ISOTRETINOIN THERAPY IN ACNE VULGARIS: A 10-YEAR RETROSPECTIVE STUDY IN SINGAPORE

Background. The use of isotretinoin, a first generation synthetic retinoid, in the treatment of patients with severe acne vulgaris was a major therapeutic advance in dermatology. This 10–year retrospective study reviews the effectiveness of isotretinoin in patients with acne vulgaris seen in a skin clinic in Singapore. Methods. The case records of 250 cases of severe inflammatory and nodulocystic acne treated with isotretinoin were analyzed with reference to the demographic data, response to isotretinoin, dosage and cost of isotretinoin used, adverse effects, clinical follow-up, and relapse. Results. Two hundred and fifty patients, 171 men (68.4%) and 79 women (31.6%), with different types and grades of acne vulgaris were studied. The dose of isotretinoin used ranged from 0.33 to 1.0 mg/kg/day (median 0.5 mg/kg/day) for a period ranging from 1 to 12 months (median 4 months). Response was excellent in 127 (50.8%) patients, good in 86 (34.4%), fair in 30 (12.0%) and poor in 7 (2.8%). Relapse occurred in 14 (5.6%) patients over a 6–month follow-up period. Adverse effects were noted in 140 (56.0%) patients and were mild in most cases. Eighteen (7.2%) patients had to discontinue the drug due to significant side effects. Conclusion. This study confirms that isotretinoin is very effective for severe acne, and complete remission can be induced in more than 90% of cases even with lower dosage regimens. Significant clinical improvement can be achieved with the use of lower doses (mean 0.5 mg/kg/day) for an average of 4 months of treatment with lower risk of adverse effects.     

DERMATOPHYTOSIS IN HONG KONG

SUMMARY. During the 2 years 1965–66 1285 cases of mycologically proven dermatophytosis were seen in the Government Dermatological Clinics in Hong Kong.
Tinea cruris and corporis were the commonest forms of infection and T. rubrum was the species isolated in 63·7% of cases.
T. rubrum infections were unusual in children, and when they occurred were most often seen in infants, in whom the infection runs an acute inflammatory course and responds readily to treatment.
In chronic infection in adults lichenification or nodular prurigo are sometimes associated.
T. rubrum infection of the groins very frequently spreads to involve perineum and buttocks.     

PHARMACOLOGY AND THERAPEUTICS ETRETINATE THERAPY FOR PSORIASIS AND OTHER KE RATINIZING DISORDERS: A 10-YEAR RETROSPECTIVE STUDY IN SINGAPORE

Background. Etretinate, a second generation retinoic acid, has been reported to be useful in the treatment of psoriasis and other keratinizing disorders. The effectiveness of etretinate for these disorders are studied in a 10-year retrospective study of all patients treated with etretinate in a skin clinic in Singapore. Methods. The case records of 190 cases of psoriasis and other keratinizing disorders treated with etretinate were analyzed. Information collected included demographic data, dosage of etretinate taken, response and side effects, clinical follow-up, and relapse. Results. Most of the cases (72.6%) had psoriasis (138/190). The others had different keratinizing disorders. The dose of etretinate used was 0.15 to 1 mg/kg/day (median 0.36 mg/kg/day), and the duration of the treatment varied from 1 to 120 months (median 6 months). Etretinate was coadministered with UVB (ReuvB) or PUVA (RepuvA) in 89 (46.8%) patients. In psoriasis, the response to treatment was excellent in 41.3% (57/138), good in 36.2% (50/138), fair in 15.9% (22/138), and poor in 6.5% (9/138) of the cases. Patients with plaque-type psoriasis did better with combination therapy than with monotherapy. Those with keratinizing disorders showed excellent, good, fair, and poor responses in 32.7% (17/52), 32.7% (17/52), 25.0% (13/52), and 9.6% (5/52) respectively. Adverse effects were noted in 102 (53.7%) cases and were generally mild and tolerable. Etretinate was discontinued in 24 (12.6%) patients due to significant toxicity. Conclusions. Etretinate is effective for treating psoriasis and other keratinizing disorders. Combination therapy is preferred in chronic plaque psoriasis. Adverse effects are common, but mild and tolerable.     

DERMATOMYOSITIS: A CLINICAL OF TWENTY-THREE CASES IN HONG KONG

SUMMARY.— Twenty-three cases of dermatomyositis are reported of which 12 (52%) were associated with internal malignancy. In the patients over 40 years of age, malignant diseases were encountered in 69%, while only one of 7 cases under 40 had associated malignancy. Nasopharyngeal carcinoma accounted for 75% of the malignant disease.
A distinctive skin eruption, consisting of hyperkeratotic, follicular, erythematous papules, is described. On the face, trunk and limbs, the papules tended to become confluent. Along the tendons and over the bony prominences on the backs of the hands and feet, the eruption was usually arranged in a linear fashion. There was alopecia of the scalp. On the palms and soles were hyperkeratotic papules or plaques. The occurrence of this form of eruption in dermatomyositis may be influenced by racial factors.     

A VARIANT OF TRICHOPHYTON RUBRUM ISOLATED IN HONG KONG

SUMMARY.— A distinctive strain of Trichophyton rubrum has been isolated from 5 patients in Hong Kong.
The infections caused by this strain were clinically more inflammatory and responded more rapidly to treatment than infections with the ordinary form of T. rubrum.
The mycological characteristics of the Hong Kong strain are described in detail.
It is possible that the Hong Kong and the Nigerian strains of T. rubrum are identical. The apparent differences are discussed; only further investigation will establish their significance.     

PILOMATRICOMA: A RETROSPECTIVE STUDY

A study of 53 Pakistani patients with pilomatricoma diagnosed at AFIP during 1985-1989 is presented. It constituted 37.2% of all benign adnexal tumors, during the same period. 56.2% of patients were more than 30 years of age. Differences in site, sex, and age distribution from Western reports were observed. Unusual clinical presentations were also noted. This study outlines the clinicopathologic features of pilomatricoma in Pakistan.     

PERIPHERAL T LYMPHOCYTES AND THEIR SUBSETS IN CUTANEOUS TUBERCULOSIS

Fifty-four patients with cutaneous tuberculosis, consisting of 23 with lupus vulgaris, 22 with scrofuloderma, and nine with verrucosa cutis, were investigated for cell-mediated immunity, through estimation of peripheral total T lymphocytes (CD3+), CD4+ (helper/inducer), and CD8+ (cytotoxic/suppressor) lymphocytes, by immunohistochemical staining of peripheral blood smears, using specific monoclonal antibodies and the alkaline phosphatase-antialkaline phosphatase (APAAP) method. Absolute values of total T lymphocytes (CD3+), and CD4+ and CD8+ subsets, were found to be significantly raised in scrofuloderma, but the percentage values and the CD4+/CD8+ ratio remained unaltered. In tuberculosis verrucosa cutis, only the percentage of the CD8+ subset of T lymphocytes was found to be significantly lowered, and this altered the CD4+/CD8+ ratio. No significant change was observed in the peripheral blood T cells and their subpopulations in patients suffering from lupus vulgaris.     

ELEPHANTIASIS OF THE EXTERNAL GENITALIA: A SEQUEL TO CUTANEOUS TUBERCULOSIS

Tuberculosis continues to be an important public health problem and cutaneous tuberculosis constitutes a minor proportion of extra pulmonary manifestations of tuberculosis. Elephantiasis of the external genitalia, as a sequel to cutaneous tuberculosis, in a 40-year-old diabetic lady is being reported for its rarity. The patient also had lesions of healed scrofuloderma of 27 years’ duration, in both axillae, with residual pedunculated nodules.     

A STUDY OF THE PHOTOSENSITIVITY FACTOR IN CUTANEOUS LYMPHOCYTOMA

SUMMARY.— Two cases of cutaneous lymphocytoma associated with solar urticaria and polymorphic light eruption are reported and the results of phototesting described. These results suggest that the action spectrum in each case was probably dependent on the type of associated photodermatosis and not on the lymphocytoma. The relationship between lymphocytoma, "actinic reticuloid" and the lymphocytic response to phototesting is discussed.     

TUBERCULOSIS OF THE SKIN IN HONG KOKG (A REVIEW OF 160 CASES)

SUMMARY.— 160 cases of tuberculosis of the skin seen in the Government Dermatological Clinics in Hong Kong are reviewed.
Tuberculosis verrucosa was the commonest form and accounted for 46% of cases. The onset was below the age of 20 in 77% of these patients.
The distribution of the lesions differed from that reported by most recent authors. The knees, thighs and buttocks were commonly affected.
In 3 of 9 cases of papulonecrotic tuberculid in men the penis was involved.
The degree of sensitivity to tuberculin appeared to be similar in all forms of cutaneous tuberculosis.
Pulmonary infection was associated in about 10% of cases of cutaneous tuberculosis.
The factors possibly responsible for the differences between the present and other series of cases are briefly discussed.     

DIAGNOSIS OF CUTANEOUS TUBERCULOSIS BY POLYMERASE CHAIN REACTION USING A SPECIES-SPECIEIC GENE

Background. Diagnosis of tuberculosis (TB), especially cutaneous TBC, by conventional microbiologic methods is still a very laborious process and the results are usually inconclusive. Our purpose was to identify M. tuberculosis bacilli in uncultured clinical samples from skin lesions by means of the rapid, specific, and sensitive polymerase chain reaction (PCR). Methods. The PCR, using a set of species-specific primers, was performed on biopsies and fluid secretions from lesions. Results. A positive amplification reaction was observed in three of the four samples studied. For one of the samples, the result was confirmed by a positive culture in Lowenstein-Jensen medium and for the other two, by molecular hybridization and the clinical course of the patients after treatment. Samples obtained from a patient with panniculitis of Christian-Weber and a normal skin biopsy were included as negative controls. Conclusions. We propose the PCR method as a tool for the diagnosis of cutaneous TBC. The presence of the M. tuberculosis in an erythema induratum of Bazin suggests a revision of the concept of this disease as a tuberculide reaction.     

A FIVE YEAR RETROSPECTIVE STUDY ON PEMPHIGUS AND PEMPHIGOID

In a five year period 73 cases of pemphigus vulgaris (PV) and 94 of bullous pemphigoid (BP) were studied to investigate important parameters for these diseases. From the results it was found that the incidence of PV was higher in women whereas that of BP was almost equal in both sexes. The incidence of PV was highest in the sixth decade but was highest in the eighth decade for BP. Indirect immunofluorescence (IIF) was more sensitive in PV whereas direct immunofluorescence (DIF) was more sensitive in BP. The present study provides a basis for comparison with results of previous or future studies in Greek and other populations.