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Long V, Chandran NS. A Glance at the practice of Paediatric teledermatology Pre- and Post- COVID-19 pandemic (Preprint). JMIR DERMATOLOGY 2021; 5:e34228. [PMID: 35610984 PMCID: PMC9118542 DOI: 10.2196/34228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 12/29/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Cho J, Lee J, Sia CH, Koo CS, Tan BY, Hong W, Choi E, Goh X, Chai L, Chandran NS, Chua HR, Chan BP, Muthiah M, Low TT, Yap ES, Lahiri M. Extrapulmonary manifestations and complications of severe acute respiratory syndrome coronavirus 2 infection: a systematic review. Singapore Med J 2021. [PMID: 34544216 DOI: 10.11622/smedj.2021100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION We aimed to describe the extrapulmonary manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, including their frequency, onset with respect to respiratory symptoms, pathogenesis and association with disease severity. METHODS We searched the MEDLINE and Embase databases for SARS-CoV-2-related studies. Meta-analysis, observational studies, case series and case reports published in English or Chinese between 1 January and 1 May 2020 were included. Reports with only paediatric or obstetric cases were excluded. RESULTS 169 articles were included. Early manifestations (preceding respiratory symptoms until Day 6 of onset) included olfactory and gustatory disturbance (self-reported in up to 68% and 85% of cases, respectively), gastrointestinal symptoms (up to 65.9%) and rash (up to 20.4%). From Day 7 onwards, hypercytokinaemia, paralleled multi-organ complications including acute cardiac injury (pooled incidence of 17.7% in 1,412 patients, mostly with severe disease and 17.4% mortality), kidney and liver injury (up to 17% and 33%, respectively) and thrombocytopenia (up to 30%). Hypercoagulability resulted in venous thromboembolic events in up to 31% of all patients. Uncommon disease presentation and complications comprised Guillain-Barré syndrome, rhabdomyolysis, otitis media, meningoencephalitis and spontaneous pneumomediastinum. CONCLUSION Although the systemic manifestations of SARS-CoV-2 infection are variegated, they are deeply interwoven by shared mechanisms. Two phases of extrapulmonary disease were identified: (a) an early phase with possible gastrointestinal, ocular and cutaneous involvement and (b) a late phase characterised by multiorgan dysfunction and clinical deterioration. A clear, multidisciplinary consensus to define and approach thromboinflammation and cytokine release syndrome in SARS-CoV-2 is needed.
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Juay L, Chandran NS. Two Cases of Dyskeratosis Congenita with Clinically Distinct Presentations, Seen in National University Hospital, Singapore. Skin Appendage Disord 2021; 8:53-56. [DOI: 10.1159/000518299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/02/2021] [Indexed: 11/19/2022] Open
Abstract
Dyskeratosis congenita (DKC) is a genodermatosis of variable inheritance and is often characterised by the classical triad of nail dysplasia, reticulate hyperpigmentation of upper chest and neck, and oral leukoplakia. We report 2 cases of DKC from National University Hospital, Singapore, whose clinical presentations differed greatly from each other. Dermatologists should hold a high index of suspicion for DKC in young patients who present without the classical triad of features, as early dermatological care can be instituted through reinforcement of rigorous sun protection and regular surveillance for skin cancers. Early diagnosis also offers physicians the time to organise haematopoietic stem cell transplantation if necessary, as bone marrow failure is often inevitable. As a multisystemic disease with high morbidity and mortality particularly from haematological complications if left undetected and untreated in the early stages, the role of the dermatologist in diagnosing DKC is a crucial one.
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Tan SY, Chandran NS, Choi ECE. Steroid Phobia: Is There a Basis? A Review of Topical Steroid Safety, Addiction and Withdrawal. Clin Drug Investig 2021; 41:835-842. [PMID: 34409577 PMCID: PMC8481181 DOI: 10.1007/s40261-021-01072-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 12/01/2022]
Abstract
There is a growing concern amongst patients about topical corticosteroid (TCS) side effects, with increasing discussion of topical steroid addiction (TSA) and topical steroid withdrawal (TSW) particularly on social media platforms. However, the acceptance of TSA/TSW as a distinct condition remains controversial within the dermatological community. We conducted a literature search using PubMed, MEDLINE, Cochrane Library, Google Scholar, Embase and Web of Science to identify original articles addressing TSA/TSW. We described the definition and reported clinical features of TSA/TSW including its classification into erythemato-edematous and papulopustular subtype. To assess the validity of TSA/TSW, we summarised and objectively appraised the postulated mechanisms for this condition, including tachyphylaxis, dysregulation of glucocorticoid receptors, rebound vasodilation and impaired skin barrier leading to a cytokine cascade. Understanding the evidence including its limitations and uncertainties highlights areas for future research and helps medical practitioners better counsel and provide care to patients who may be experiencing or who have concerns about TSA/TSW.
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Juay L, Chandran NS. Three cases of vesiculobullous non-IgE-mediated cutaneous reactions to tozinameran (Pfizer-BioNTech COVID-19 vaccine). J Eur Acad Dermatol Venereol 2021; 35:e855-e857. [PMID: 34363258 PMCID: PMC8447196 DOI: 10.1111/jdv.17581] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/29/2021] [Indexed: 12/26/2022]
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Ren YK, Chandran NS, Yong Meng JT. Ulcerated yellow-brown nodules on the chest. JAAD Case Rep 2021; 14:27-29. [PMID: 34258347 PMCID: PMC8253881 DOI: 10.1016/j.jdcr.2021.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Chandran NS, Lee JH, Kurokawa I. Hidradenitis suppurativa in South-East Asia and East Asia. Exp Dermatol 2021; 30 Suppl 1:23-26. [PMID: 34085331 DOI: 10.1111/exd.14340] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hidradenitis suppurativa (HS) in South-East Asia and East Asia shows distinct clinical, environmental, physiological and likely genetic differences compared with the West. A male predominance is present, which may be due to differences in smoking habits. Involvement of the buttocks is common in East Asian patients, while the axillae are most commonly affected in South-East Asian patients. Metabolic comorbidities are prevalent in South-East Asian and East Asian HS patients. A family history of HS is less common than noted in Western populations. Asian ethnic subgroups deserve further study.
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Leong WMS, Samuel M, Chandran NS, Choi CEE, Yiong Huak C, Marsden H, Tam WWS. Interventions for inherited forms of epidermolysis bullosa. Hippokratia 2021. [DOI: 10.1002/14651858.cd014223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Juay L, Choi E, Wong J, Chandran NS. Pigmented nodule on the dorsum of the foot. JAAD Case Rep 2021; 13:49-51. [PMID: 34150967 PMCID: PMC8190128 DOI: 10.1016/j.jdcr.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Lee PY, Oen KQX, Lim GRS, Hartono JL, Muthiah M, Huang DQ, Teo FSW, Li AY, Mak A, Chandran NS, Tan CL, Yang P, Tai ES, Ng KWP, Vijayan J, Chan YC, Tan LL, Lee MBH, Chua HR, Hong WZ, Yap ES, Lim DK, Yuen YS, Chan YH, Aminkeng F, Wong ASC, Huang Y, Tay SH. Neutrophil-to-Lymphocyte Ratio Predicts Development of Immune-Related Adverse Events and Outcomes from Immune Checkpoint Blockade: A Case-Control Study. Cancers (Basel) 2021; 13:cancers13061308. [PMID: 33804050 PMCID: PMC8001500 DOI: 10.3390/cancers13061308] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/16/2022] Open
Abstract
The utility of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) utility in predicting immune-related adverse events (irAEs) and survival have not been well studied in the context of treatment with immune checkpoint inhibitors (ICIs). We performed a case-control study of cancer patients who received at least one dose of ICI in a tertiary hospital. We examined NLR and PLR in irAE cases and controls. Logistic and Cox regression models were used to identify independent risk factors for irAEs, progression-free survival (PFS), and overall survival (OS). The study included 91 patients with irAEs and 56 controls. Multiple logistic regression showed that NLR < 3 at baseline was associated with higher occurrence of irAEs. Multivariate Cox regression showed that development of irAEs and reduction in NLR from baseline to week 6 were associated with longer PFS. Higher NLR values at baseline and/or week 6 were independently associated with shorter OS. A reduction in NLR from baseline to week 6 was associated with longer OS. In this study of cancer patients treated with ICIs, NLR has a bidirectional relationship with adverse outcomes. Lower NLR was associated with increased occurrence of irAEs while higher NLR values were associated with worse clinical outcomes.
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Ee S, Ng SSY, Tay YK, Gan EY, Santosa A, Chandran NS, Koh MJA. Vitiligo in Asian children: A retrospective review. Australas J Dermatol 2021; 62:409-410. [PMID: 33660841 DOI: 10.1111/ajd.13582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 11/26/2022]
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Yong AMY, Leung AJ, Chandran NS. A dermatology health services study of nursing homes in Singapore. Singapore Med J 2021; 61:661-664. [PMID: 33415344 DOI: 10.11622/smedj.2020178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Choi E, Fengjie T, Wei TK, Chandran NS, Tan C. 13266 Targeting steroid phobia: A health services research and randomized controlled trial. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Choi E, Tan KW, Tang F, Tan C, Chandran NS. Efficacy of targeted education in reducing topical steroid phobia: A randomized clinical trial. J Am Acad Dermatol 2020; 83:1681-1687. [DOI: 10.1016/j.jaad.2020.02.079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 10/23/2022]
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Koh XQ, Ooi XT, Sun Y, Chandran NS, Tan CL. A retrospective analysis of dermatological problems in haematology and oncology patients at a tertiary Singapore hospital. Australas J Dermatol 2020; 61:e474-e476. [DOI: 10.1111/ajd.13328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 01/03/2023]
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Law JY, Choi EC, Chandran NS. Radiofrequency ablation-induced thermal cutaneous injury in a neonate: A potential complication after intrauterine radiofrequency ablation. Pediatr Dermatol 2020; 37:1189-1190. [PMID: 32897600 DOI: 10.1111/pde.14350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/01/2020] [Accepted: 08/09/2020] [Indexed: 12/01/2022]
Abstract
Over the years, the application and complications of radiofrequency ablation (RFA) in selective fetal reduction for complex pregnancies have been increasingly documented. Despite its rising use in the field of obstetrics and gynecology, the cutaneous complications of RFA have not been commonly reported. Here, we present a case of cutaneous thermal injury to the fetus likely secondary to intrauterine RFA for fetal reduction.
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Leong WMS, Mok ZR, Chandran NS. Limited efficacy of diphenylcyclopropenone in the treatment of alopecia areata: Experience from a Tertiary Healthcare Institution in Singapore. Dermatol Ther 2020; 33:e14447. [PMID: 33098604 DOI: 10.1111/dth.14447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/26/2020] [Accepted: 10/18/2020] [Indexed: 11/29/2022]
Abstract
Alopecia areata (AA) is a common cause of nonscarring hair loss. Diphenylcyclopropenone (DPCP) is a form of contact immunotherapy used in the treatment of AA. We retrospectively reviewed all patients who were diagnosed with AA over a 4-year period (1st January 2012 to 31st December 2015) and who have received DPCP. Forty patients were studied in total. The mean duration of disease prior to the study was 195 days. Patients received a mean number of 14.91 sessions (range: 1-65). The mean number of sessions required before clinical response was seen was 2.33 sessions, corresponding to 0.001% DPCP. Based on the modified Global Assessment Grading System, 33.5% (n = 11) of the patients experienced less than 25% improvement, 48.5% (n = 16) experienced 25%-74% improvement and 18.3% (n = 6) experienced more than 75% improvement. One patient had severe sensitisation reaction amounting to near erythroderma which resolved completely upon cessation of DPCP therapy. No other adverse reactions were noted in the cohort. DPCP remains a valuable tool in a dermatologist's armamentarium in treating alopecia areata as it is safe, well-tolerated, and shows limited efficacy.
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Tan J, Huang J, Chandran NS. Trichostasis Spinulosa as Manifestation of Cutaneous Graft versus Host Disease. Ann Dermatol 2020; 32:258-259. [PMID: 33911749 PMCID: PMC7992617 DOI: 10.5021/ad.2020.32.3.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 05/25/2019] [Accepted: 08/10/2019] [Indexed: 11/08/2022] Open
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Abstract
INTRODUCTION Topical corticosteroids (TCS) are commonly used in dermatology for their anti-inflammatory action. The recent development of the TOPICOP© (Topical Corticosteroid Phobia) scale to assess steroid phobia has made the quantification and comparison of steroid phobia easier. The objective of this study was to assess the degree of steroid phobia at our institute and identify sources from which patients obtain information regarding TCS. METHODS A cross-sectional survey was performed of dermatology patients regardless of steroid use. TOPICOP scale was used for the survey. Sources from which patients obtained information were identified and their level of trust in these sources assessed. RESULTS 186 surveys were analysed. The median domain TOPICOP subscores were 38.9% (interquartile range [IQR] 27.8%-50.0%, standard deviation [SD] 24.4%) for knowledge and beliefs, 44.4% (IQR 33.3%-66.7%, SD 24.4%) for fears and 55.6% (IQR 33.3%-66.7%, SD 27.2%) for behaviour. The median global TOPICOP score was 44.4% (IQR 33.3%-55.6%, SD 17.6%). Female gender was associated with higher behaviour, fear and global TOPICOP scores. There was no difference in the scores based on disease condition, steroid use, age or education. Dermatologists were the most common source of information on topical steroids and trust was highest in dermatologists. CONCLUSION The prevalence of steroid phobia in our dermatology outpatient setting was moderately high, with gender differences. Dermatologists were the most common source of information on TCS, and it was heartening to note that trust was also highest in dermatologists. Strategies to target steroid phobia should take into account these factors.
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Yan G, Tan KB, Chandran NS, Chai L, Chew KL, Somani J, Tambyah PA. Histoplasmosis presenting with Sweet's syndrome. Clin Microbiol Infect 2020; 26:795-796. [PMID: 32035234 DOI: 10.1016/j.cmi.2020.01.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/02/2020] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
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Santosa A, Yang SS, Chandran NS. DRESS Masquerading as Acute Cholecystitis. Am J Med 2020; 133:e56-e57. [PMID: 31421066 DOI: 10.1016/j.amjmed.2019.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 11/29/2022]
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Choi E, Yang S, Tan KB, Aw D, Chandran NS. Three Sequential Lymphomatous Tumours in a Patient - Authors' reply. Indian J Dermatol 2020; 65:315-316. [PMID: 32831377 PMCID: PMC7423222 DOI: 10.4103/ijd.ijd_687_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Choi E, Cook A, Phuan C, Martin A, Yang S, Aw D, Chandran NS. Outcomes of prolonged and low-dose ciclosporin in an Asian population. J DERMATOL TREAT 2019; 32:432-437. [DOI: 10.1080/09546634.2019.1662881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Yin LJ, Wei TK, Choi E, Chandran NS. TOPICOP © scale for steroid phobia - difficulties and suggestions for application in clinical research. J DERMATOL TREAT 2019; 31:624-625. [PMID: 31418325 DOI: 10.1080/09546634.2019.1657221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
PURPOSE OF REVIEW We review the range of dermatological signs seen in Zika infection and the possible relationship between the rash and viremia. We also hoped to explore the utility of mucocutaneous manifestations in narrowing the differential diagnosis from other similar flaviviruses. RECENT FINDINGS Clinical manifestations of Zika infection share many similarities with other mosquito-borne viruses such as dengue. These include non-specific symptoms such as a fever, rash, arthralgia, myalgia, and conjunctivitis. The morphology of the rash in Zika infection is not very specific and commonly described as maculopapular and centrifugal that usually extends to become diffuse. We reviewed 123 publications, encompassing a total of 368 Zika cases. One hundred seven cases with rash had sufficient data for detailed analysis. 8.4% of cases with rash had hemorrhagic manifestations such as palatal petechiae and bleeding ulcers. Only 20 reported cases were tested for viremia during presence of rash, and 70.6% of these cases were positive. While mucocutaneous complications are common in Zika infection, more research is necessary to determine the impact of rash on diagnosis, prognosis, and transmissibility in Zika infection.
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