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Fulltext Reported Adverse Drug Reactions in Infants: A Nationwide Analysis in Malaysia

Rosli R, Dali AF, Aziz NA, Ming LC, Manan MM

Front Pharmacol, 2017;8:30.
PMID: 28239351 DOI: 10.3389/fphar.2017.00030

Spontaneous adverse drug reactions (ADRs) reporting is a useful source of drug safety information in infants as only adult patients are routinely tested in clinical trials. This study was aimed to evaluate the spontaneously reported ADRs using WHO Adverse Reaction Terminology and to identify the common drugs associated with ADRs in children under 2 years of age. A retrospective analysis of ADR data for children below 2 years old from 2000 to 2013 was conducted using the data extracted from Malaysia's national pharmacovigilance database, QUEST2 System. From 2000 to 2013, Malaysia's National Pharmaceutical Control Bureau received a total of 11,932 reports for children from various healthcare facilities in Malaysia. 14.0% (n = 1667) of the ADRs reported for those children were related to children under 2 years old. The data retrieved was analyzed in terms of age, gender, source of reporting, type of reporters, suspected medicines and characteristics of ADRs (category, onset, severity, and outcomes). A total of 1312 ADRs reported in 907 ADR reports were analyzed. The most common ADRs reported were skin appendage disorders (60.1%), and the most frequently reported symptoms were rash (n = 215), maculopapular rash (n = 206), urticaria (n = 169), erythematous rash (n = 76), and pruritus (n = 58). In general, drugs from antibacterials for systemic use (58.8%) appeared to be the most common contributors to ADRs in children below 2 years old. Penicillins and other β-Lactam Antibacterials accounted for more than 40% of all drugs implicated in ADRs. The majority of ADRs were subacute reactions that occurred within 24 h of exposure to the drug. A high proportion of ADRs was classified as mild, and most victims had no sequela. Only one fatality was seen. There were 10 cases for each symptom, namely erythema multiforme and Stevens-Johnson Syndrome, observed in this study. A large proportion of ADRs in children under 2 years old were mainly caused by drugs from antibacterial for systemic use, with most of the ADRs manifesting in skin reactions. This study also reveals rare cutaneous ADRs experienced by Malaysian children under the age of 2, which constitutes a crucial cause of harm among children.

Matched MeSH terms: Erythema Multiforme
Fulltext An 8-Year-Old Child with Delayed Diagnosis of Netherton Syndrome

Leung AKC, Barankin B, Leong KF

Case Rep Pediatr, 2018;2018:9434916.
PMID: 29527381 DOI: 10.1155/2018/9434916

We report an 8-year-old boy with Netherton syndrome who was misdiagnosed and treated as severe atopic dermatitis. The diagnosis of Netherton syndrome was not made until the child was 8 years of age. We discuss the pitfalls in the diagnosis and alert physicians to the proper and early diagnosis of this syndrome. The child was treated with a low dose (0.25 mg/kg) of oral acitretin and a topical moisturizer with marked improvement of his skin and pruritus in 2 months. At 6-month follow-up, the skin was almost clear of erythema and scaling, and the hair was longer and stronger. The dose of acitretin was reduced to 0.12 mg/kg for another 6 months and then discontinued.

Matched MeSH terms: Erythema
Efficacy and safety of topical Trikatu preparation in, relieving mosquito bite reactions: a randomized controlled trial

Maenthaisong R, Chaiyakunapruk N, Tiyaboonchai W, Tawatsin A, Rojanawiwat A, Thavara U

Complement Ther Med, 2014 Feb;22(1):34-9.
PMID: 24559814 DOI: 10.1016/j.ctim.2013.08.014

INTRODUCTION: Trikatu is composed of dried fruits of Piper nigrum L and Piper retrofractum Vahl, and dried rhizomes of Zingiber officinale R. Although this preparation has been used to relieve pruritis, pain, and inflammation for a long time, there is no clinical evidence to confirm its efficacy and safety. Therefore, we performed a double-blind, within person-randomized controlled study of 30 healthy volunteers to determine efficacy and safety of topical Trikatu on mosquito bite reactions.
METHODS: All subjects were bitten by Aedes aegypti laboratory mosquitoes on their forearms and they were randomly assigned arms to apply either Trikatu or reference product on the mosquito bite papule. The main outcome was the difference of papule size reduction at 30 min, measured by a caliper, between the Trikatu and reference arms. Pruritis, redness, pain, and patient satisfaction were assessed at 15, 30, 60, 180, and 360 min as secondary outcomes.
RESULTS: There were no significant differences between treatment and reference arms on any outcome at any time of measurement.
CONCLUSION: Trikatu did not show additional effects for relieving mosquito bite reaction as compared with the reference product containing camphor, menthol, and eucalyptus. For further study, it is very important to consider a proper selection of subjects, comparator product, and concentration of extract when Trikatu preparation is investigated.
KEYWORDS: Eucalyptus oil; Mosquito bite; Mosquito bite symptoms; Papule size reduction; Trikatu preparation

Matched MeSH terms: Erythema/drug therapy
Smallpox vaccination: complications and present role

Balasundram R

Med J Malaya, 1972 Dec;27(2):89-94.
PMID: 4145716
Matched MeSH terms: Erythema/etiology
Fulltext A novel de novo NLRC4 mutation reinforces the likely pathogenicity of specific LRR domain mutation

Chear CT, Nallusamy R, Canna SW, Chan KC, Baharin MF, Hishamshah M, et al.

Clin Immunol, 2020 02;211:108328.
PMID: 31870725 DOI: 10.1016/j.clim.2019.108328

Autoinflammatory disorders are characterized by dysregulated innate immune response, resulting in recurrent uncontrolled systemic inflammation and fever. Gain-of-function mutations in NLRC4 have been described to cause a range of autoinflammatory disorders. We report a twelve-year-old Malay girl with recurrent fever, skin erythema, and inflammatory arthritis. Whole exome sequencing and subsequent bidirectional Sanger sequencing identified a heterozygous missense mutation in NLRC4 (NM_001199138: c.1970A > T). This variant was predicted to be damaging in silico, was absent in public and local databases and occurred in a highly conserved residue in the leucine-rich repeat (LRR) domain. Cytokine analysis showed extremely high serum IL-18 and IL-18/CXCL9 ratio, consistent with other NLRC4-MAS patients. In summary, we identified the first patient with a novel de novo heterozygous NLRC4 gene mutation contributing to autoinflammatory disease in Malaysia. Our findings reinforce the likely pathogenicity of specific LRR domain mutations in NLRC4 and expand the clinical spectrum of NLRC4 mutations.

Matched MeSH terms: Erythema/blood
Fulltext Occupational and Environmental Risk Factors Influencing the Inducement of Erythema among Nigerian Laboratory University Workers with Multiple Chemical Exposures

Reuben U, Ismail AF, Ahmad AL, Maina HM, Daud A

Int J Environ Res Public Health, 2019 04 13;16(8).
PMID: 31013942 DOI: 10.3390/ijerph16081334

: The chemicals from laboratories pose a significant risk forinducing erythema, an abnormal redness of the skin, as a result of poor occupational and environmental factors that promote hypersensitivity to a chemical agent. The aim of this present study was to determine the occupational and environmental risk factors influencing the inducement of erythema in laboratory workers due to exposure to chemicals. This was a cross-sectional study on a population-based sample of Nigerian university laboratory workers. Data were collected using the erythema index meter and an indoor air control meter. The study included 287 laboratory workers. The laboratory workers who properly used personal protective equipment (PPE) were 60% less likely to have induced erythema (adjusted odds ratio (AOR) = 0.40; 95% confidence interval CI: 0.22-0.77; probability value p = 0.011). The chemical mixture exceeding the permissible exposure limit (PEL) was found to have a small effect in inducing the erythema (AOR = 4.22; 95%CI: 2.88-12.11; p = 0.004). Most of the sampled laboratories where the respondents worked had unsuitable temperatures (AOR = 8.21; 95% CI: 4.03-15.01; p = 0.001). Erythema was more frequently found in the respondents who spent 4-5h in the laboratory (AOR = 3.11; 95%CI: 1.77-9.23; p = 0.001). However, high levels of ventilation reduce the likelihood of erythema in a laboratory by 82% (0.18). Multiple logistic regressions revealed that PPE, PEL, exposure time, temperature, and ventilation were the probable predictive factors associated with the inducement of erythema. Providing better educational knowledge and improving the attitude towards hazards and safety in a laboratory would lead to reduced rates of new cases.

Matched MeSH terms: Erythema/chemically induced*
Phytohaemagglutinin-induced lymphocyte transformation in leprosy

Nelson DS, Nelson M, Thurston JM, Waters MF, Pearson JM

Clin Exp Immunol, 1971 Jul;9(1):33-43.
PMID: 5559093
Matched MeSH terms: Erythema Nodosum/immunology
Polymorphisms in P53 and VEGFA genes in different subtypes of periorbital hyperpigmentation in a Malaysian Chinese population

Amini F, Thazin Oo NM, Okechukwu PN, Seghayat MS, Ng ESC

Australas J Dermatol, 2019 May;60(2):e99-e104.
PMID: 30215845 DOI: 10.1111/ajd.12918

BACKGROUND/OBJECTIVES: The unknown pathogenesis of periorbital hyperpigmentation makes its treatment difficult. Existing evidence links p53 and VEGFA genes with skin hyperpigmentation. This study was aimed at (i) identifying the clinical pattern of periorbital hyperpigmentation; and (ii) detecting the presence of VEGFA and P53 single nucleotide polymorphism (SNPs) in different subtypes of periorbital hyperpigmentation in Malaysian Chinese.
METHODS: A cross-sectional study was conducted among Malaysian Chinese. Clinical assessments were performed, and medical history was collected. Three regions of p53 and two of VEGFA were amplified by PCR followed by direct sequencing using saliva-extracted DNA.
RESULTS: Eighty-four participants were recruited (average age 22.2 years). In the majority (n = 62), both eyelids were affected. Facial pigmentary, demarcation lines, tear trough and eye bags were not observed. Mixed (pigmented-vascular) was the most common subtype. Thirteen SNPs were found, nine of which are new. Only three out of 13 SNPs showed significant association with periorbital hyperpigmentation presentation. TA genotype in rs1437756379 (p53) was significantly more prevalent among participants with mixed subtype (P = 0.011) while AC genotype in rs1377053612 (VEGFA) was significantly more prevalent among pigmented subtype (P = 0.028). AA genotype in rs1479430148 (VEGFA) was significantly associated with allergic rhinitis in mixed subtype (P = 0.012).
CONCLUSION: Mixed subtype was the most prevalent type of periorbital hyperpigmentation in the study population. Three polymorphisms in p53 and VEGFA genes were statistically linked with different clinical presentations of periorbital hyperpigmentation.

Matched MeSH terms: Erythema/pathology
The past, present, and prospective on UV-VIS-NIR skin photonics and spectroscopy-a wavelength guide

Poh AH, Adikan FRM, Moghavvemi M

Med Biol Eng Comput, 2020 Jun;58(6):1159-1175.
PMID: 32319030 DOI: 10.1007/s11517-019-02077-9

The study and applications of in vivo skin optics have been openly documented as early as the year 1954, or possibly earlier. To date, challenges in analyzing the complexities of this field remain, with wide scopes requiring more scrutiny. Recent advances in spectroscopic research and multivariate analytics allow a closer look into applications potentially for detecting or monitoring diseases. One of the challenges in this field is in establishing a reference for applications which correspond to certain bandwidths. This article reviews the scope on past research on skin spectroscopy, and the clinical aspects which have or may have applications on disease detection or enhancing diagnostics. A summary is supplied on the technicalities surrounding the measurements reported in literature, focused towards the wavelength-dependent applications in themes central to the respective research. Analytics on the topology of the papers' data cited in this work is also provided for a statistical perspective. In short, this paper strives to immediately inform the reader with possible applications via the spectroscopic devices at hand. Graphical Abstract .

Matched MeSH terms: Erythema/pathology
Fulltext Contact dermatitis presenting as non-healing wound: case report

Leelavathi M, Le Y, Tohid H, Hasliza A

Asia Pac Fam Med, 2011 May 15;10(1):6.
PMID: 21575147 DOI: 10.1186/1447-056X-10-6

Topical antiseptics are commonly used in the management of minor wounds, burns, and infected skin. These agents are widely used by health professionals and are often self-prescribed by patients as they are easily available over-the-counter. This case illustrates a 73 year old man who presented with a non-healing wound on his right forearm for 4 weeks. The wound started from an insect bite and progressively enlarged with increasing pruritus and burning sensation. Clinically an ill-defined ulcer with surrounding erythema and erosion was noted. There was a yellow crust overlying the center of the ulcer and the periphery was scaly. Further inquiry revealed history of self treatment with a yellow solution to clean his wound for 3 weeks. Patient was provisionally diagnosed to have allergic contact dermatitis secondary to acriflavine. Topical acriflavine was stopped and the ulcer resolved after treatment with non-occlusive saline dressing. Skin patch test which is the gold standard for detection and confirmation of contact dermatitis showed a positive reaction (2+) to acriflavine. Acriflavine is widely used as a topical antiseptic agent in this part of the world. Hence, primary care physicians managing a large variety of poorly healing wounds should consider the possibility of contact allergy in recalcitrant cases, not responding to conventional treatment. Patient education is an important aspect of management as this would help curb the incidence of future contact allergies.

Matched MeSH terms: Erythema
Systemic lupus erythematosus in a malay boy

Wan Mohamad WM, Mohd Ashari NS, Wan AbHamid WZ

International Medical Journal (Tokyo), 2017;24(3):295-296.

Objective: We presented a case report, systemic lupus erythematosus (SLE) in a Malay boy. Interestingly, this case occurs in a boy, which is not so common because autoimmune disease usually occurs in female. Design: Case report. Methods: We highlighted a case of a boy with SLE who presented with clinical symptoms suggestive of SLE and fulfilled the criteria for SLE diagnosis. Results: The patient was successfully managed with antihypertensive, intravenous cyclophosphamide and oral prednisolone and respond well to the therapy. Conclusion: Systemic lupus erythematosus is a chronic autoimmune disease which rarely occurs in male. However we reported one such case which fulfilled the criteria for SLE. © 2017 Japan Health Sciences University & Japan International Cultural Exchange Foundation.

Matched MeSH terms: Erythema; Lupus Erythematosus, Systemic*
Fulltext Isolated Bilateral Pinna Swelling: A Rare Initial Presentation of Leprosy

Yusuf SYM, Ismail IA, Hamid RA, Jamil NA, Yasin MM

Open Access Maced J Med Sci, 2019 Jun 15;7(11):1815-1817.
PMID: 31316665 DOI: 10.3889/oamjms.2019.481

BACKGROUND: Leprosy or Hansen disease is a chronic infectious disease that causes social stigma due to its deforming bodily appearance and physical disability. It has a wide spectrum of presentation affecting diagnosis.
CASE REPORT: A 21-year-old man who presented with chronic isolated bilateral pinna swelling as a result of leprosy is reported. The bilateral pinna swelling started as multiple shiny papules with an erythematous background and progressively became hyperpigmented and lobular over two years. This rare presentation of leprosy poses initial diagnostic difficulties, leading to misdiagnoses by various health care professionals. Diagnoses ascribed include eczema, insect bite and perichondritis. A suspicion of leprosy was raised when hyperaesthetic hypopigmentation of skin started to appear on the body after two years, with worsening of the pinna swellings. This was confirmed by identification of Mycobacterium leprae in slit skin smear test and skin biopsy.
CONCLUSION: Isolated involvement of pinna in a patient without lesions in other body parts is an unusual initial presentation of leprosy. However, leprosy should be kept as a rare differential diagnosis of isolated lesions on the ear in patients not responding to conventional treatment.

Matched MeSH terms: Erythema
Fulltext Efficacy of chitosan derivative films versus hydrocolloid dressing on superficial wounds

Halim AS, Nor FM, Mat Saad AZ, Mohd Nasir NA, Norsa'adah B, Ujang Z

J Taibah Univ Med Sci, 2018 Dec;13(6):512-520.
PMID: 31435371 DOI: 10.1016/j.jtumed.2018.10.004

Objectives: Chitosan, the N-deacetylated derivative of chitin, has useful biological properties that promote haemostasis, analgesia, wound healing, and scar reduction; chitosan is bacteriostatic, biocompatible, and biodegradable. This study determined the efficacy of chitosan derivative film as a superficial wound dressing.
Methods: This multicentre randomised controlled trial included 244 patients, of whom 86 were treated with chitosan derivative film and 84 with hydrocolloid. The percentage of epithelisation, as well as patient comfort, clinical signs, and patient convenience in application and removal of the dressings were assessed.
Results: The primary outcome of this study was the percentage of epithelisation. Except for race (p = 0.04), there were no significant differences between groups in sex, age, antibiotic usage, or initial wound size (p > 0.05). There was no significant difference in the mean epithelisation percentage between groups (p = 0.29). Patients using chitosan derivative film experienced more pain during removal of dressing than those in the hydrocolloid group (p = 0.007). The chitosan derivative film group showed less exudate (p = 0.036) and less odour (p = 0.024) than the control group. Furthermore, there were no significant differences between groups in terms of adherence, ease of removal, wound drainage, erythema, itchiness, pain, and tenderness. No oedema or localised warmth was observed during the study.
Conclusion: This study concluded that chitosan derivative film is equivalent to hydrocolloid dressing and can be an option in the management of superficial and abrasion wounds.
Clinical trial No: NMRR-11-948-10565.

Matched MeSH terms: Erythema
Fulltext Eyelid abscess with dacryocystitis due to burkholderia pseudomallei

Chee, Yik Chang

Borneo Journal of Medical Sciences, 2020;14(3):61-62.
MyJurnal

A 24-year-old female complained of a 2-week history of fever and right-eye swelling. There was no ocular pain, blurring of vision, or history of prior trauma to the affected eye. On examination, she was febrile and not in respiratory distress. The right lower eyelid appeared swollen with skin erythema (Figure 1), while the visual acuity was normal. The white cell count was 14.8 × 103/μL (normal range = 4 – 10 × 103/μL). Her liver and renal function tests were within the normal range. The abdominal ultrasonography revealed multiple splenic microabscesses, while chest radiograph was normal. Contrast-enhanced computed tomography of the orbit showed a right lower eyelid abscess with extension into the right nasolacrimal duct (Figure 2). Incision and drainage of the eyelid abscess were performed and the culture of the pus, as well as the blood, yielded Burkholderia pseudomallei. She received intravenous ceftazidime 2 g every 8 hours for 4 weeks, followed by oral trimethoprim-sulfamethoxazole for 20 weeks’ duration. The right eyelid abscess and splenic microabscesses resolved completely post-treatment. Please interpret the figures and suggest the provisional diagnosis.

Matched MeSH terms: Erythema
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: Erythema

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