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Fulltext A case series exploring the efficacy, secondary failure, paradoxical event & relapse with ustekinumab therapy in chronic plaque psoriasis

Rasimah, I., Adawiyah, J., Norazirah, M.N.

Medicine & Health, 2020;15(2):153-163.
MyJurnal

Ustekinumab adalah agen biologi yang berkesan untuk rawatan kulit psoriasis dengan menyasarkan molekul interleukin 12 dan 23. Namun begitu ada beberapa halangan ketika penggunaannya seperti kegagalan sekunder dan juga peristiwa paradoks. Penyakit juga didapati kembali menyerang selepas terapi dihentikan. Kajian kohort retrospektif telah dilakukan ke atas pesakit kulit kronik psoriasis yang telah menerima ustekinumab di antara tahun 2013 ke 2018 di Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM). Demografi, ciri-ciri klinikal, keberkesanan rawatan, komplikasi, kadar dan corak penyakit berulang dikaji melalui rekod-rekod pesakit. Enam (75%) pesakit adalah lelaki. Enam (75%) pesakit ini tidak pernah menerima agen biologi sebelum ini. Usia median pesakit adalah 41.5 tahun (IQR 26.8-48.3), tempoh median penyakit ialah 16.5 tahun (IQR 6.5- 23.0). Tempoh median untuk mencapai kadar 75% pengurangan penyakit (PAS I75) adalah 16 minggu. PASI75 pada minggu ke 12 dicapai oleh 37.5% pesakit manakala tempoh median untuk mencapai sekurang-kurangnya PASI75 adalah 16 minggu. Tempoh median keseluruhan rawatan adalah selama 102 minggu. Semua pesakit berjaya dirawat. Dua (25%) pesakit mengalami kegagalan sekunder. Seorang (12.5%) pesakit mendapat peristiwa paradoks dengan tumbuhnya fenomena nanah dan plak di kulit semasa rawatan. Tempoh median untuk penyakit berulang adalah 40 minggu. Semua pesakit kecuali seorang memerlukan rawatan biologi untuk penyakit berulang. Ustekinumab berkesan untuk semua pesakit. Kejayaan rawatan diperolehi 4 minggu selepas piawai yang dijangkakan. Kohort ini telah merekodkan kegagalan sekunder dan fenomena paradoks yang jarang berlaku. Penyakit didapati akan berulang dan corak psoriasis yang berbeza ditemui selepas rawatan dihentikan.
Fulltext Homemade remedies causing contact dermatitis: case report on two patients with acne

Leelavathi, M., Mazlin, M.B., Adawiyah, J.

Medicine & Health, 2013;8(1):0-0.
MyJurnal

Natural products are often perceived as safe due to the absence of artificial or chemical materials in its content. However, many are unaware that some of these compounds, albeit natural in existence, can cause harm. Cinnamon and lemon are two commonly used home remedies for acne. Both these naturally existing ingredients are capable of producing dermatitis upon contact with the human skin. The aim of this article is to create awareness among physicians that natural remedies are not free from harm hence, should look out for any possible untoward reactions that these products may cause. Physicians need to explore the possible use of homemade remedies to treat common or minor ailments during history taking as this information may not be given voluntarily. Early identification of the offending agent, adequate management and future avoidance could help prevent further episodes of contact dermatitis and its complications.
Fulltext Evaluating the effect of chlorpheniramine on patch test reactions amongst eczema patients sensitised to nickel

Shafinaz, S., Chan, L.C., Adawiyah, J., Norazirah, M.N.

Medicine & Health, 2018;13(1):71-76.
MyJurnal

Discontinuing antihistamines for patch testing (PT) in allergic contact dermatitis (ACD) is more conventional than evidence based. Data suggests that non-sedating antihistamines do not interfere with PT. Investigating the effects of sedating antihistamines are more relevant as these are recommended for eczema. We aimed to evaluate the effect of chlorpheniramine on PT, to determine the prevalence of nickel sensitization and common sensitizing allergens. An open labeled cohort study was conducted at two dermatology clinics. Patients indicated for PT underwent standard protocol where antihistamines were discontinued. Patients sensitised to nickel were subjected to a second nickel PT while taking chlorpheniramine. Results were evaluated using the North American Contact Dermatitis Research Group (NACDRG) score, a Mexameter measured erythema and pruritus was assessed using a visual analogue score. A total 82 patients were recruited, 28 (34.1%) were sensitised to nickel. The mean age was 40 ± 17.7 years with 22(26.8%) males and 60 (73.2%) females. Indications for PT included suspected ACD (57.3%), hand and feet eczema (34.1%) and severe eczema with suspected superimposed ACD (6.1%). The commonest sensitizing allergens were methyldibromoglutaronitrile (40.2%) nickel sulphate (34.1%), potassium dichromate (29.3%) and formaldehyde (24.4%). A second PT was performed on 23 patients. There was no difference in the NACDRG score with chlorpheniramine or without chlorpheniramine (p=0.968). Pruritus score was reduced by 1.39 ± 2.9, p=0.031 with chlorpheniramine. The degree of erythema was 611.46 ± 21.59 with chlorpheniramine versus 613.87 ± 27.5 without chlorpheniramine, p=0.671. Chlorpheniramine did not affect PT based on clinical and objective scorings. It has the additional benefit of reducing test-induced itch.
Study site: Dermatology clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur and Hospital Pulau Pinang, Malaysia
Fulltext Characteristics and factors associated with adverse cutaneous drug reactions caused by traditional, complementary and conventional medicine in Malaysia

Nor Hazlin, T., Leelavathi M., Zuhra, H., Adawiyah, J., Dawn, A.A.

Medicine & Health, 2019;14(2):50-59.
MyJurnal

Traditional and Complimentary Medicines (TCMs) can potentially cause Adverse Cutaneous Drug Reactions (ACDRs). The aim of this study was to describe the characteristics of ACDRs due to TCMs and compare with those due to conventional medicine. This was a retrospective study with 134 cases being diagnosed with ACDR at the Dermatology Clinic of a tertiary hospital in Kuala Lumpur. Most (82.1%) ACDRs were caused by conventional drugs, while 17.9% were due to TCMs. Majority (70-75%) of the ACDRs were of mild to moderate severity. The most common ACDR to TCM was Exfoliative Dermatitis (ED) and Acute Generalized Exanthematous Pustulosis (AGEP) (both 16.7%) while maculopapular rash was the most common reaction for conventional medications (25.5%). The onset of adverse reaction to TCM was about 4 weeks (60.2%) while reactions due to conventional medication was earlier (1 to 6 days, 65.4%; p
Fulltext Scales on the scalp

Adawiyah J, Leelavathi M

Malays Fam Physician, 2013;8(1):48-49.
PMID: 25606270 MyJurnal

A five-year-old boy presented with a six-week history of scales, flaking and crusting of the scalp. He had mild pruritus but no pain. He did not have a history of atopy and there were no pets at home. Examination of the scalp showed thick, yellowish dry crusts on the vertex and parietal areas and the hair was adhered to the scalp in clumps. There was non-scarring alopecia and mild erythema. There was no cervical or occipital lymphadenopathy. The patient’s nails and skin in other parts of the body were normal.
Fulltext The risk and associated factors of female sexual dysfunction (FSD) in women with psoriasis

Adawiyah J, Moonyza AAK, Mohd Rizal AM, Hatta S, Nik Ruzyanei NJ, Marhani M, et al.

International Medical Journal Malaysia, 2017;16(1):107-114.
MyJurnal

Introduction: Psoriasis is a chronic, immune mediated, hyperproliferative skin disease that has substantial impact on the sexual functions. This study aimed to determine the prevalence and associated factors of female sexual dysfunction (FSD) in patients with psoriasis.
Methods: A cross-sectional study involving 79 women with psoriasis attending two Dermatology Outpatient Clinics were interviewed and assessed for female sexual dysfunction and severity of psoriasis. The socio-demographic and clinical characteristics of the subjects were compared between the women with and without sexual dysfunction. The subjects were interviewed using Mini International Neuropsychiatric Interview (M.I.N.I.) to exclude any existing psychiatric illness. Sexual dysfunction was assessed using a validated questionnaire on sexual function and the severity of psoriasis was assessed using Psoriasis Area and Severity Index (PASI).
Results: The prevalence of FSD in the patients with psoriasis was 20.3%, with hypoactive sexual desire being the most prevalent problem (44.3%). Sexual dysfunction was associated with older age, menopause, low body mass index, longer duration of marriage and presence of psoriasis in the genital area. Female sexual dysfunction was highly prevalent in patients with psoriasis.
Conclusion: Management of psoriasis should include assessment in patients’ sexual health. Genital area involvement with psoriasis should not be overlooked as it can cause significant psychosexual distress.
Keywords: Psoriasis, female, sexual dysfunction, prevalence, risk factor, Malaysia
Study site: Dermatology clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Fulltext Drug reaction with herbal supplement: a possible case of drug induced lupus erythematosus

Muthupalaniappen L, Jamani N, Muhammad M, Adawiyah J, Aziz N

Malays Fam Physician, 2010;5(2):99-100.
PMID: 25606196 MyJurnal

A 24-year-old lady presented with four days history of fever, non-pruritic rash, ankle pain and swelling. She had consumed herbal supplement five days before the onset of symptoms. Examinations revealed erythematous maculo-papular lesions of varying sizes on sun exposed areas. Patient was suspected to have Drug Induced Lupus Erythematosus (DILE) and subsequently symptoms subsided rapidly on withholding the herbal medication.
Fulltext Oral antibiotics in acne vulgaris: therapeutic response over 5 years

Adawiyah J, Gill P, Roshidah B

Malays Fam Physician, 2010;5(3):130-133.
PMID: 25606204 MyJurnal

Antibiotic resistant P. acnes have influenced acne therapy worldwide resulting in increased use of topical and systemic retinoids. Judicious use of oral antibiotic is important for effective therapeutic outcome. To determine the response and side effects of oral antibiotic treatment in acne vulgaris. To determine the type of antibiotic used, therapy duration and the types of concomitant topical therapy. Retrospective analysis of the therapeutic response to oral antibiotics therapy in acne vulgaris in the Dermatology Department, Hospital Kuala Lumpur. New cases of acne vulgaris from 2005 to 2009 were randomly selected. The clinical notes of 250 patients treated with oral antibiotics were reviewed. About 60% of patients achieved good to excellent response to therapy while satisfactory response was seen in 26%. Only 8% patients experienced minor side effects. Doxycycline was the most frequently prescribed antibiotic, followed by tetracycline and erythromycin ethylsuccinate. The prescribing pattern was consistent over the years. The mean duration of treatment is four to five months. Oral antibiotic was augmented with topical therapy in 98.8% of patients. Good to excellent therapeutic response was achieved in the majority of patients and results observed have remained stable over the last five years.
Fulltext The non-thyroidal illness syndrome in acute coronary syndrome is associated with increased cardiac morbidity and mortality

Adawiyah J, Norasyikin AW, Mat NH, Shamsul AS, Azmi KN

Heart Asia, 2010;2(1):11-4.
PMID: 27325934 DOI: 10.1136/ha.2009.001503

The non-thyroidal illness syndrome (NTIS) or the sick euthyroid syndrome refers to abnormal changes in circulating thyroid hormones due to systemic illnesses. Thyroid hormones are pivotal in the regulation of normal cardiac functions. However, the effects of the NTIS on the heart in acute coronary syndrome (ACS) are still unclear.
The risk factors of lower limb cellulitis: A case-control study in a tertiary centre

Norazirah MN, Khor IS, Adawiyah J, Tamil AM, Azmawati MN

Malays Fam Physician, 2020;15(1):23-29.
PMID: 32284801

INTRODUCTION: Lower limb cellulitis is a common superficial skin infection that leads to morbidity and mortality. Cellulitis risk factors have been well studied in many countries, but to date, not in Malaysia. Geographical and climate variables may affect risk factors. Early identification of the preventable risk factors is vital to prevent cellulitis and improve holistic patient care.
OBJECTIVE: To determine the risk factors of lower limb cellulitis amongst hospitalized patients at a tertiary center.
METHODS: A prospective case-control study of hospitalized patients with a clinical diagnosis of lower limb cellulitis was conducted at UKM Medical Centre, January-August 2015. Each patient was compared to two age and gender-matched control patients. All patients were interviewed and examined for risk factors of cellulitis.
RESULTS: A total of 96 cellulitis patients and 192 controls participated in this study. The cellulitis patients included 61 males and 35 females with a mean age of 62.07±15.43 years. The majority of patients were experiencing their first episode of cellulitis. Multivariate analysis showed a previous history of cellulitis (OR 25.53; 95% CI 4.73-137.79), sole anomalies (OR 16.32; 95% CI 6.65-40.06), ulceration (OR 14.86; 95% CI 1.00-219.39), venous insufficiency (OR 10.46 95% CI 1.98-55.22), interdigital intertrigo (OR 8.86; 95% CI 3.33-23.56), eczema (OR 5.74; 95% CI 0.96.-34.21), and limb edema (OR 3.95; 95% CI 1.82-8.59) were the significant risk factors for lower limb cellulitis.
CONCLUSION: Previous cellulitis and factors causing skin barrier disruption such as sole anomalies, ulceration, venous insufficiency, eczema, intertrigo, and limb edema were the risk factors for lower limb cellulitis. Physician awareness, early detection, and treatment of these factors at the primary care level may prevent hospital admission and morbidity associated with cellulitis.
Skin eruption induced by dieting - an underdiagnosed skin disease in Malaysia

Goh SW, Adawiyah J, Md Nor N, Yap F, Ch'ng P, Chang CC

Malays Fam Physician, 2019;14(1):42-46.
PMID: 31289632

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.
Fulltext Malaysian Clinical Practice Guideline for the Management of Psoriasis Vulgaris: Summary of recommendations for management in primary healthcare setting

Choon SE, Adawiyah J, Chin CL, Cheng CH, Ambrose D, Hazreen AM, et al.

Malays Fam Physician, 2014;9(1):16-21.
PMID: 25606292 MyJurnal