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.
Extramammary Paget’s disease (EMPD) is a rare malignant disorder of the skin, which was described
in as early as the nineteenth century. EMPD usually occurs as a single lesion in the apocrine sweat
gland–bearing skin with abundant hair follicles. Here, we present an elderly man who suffered from
a non-resolving chronic genital pruritus for 8 months. Initially, he was managed for recurrent fungal
infection and eczema. Later, a diagnosis of the rare condition multiple primary EMPD was made
based on the histopathology findings and appropriate treatment was given.
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
Psoriasis imposes a great economic burden as a result of higher expenditures for different interventions, diagnostic procedures, pharmaceuticals and loss of productivity. Less is known about the economic impact of psoriasis treatment in Asean region. The aim of this research was to calculate the costs associated with four psoriasis treatment modalities. A prospective cohort study was conducted in five hospitals involving 91 moderate to severe psoriasis patients. Costs were calculated from the societal perspective using the principle of Step Down and Activity Based Costing (ABC) within a six (6) months follow-up duration. The components of the costs borne by the provider were inpatient cost, cost of medication, laboratory investigation and radiology. Patient’s cost included out of pocket expenses, travelling cost and loss of productivity. Cost per patient per day was RM1,105.24 (inpatient) (US$315.94) and RM298.02 (outpatient) (US$85.19). Medication accounted for almost 90% (RM457,014.00) (US$130 638.45) of the total provider cost. Meanwhile, loss of productivity represented 84% (RM167,439.00) (US$47,862.80) of the total patient’s cost. Biologic treatment exhibited the highest cost which was RM342,377.00 (US$97,869.21), followed by systemic treatment (RM105,607.00) (US$30,187.99), topical treatment (RM38,280.00) (US$10,942.42) and topical phototherapy treatment (RM21,824.00) (US$6,238.44). Understanding the relationship between direct and indirect costs from both perspectives is important to accurately identify and evaluate effective treatment for psoriasis.