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Transepidermal water loss in erythrodermic patients of various aetiologies

Mohd Noor N, Hussein SH

Skin Res Technol, 2013 Aug;19(3):320-3.
PMID: 23530728 DOI: 10.1111/srt.12048

Despite its severity not much work has been done to explore the barrier function in patients with erythroderma. This study compares TEWL between skin of healthy subjects and erythrodermic patients of various aetiologies and at different sites. We also assess TEWL between patients with acute and chronic erythroderma.
Drug-induced urticaria and angioedema: pathomechanisms and frequencies in a developing country and in developed countries

Greaves MW, Hussein SH

Int Arch Allergy Immunol, 2002 May;128(1):1-7.
PMID: 12037395 DOI: 10.1159/000057997

A careful drug history should be obtained from all patients with acute or chronic urticaria/angioedema, especially in the elderly. Although strictly comparable data are lacking, drug-induced urticaria appears to be more common in developed countries than in Malaysia, at least in a Hospital setting. Culprit drugs include antibiotics, analgesics and contrast media. Pseudoallergic drug-induced urticaria mimicks true allergic urticaria, but without an evident immunological basis, and is at least as common as the allergic type. In Malaysia, and in many other countries compulsory, ingredient labelling of 'traditional' medicines would do much to reduce the frequency of drug-induced urticaria.
Fulltext Malaysian Psoriasis Registry--preliminary report of a pilot study using a newly revised registry form

Chang CC, Gangaram HB, Hussein SH

Med J Malaysia, 2008 Sep;63 Suppl C:68-71.
PMID: 19227676

The Malaysian Psoriasis Registry, established in 1998, is the first skin disease clinical registry in Malaysia. It aims to provide useful data on various aspects of psoriasis. Following an extensive revision of the registry form in 2007, a total of 509 psoriasis patients from 10 government dermatologic centres were reviewed in a three month pilot study. The onset of psoriasis was during the second to fourth decade of life in the majority of patients. There was no sexual and ethnic predilection. A positive family history was present in 21.2%, and more common in patients with younger disease onset. The main aggravating factors of psoriasis were stress, sunlight and infection. Plaque psoriasis was the commonest clinical type (80.9%). Joint disease was present in 17.3% of patients, among which mono-/oligoarticular type being the commonest. Nail changes occurred in 68%. More psoriasis patients were overweight and obese compared to the normal population. The mean Dermatologic Life Quality Index (DLQI) score was 8.08 +/- 6.29, and changes during subsequent follow-up may reflect therapeutic effectiveness. This study enabled evaluation of the revised registry form and helped in identifying shortcomings in the implementation of the registry.
Fulltext A novel therapy for the treatment of pyoderma gangrenosum

Azizan NZ, Gangaram HB, Hussein SH

Med J Malaysia, 2008 Mar;63(1):51-4.
PMID: 18935734 MyJurnal

Pyoderma gangrenosum (PG) is an uncommon, chronic, painful, ulcerative skin disease of unknown origin, often associated with systemic diseases including inflammatory bowel disease, rheumatoid arthritis; monoclonal gammopathy, hepatitis and myeloproliferative disorders. The mainstay of therapy for PG has been high-dose corticosteroids but not all patients have a favourable outcome. Other systemic agents have also been used such as cyclosporine, azathioprine, cyclophosphamide and tacrolimus. However, all these systemic therapies can be complicated by serious side effects. In this paper, we report a series of four patients with pyoderma gangrenosum treated successfully with topical cyclosporine. No side-effects were observed in any of the patients and there was minimal systemic absorption of the topical cyclosporine.
Computerised image analysis of vitiligo lesion: evaluation using manually defined lesion areas

Nugroho H, Ahmad Fadzil MH, Shamsudin N, Hussein SH

Skin Res Technol, 2013 Feb;19(1):e72-7.
PMID: 22233154 DOI: 10.1111/j.1600-0846.2011.00610.x

Vitiligo is a cutaneous pigmentary disorder characterized by depigmented macules and patches that result from loss of epidermal melanocytes. Physician evaluates the efficacy of treatment by comparing the extent of vitiligo lesions before and after treatment based on the overall visual impression of the treatment response. This method is called the physician's global assessment (PGA) which is subjective. In this article, we present an innovative digital image processing method to determine vitiligo lesion area in an objective manner.
Association of HLA-B*1502 allele with carbamazepine-induced toxic epidermal necrolysis and Stevens-Johnson syndrome in the multi-ethnic Malaysian population

Chang CC, Too CL, Murad S, Hussein SH

Int J Dermatol, 2011 Feb;50(2):221-4.
PMID: 21244392 DOI: 10.1111/j.1365-4632.2010.04745.x

BACKGROUND: Carbamazepine (CBZ), a frequently used anticonvulsant drug, is one of the most common causes of life-threatening cutaneous adverse drug reactions such as toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS). Recent studies have revealed a strong association between HLA-B*1502 and CBZ-induced TEN/SJS in the Taiwan Han Chinese population.
OBJECTIVES: This study is aimed to investigate the association between human leucocyte antigens (HLA) and CBZ-induced TEN/SJS in the multi-ethnic Malaysian population.
METHODS: A sample of 21 unrelated patients with CBZ-induced TEN/SJS and 300 race-matched, healthy controls were genotyped for HLA-A, -B and -DR using polymerase chain reaction (PCR). Allele frequencies were compared.
RESULTS: HLA-B*1502 was present in 75.0% (12/16) of Malay patients with CBZ-induced TEN/SJS but in only 15.7% (47/300) of normal controls (odds ratio 16.15, 95% confidence interval 4.57-62.4; corrected P-value = 7.87 × 10(-6) ), which suggests a strong association between HLA and CBZ-induced TEN/SJS. Additionally, HLA-B*1502 was found in all three Chinese and two Indian patients. Existing data show that frequencies of the HLA-B*1502 allele are generally much higher in Asian populations than in White European populations, which explains the higher incidences of SJS and TEN in Asian countries.
CONCLUSIONS: HLA-B*1502 is strongly associated with CBZ-induced TEN/SJS in the Malay population in Malaysia, as has been seen in Han Chinese in Taiwan. This indicates that the genetic association apparent in the incidence of CBZ-induced TEN/SJS is linked with the presence of HLA-B*1502, irrespective of racial origin. Screening of patients for this genetic marker can help to prevent the occurrence of TEN/SJS.
Fulltext Cutaneous vasculitis: a review of aetiology and clinical manifestations in 85 patients in Malaysia

Muthupalaniappen L, Aziz SA, Gangaram HB, Hussein SH

Med J Malaysia, 2009 Sep;64(3):210-2.
PMID: 20527269 MyJurnal

Cutaneous vasculitis presents with a variety of clinical morphologies and causes significant morbidity. A total of 85 patients with cutaneous vasculitis at Hospital Kuala Lumpur were retrospectively reviewed. Palpable purpura was seen in 49.4% and frequently involved the lower limbs (50.6%). Identifiable causes include drugs (28.2%), infections (20.0%) and connective tissue disorders (16.5%). Non steroidal antiinflammatory were the commonest group of drugs responsible for 25% of cases while B-haemolytic streptococci was the leading infectious cause (64.7%).
Objective assessment of psoriasis erythema for PASI scoring

Ahmad Fadzil MH, Ihtatho D, Mohd Affandi A, Hussein SH

J Med Eng Technol, 2009;33(7):516-24.
PMID: 19639508 DOI: 10.1080/07434610902744074

Skin colour is vital information in dermatological diagnosis as it reflects the pathological condition beneath the skin. It is commonly used to indicate the extent of diseases such as psoriasis, which is indicated by the appearance of red plaques. Although there is no cure for psoriasis, there are many treatment modalities to help control the disease. To evaluate treatment efficacy, the current gold standard method, PASI (Psoriasis Area and Severity Index), is used to determine severity of psoriasis lesion. Erythema (redness) is one parameter in PASI and this condition is assessed visually, thus leading to subjective and inconsistent results. Current methods or instruments that assess erythema have limitations, such as being able to measure erythema well for low pigmented skin (fair skin) but not for highly pigmented skin (dark skin) or vice versa. In this work, we proposed an objective assessment of psoriasis erythema for PASI scoring for different (low to highly pigmented) skin types. The colour of psoriasis lesions are initially obtained by using a chromameter giving the values L*, a*, and b* of CIELAB colour space. The L* value is used to classify skin into three categories: low, medium and highly pigmented skin. The lightness difference (DeltaL*), hue difference (Deltah(ab)), chroma (DeltaC*(ab)) between lesions and the surrounding normal skin are calculated and analysed. It is found that the erythema score of a lesion can be distinguished by their Deltah(ab) value within a particular skin type group. References of lesion with different scores are obtained from the selected lesions by two dermatologists. Results based on 38 lesions from 22 patients with various level of skin pigmentation show that PASI erythema score for different skin types i.e. low (fair skin) to highly pigmented (dark skin) skin types can be determined objectively and consistent with dermatology scoring.
Area assessment of psoriasis lesions for PASI scoring

Fadzil MH, Ihtatho D, Affandi AM, Hussein SH

J Med Eng Technol, 2009;33(6):426-36.
PMID: 19557605 DOI: 10.1080/07434610902744066

Psoriasis is a skin disorder which is caused by a genetic fault. Although there is no cure for psoriasis, there are many treatment modalities to help control the disease. To evaluate treatment efficacy, the current gold standard method, PASI (Psoriasis Area and Severity Index), is used to measure psoriasis severity by evaluating the area, erythema, scaliness and thickness of the plaques. However, the determination of PASI can be tedious and subjective. In this work, we develop a computer vision method that determines one of the PASI parameters, the lesion area. The method isolates healthy and healed skin areas from lesion areas by analysing the hue and chroma information in the CIE L*a*b* colour space. Centroids of healthy skin and psoriasis in the hue-chroma space are determined from selected sample. The Euclidean distance of all pixels from each centroid is calculated. Pixels are assigned to either healthy skin or psorasis lesion classes based on the minimum Euclidean distance. The study involves patients from different ethnic origins having three different skin tones. Results obtained show that the proposed method is able to determine lesion areas with accuracy higher than 90% for 28 out of 30 cases.

Study site: Dermatology Clinic, Hospital Kuala Lumpur
Area assessment of psoriasis lesion for PASI scoring

Ihtatho D, Fadzil MH, Affandi AM, Hussein SH

Annu Int Conf IEEE Eng Med Biol Soc, 2007;2007:3446-9.
PMID: 18002738

Psoriasis is a skin disorder which is caused by genetic fault. There is no cure for psoriasis, however, there are many treatment modalities to help control the disease. To evaluate treatment efficacy, PASI (Psoriasis Area and Severity Index) which is the current gold standard method is used to measure psoriasis severity by evaluating the area, erythema, scaliness and thickness of the plaques. However, the calculation of PASI can be tedious and subjective. In this work, we develop a computer vision method that determines one of the PASI parameter, the lesion area. The method isolates healthy (or healed) skin areas from lesion areas by analyzing the hue and chroma information in the CIE L*a*b* colour space. Centroids of healthy skin and psoriasis in the hue-chroma space are determined from selected sample. Euclidean distance of all pixels from each centroid is calculated. Each pixel is assigned to the class with minimum Euclidean distance. The study involves patients from three different ethnic origins having different skin tones. Results obtained show that the proposed method is comparable to the dermatologist visual approach.
Fulltext Subcutaneous panniculitic T-cell lymphoma-review of five cases

Ng TG, Ayadurai K, Gangaram HB, Hussein SH

Med J Malaysia, 2006 Dec;61(5):586-91.
PMID: 17623960 MyJurnal

Subcutaneous panniculitic T-cell lymphoma (SPTL) is a rare variant of cutaneous T-cell lymphoma where lymphoma cells infiltrate preferentially into subcutaneous tissue. Five cases of SPTL were seen during the period from 2001-2004 at the Department of Dermatology, Hospital Kuala Lumpur. All five presented with multiple subcutaneous nodules on the face, trunk and limbs of one week to six months duration with associated fever and loss of weight. Physical examination showed multiple tender, erythematous indurated plaques and subcutaneous nodules on their face, trunk and limbs. One patient also presented with unhealing ulcerated nodules. Two patients had hepatosplenomegaly and one hepatomegaly. Two patients had pancytopaenia while the other three had leucopaenia. One patient had deranged liver function. Out of the five patients, three had bone marrow examination with haemophaegocytosis in two and one hypocellular marrow. Skin biopsy of all patients showed infiltration with atypical lymphoid cells in the upper dermis and subcutaneous fat. These neoplastic cells showed positivity for CD3 and CD30 in three patients with CD8, TIA-1 and LCA (Leucocyte common antigen) being positive in one patient. One patient treated with prednisolone and subcutaneous Roferon 3Mu three times a week since 2001 was in remission. Two patients who were planned for chemotherapy had deteriorated rapidly and succumbed to septicaemia from pancytopaenia. Subcutaneous panniculitic T-cell lymphoma has been reported to show two distinct clinical presentations. The first is characterized by an indolent course with good prognosis and the second with rapid clinical deterioration, haemophaegocytosis and death. Both presentations were seen in our five patients seem to demonstrate these two subtypes of SPTL.
Chronic mucocutaneous candidiasis with deficient CD2 (E receptor) but normal CD3 mononuclear cells

Noh LM, Hussein SH, Sukumaran KD, Rose I, Abdullah N

J Clin Lab Immunol, 1991 Jun;35(2):89-93.
PMID: 1688166

A case of chronic mucocutaneous candidiasis in a Malaysian child who subsequently developed disseminated tuberculosis and toxoplasmosis is described. The phenotype of her peripheral blood mononuclear cells showed discordance for her T cell markers. The presence of a subpopulation of CD2-/CD3+ mononuclear cells leading to an immunodeficiency state is consistent with failure of activation of CD2-mediated alternative pathway resulting in immunodeficiency. Such abnormal CD2-/CD3+ subpopulations have been described in lepromatous leprosy and foetal abortuses.
Fulltext A case of erythropoietic protoporphyria

Ch'ng SL, Gangaram HB, Hussein SH, Rajagopalan K

Med J Malaysia, 1988 Sep;43(3):243-5.
PMID: 3241583
Objective assessment of vitiligo with a computerised digital imaging analysis system

Shamsudin N, Hussein SH, Nugroho H, Fadzil MH

Australas J Dermatol, 2015 Nov;56(4):285-9.
PMID: 25367709 DOI: 10.1111/ajd.12247

An objective tool to quantify treatment response in vitiligo is currently lacking. This study aimed to objectively evaluate the treatment response in vitiligo by using a computerised digital imaging analysis system (C-DIAS) and to compare it with the physician's global assessment (PGA). Tacrolimus ointment 0.1% (Protopic; Astellas Pharma Tech,Toyama, Japan) was applied twice daily on selected lesions which were photographed every 6 weeks for 24 weeks. The primary efficacy end-point was the mean percentage of repigmentation (MPR), as assessed by the digital method (MPR-C-DIAS) or by the PGA. The response was categorised into none (0%), mild (1-25%), moderate (26-50%), good (51-75%) and excellent (76-100%).
Objective assessment of psoriasis erythema for PASI scoring

Ahmad Fadzil MH, Ihtatho D, Affandi AM, Hussein SH

Annu Int Conf IEEE Eng Med Biol Soc, 2008;2008:4070-3.
PMID: 19163606 DOI: 10.1109/IEMBS.2008.4650103

Skin colour is vital information in dermatological diagnosis. It reflects pathological condition beneath the skin and commonly being used to indicate the extent of a disease. Psoriasis is a skin disease which is indicated by the appearance of red plaques. Although there is no cure for psoriasis, there are many treatment modalities to help control the disease. To evaluate treatment efficacy, PASI (Psoriasis Area and Severity Index) which is the current gold standard method is used to determine severity of psoriasis lesion. Erythema (redness) is one parameter in PASI. Commonly, the erythema is assessed visually, thus leading to subjective and inconsistent result. In this work, we proposed an objective assessment of psoriasis erythema for PASI scoring. The colour of psoriasis lesion is analyzed by DeltaL, Deltahue, and Deltachroma of CIELAB colour space. References of lesion with different scores are obtained from the selected lesions by two dermatologists. Results based on 38 lesions from 22 patients with various level of skin pigmentation show that PASI erythema score can be determined objectively and consistent with dermatology scoring.
3D surface roughness measurement for scaliness scoring of psoriasis lesions

Ahmad Fadzil MH, Prakasa E, Asirvadam VS, Nugroho H, Affandi AM, Hussein SH

Comput Biol Med, 2013 Nov;43(11):1987-2000.
PMID: 24054912 DOI: 10.1016/j.compbiomed.2013.08.009

Psoriasis is an incurable skin disorder affecting 2-3% of the world population. The scaliness of psoriasis is a key assessment parameter of the Psoriasis Area and Severity Index (PASI). Dermatologists typically use visual and tactile senses in PASI scaliness assessment. However, the assessment can be subjective resulting in inter- and intra-rater variability in the scores. This paper proposes an assessment method that incorporates 3D surface roughness with standard clustering techniques to objectively determine the PASI scaliness score for psoriasis lesions. A surface roughness algorithm using structured light projection has been applied to 1999 3D psoriasis lesion surfaces. The algorithm has been validated with an accuracy of 94.12%. Clustering algorithms were used to classify the surface roughness measured using the proposed assessment method for PASI scaliness scoring. The reliability of the developed PASI scaliness algorithm was high with kappa coefficients>0.84 (almost perfect agreement).
A biomarker for exposure to organophosphate and carbamate pesticides

Lubis SH, El Sersi M, Hussein SH, Sakian NI, Salleh R, Rafai J, et al.

Asia Pac J Public Health, 2008 Oct;20 Suppl:162-5.
PMID: 19533876

A cross sectional study was conducted to investigate the effects of pesticide exposure (organophosphate and carbamate) using nerve conductive velocity, current perception threshold (CPT). Cluster random sampling was employed to recruit 64 paddy farmers and 22 fishermen in June 2006. The duration of pesticide exposure was between (5-20) years. The CPT values were measured using Neurometer CPT/Eagle, on the index finger and the great toe with three neuroselective frequencies range (2000, 250, and 5 Hz). The results showed that at the three different frequencies, the CPT values were significantly elevated among farmers on both the medial and peroneal nerves (P < .002). The measurement of CPT can be used as a biomarker to determine and monitor the effects of organophosphate and carbamate exposure among workers who may have been exposed.
Body surface area measurement and soft clustering for PASI area assessment

Hani AF, Prakasa E, Nugroho H, Affandi AM, Hussein SH

Annu Int Conf IEEE Eng Med Biol Soc, 2012;2012:4398-401.
PMID: 23366902 DOI: 10.1109/EMBC.2012.6346941

Psoriasis is a common skin disorder with a prevalence of 0.6 - 4.8% around the world. The most common is plaques psoriasis and it appears as red scaling plaques. Psoriasis is incurable but treatable in a long term treatment. Although PASI (Psoriasis Area and Severity Index) scoring is recognised as gold standard for psoriasis assessment, this method is still influenced by inter and intra-rater variation. An imaging and analysis system called α-PASI is developed to perform PASI scoring objectively. Percentage of lesion area to the body surface area is one of PASI parameter. In this paper, enhanced imaging methods are developed to improve the determination of body surface area (BSA) and lesion area. BSA determination method has been validated on medical mannequin. BSA accuracies obtained at four body regions are 97.80% (lower limb), 92.41% (trunk), 87.72% (upper limb), and 83.82% (head). By applying fuzzy c-means clustering algorithm, the membership functions of lesions area for PASI area scoring have been determined. Performance of scoring result has been tested with double assessment by α-PASI area algorithm on body region images from 46 patients. Kappa coefficients for α-PASI system are greater than or equal to 0.72 for all body regions (Head - 0.76, Upper limb - 0.81, Trunk - 0.85, Lower limb - 0.72). The overall kappa coefficient for the α-PASI area is 0.80 that can be categorised as substantial agreement. This shows that the α-PASI area system has a high reliability and can be used in psoriasis area assessment.
Fulltext Urethritis in men at the Genito-Urinary Medicine Clinic Kuala Lumpur Hospital

Gangaram HB, Akbal K, Gan AT, Hussein SH, Mangalam S, Rohani Y, et al.

Med J Malaysia, 2003 Mar;58(1):21-6.
PMID: 14556323 MyJurnal

The clinical features and aetiology of 100 consecutive symptomatic heterosexual male patients with urethritis were studied from March 1994 to August 1994 in the Genito-Urinary Medicine (GUM) Clinic, Kuala Lumpur Hospital. Gonococcal urethritis (GU) was found to be more common (53%) than non-gonococcal urethritis(47%). All patients with GU confirmed microbiologically had clinically evident urethral discharge. Almost half (41%) of the patients with GU developed post-gonococcal urethritis (PGU). The most common organism isolated in PGU was Ureaplasma urealyticum (37%) whilst only 4% had both Chlamydia trachomatis and Ureaplasma urealyticum. Of the 47% of patients with non-gonococcal urethritis (NGU), 50% had no microorganism isolated, 32% had Ureaplasma urealyticum, 7% Chlamydia trachomatis and 11% both Chlamydia trachomatis and Ureaplasma urealyticum.

Study site: Genito-Urinary Medicine (GUM) Clinic, Hospital Kuala Lumpur
Fulltext Efficacy and safety of latanoprost/timolol fixed combination dosed twice daily compared to once daily in patients with primary open angle glaucoma

Azal AB, Hussein SH, Tang SF, Othman O, Din NM

Int J Ophthalmol, 2023;16(8):1243-1249.
PMID: 37602343 DOI: 10.18240/ijo.2023.08.09

AIM: To evaluate whether latanoprost/timolol fixed combination (LTFC) dosed twice daily may provide further intraocular pressure (IOP) reduction and evaluate the safety profile at this dose.
METHODS: This is an open-labeled, randomized, prospective crossover study on fourty primary open angle glaucoma patients. Two weeks of washout period were followed by randomization to either once daily (OD, group A) or twice daily dosing (BD, group B) of LTFC for 4wk. After another 2-week washout period, the patients' treatment dose was crossed-over for another 4wk. IOP reduction alongside ocular and systemic side effects were evaluated.
RESULTS: Mean baseline IOP was 18.57±2.93 and 17.8±3.01 mm Hg before OD and BD dose respectively, (P=0.27). Mean IOP after BD dose was statistically lower (12.49±1.59 mm Hg) compared to OD (13.48±1.81 mm Hg, P=0.017). Although IOP reduction after BD dose was more (5.32±3.24 mm Hg, 29.89%) than after OD dosing (5.04 mm Hg, 27.14%), it did not reach statistical significance (P=0.68). Patients switched from OD to BD (group A) showed mean IOP reduction by 0.69 mm Hg [95% confidence interval (CI): -0.09 to 1.48 mm Hg, P=0.078]; but patients switched from BD to OD (group B) had significantly higher mean IOP by 1.25 mm Hg (95%CI: -2.04 to -0.46 mm Hg, P=0.006). BD dose had more ocular side effects albeit mild.
CONCLUSION: Mean IOP after LTFC dosed twice daily is statistically lower, with additional mild side effects.

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