intelligent healthcare systems. Dynamic image classification is one of the major areas of concern for researchers, which may take place during analysis under the IoT environment. Dynamic image classification is associated with several temporal data perturbations (such as novel class arrival and class evolution issue) which cause a massive classification deterioration in the deployed classification models and make them in-effective. Therefore, this study addresses such temporal inconsistencies (novel class arrival and class evolution issue) and proposes an adapted deep learning framework (ameliorated adaptive convolutional neural network (CNN) ensemble framework), which handles novel class arrival and class evaluation issue during dynamic image classification. The proposed framework is an improved version of previous adaptive CNN ensemble with an additional online training (OT) and online classifier update (OCU) modules. An OT module is a clustering-based approach which uses the Euclidean distance and silhouette method to determine the potential new classes, whereas, the OCU updates the weights of the existing instances of the ensemble with newly arrived samples. The proposed framework showed the desirable classification improvement under non-stationary scenarios for the benchmark (CIFAR10) and real (ISIC 2019: Skin disease) data streams. Also, the proposed framework outperformed against state-of-art shallow learning and deep learning models. The results have shown the effectiveness and proven the diversity of the proposed framework to adapt the new concept changes during dynamic image classification. In future work, the authors of this study aim to develop an IoT-enabled adaptive intelligent dermoscopy device (for dermatologists). Therefore, further improvements in classification accuracy (for real dataset) is the future concern of this study.

Matched MeSH terms: Skin Diseases
An industrial dermatosis due to enzyme action

Polunin I

Nature, 1951;167:442.

LABOURERS in factories in South Malaya who cut up pineapples by hand for canning invariably show an abnormality of those parts of the body which are exposed to slight pressure and pineapple juice, notably the palmar surfaces of the fingertips and the periphery of the palms. At the beginning of the canning season, the left hand, which comes more into contact with the fruit than the knife-holding hand, becomes sore and small superficial raw areas on the fingertips are often seen. Within several days, however, these heal, and the skin ceases to be sore. The labourers state that this tolerance to the pineapple juice is due to the development of an abnormality of the skin, which in the affected area becomes bluish-white and so smooth that fingerprints may be completely lost. Deep cracks are sometimes seen in the region of the skin creases. These often stay raw and bleeding for a long time, and show no clinical signs of infection, presumably because of removal of dead tissues by enzymatic action.

Matched MeSH terms: Skin Diseases
Fulltext Assessment of non-invasive techniques and herbal-based products on dermatological physiology and intercellular lipid properties

Mohd Ariffin NH, Hasham R

Heliyon, 2020 May;6(5):e03955.
PMID: 32478187 DOI: 10.1016/j.heliyon.2020.e03955

Skin is the largest external organ of the human body. It acts as a barrier to protect the human body from environmental pollution, mechanical stress, and excessive water loss. The defensive function resides primarily on top of the epidermis layer commonly known as stratum corneum (SC). Human SC consists of three major lipids, namely ceramide, free fatty acid, and cholesterol that comprise approximately 50%, 25%, and 25% of the total lipid mass, respectively. The optimal composition of SC lipids is the vital epidermal barrier function of the skin. On the other hand, skin barrier serves to limit passive water loss from the body, reduces chemical absorption from the environment, and prevents microbial infection. In contrast, epidermal lipids are important to maintain the cell structure, growth and differentiation, cohesion and desquamation as well as formation of a permeability barrier. Multiple non-invasive in vivo approaches were implemented on a regular basis to monitor skin physiological and intercellular lipid properties. The measurement of different parameters such as transepidermal water loss (TEWL), hydration level, skin elasticity, collagen intensity, melanin content, sebum, pH, and tape stripping is essential to evaluate the epidermal barrier function. Novel non-invasive techniques such as tape stripping, ultrasound imaging, and laser confocal microscopy offer higher possibility of accurate and detailed characterisation of skin barrier. To date, these techniques have also been widely used to determine the effects of herbal plants in dermatology. Herbal plants have been traditionally used for ages to treat a variety of skin diseases, as reported by the World Health Organisation (WHO). Their availability, lower cost, and minimal or no side effects have created awareness among society, thus increase the demand for natural sources as the remedy to treat various skin diseases. This paper reviews several non-invasive techniques and evaluations of herbal-based product in dermatology.

Matched MeSH terms: Skin Diseases
Bacterial biofilms associated skin disorders: Pathogenesis, advanced pharmacotherapy and nanotechnology-based drug delivery systems as a treatment approach

Vyas T, Rapalli VK, Chellappan DK, Dua K, Dubey SK, Singhvi G

Life Sci, 2021 Dec 15;287:120148.
PMID: 34785190 DOI: 10.1016/j.lfs.2021.120148

BACKGROUND: Biofilms are microcolonies of microbes that form communities with a variety of microbes, exhibit the same gene composition but differ in gene expression. Biofilm-associated infections have been in existence for a long, however, biofilm-associated skin disorders have not been investigated much.
OBJECTIVES: Biofilms, which are made mostly of the matrix can be thought of as communities of microbes that are more virulent and more difficult to eradicate as compared to their planktonic counterparts. Currently, several formulations are available in the market which have the potential to treat biofilm-assisted skin disorders. However, the existing pharmacotherapies are not competent enough to cure them effectively and entirely, in several cases.
KEY FINDINGS: Especially with the rising resistance towards antibiotics, it has become particularly challenging to ameliorate these disorders completely. The new approaches are being used to combat biofilm-associated skin disorders, some of them being photodynamic therapy, nanotherapies, and the use of novel drug delivery systems. The focus of attention, however, is nanotherapy. Micelles, solid lipid nanoparticles, quatsomes, and many others are being considered to find a better solution for the biofilm-associated skin disorders.
SIGNIFICANCE: This review is an attempt to give a perspective on these new approaches for treating bacterial biofilms associated with skin disorders.

Matched MeSH terms: Skin Diseases/drug therapy*; Skin Diseases/metabolism; Skin Diseases/physiopathology
Bactericidal effects of polyhexamethylene biguanide against intracellular Staphylococcus aureus EMRSA-15 and USA 300

Kamaruzzaman NF, Firdessa R, Good L

J Antimicrob Chemother, 2016 May;71(5):1252-9.
PMID: 26825118 DOI: 10.1093/jac/dkv474

The treatment of skin infections caused by Staphylococcus aureus is limited by acquired antibiotic resistance and poor drug delivery into pathogen and host cells. Here, we investigated the antibacterial activities of six topically used antimicrobials and a cationic polymer, polyhexamethylene biguanide (PHMB), against intracellular MSSA strain RN4420 and MRSA strains EMRSA-15 and USA 300.

Matched MeSH terms: Skin Diseases, Infectious
Black piedra in west Malaysia

Adam BA, Soo-Hoo TS, Chong KC

Australas J Dermatol, 1977 Apr;18(1):45-7.
PMID: 883925
Matched MeSH terms: Skin Diseases/microbiology; Skin Diseases/epidemiology
Book Review: Handbook of Occupational Skin Diseases

Chew SS

Family Physician, 1991;3:71-71.

Matched MeSH terms: Skin Diseases

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