Spectrum of cutaneous granulomatous lesions: A 5-year experience in a tertiary care centre in Sarawak

INTRODUCTION

Granulomatous skin lesions can have various histopathological features leading to diagnostic confusion. The study aimed to determine the frequency and pattern of different granulomatous skin lesions.

MATERIALS AND METHODS

This was a 5-year retrospective study done between April 2017 and March 2022 at Dermatology Department, Sarawak General Hospital. Subjects with a clinicopathological diagnosis of granulomatous diseases were included in the analysis.

RESULTS

A total of 1718 skin biopsies were done during the study periods, with 49 (2.8%) confirmed granulomatous skin lesions. Most patients were aged 40-60 with a male predominance of 51%. Most of the skin biopsy samples were taken from the upper limb (36%). In this study, epitheloid granuloma was the commonest subtype (21, 43%) followed by suppurative granuloma (12, 24%), tuberculoid granuloma (8, 16%) and foreign body granuloma (5, 10%). The commonest aetiology of granulomatous skin lesions in our study was infections (30, 61%) followed by foreign body inoculation (8, 16%). Fungal infection was the most common infective cause, followed by cutaneous tuberculosis.

CONCLUSION

The major cause of granulomatous dermatoses in developing countries is still infections, fungal and tuberculosis being the leading causes.

Prevalence and psychosocial impact of acne vulgaris among high school and university students in Sarawak, Malaysia

BACKGROUND

Acne vulgaris is a common skin condition that affects adolescents and young adults. Its psychosocial impact can be significant. The primary objective of this study was to determine the prevalence of acne vulgaris and its psychosocial impact among high school and university students in Kuching, Sarawak. In addition, the clinical characteristics of acne and its potential predisposing factors were assessed.

METHODS

This cross-sectional study was conducted among high school and university students in Kuching, Sarawak. A team of dermatology-trained doctors examined a representative sample of high school and university students aged 16 to 25 years to identify acne vulgaris. The Dermatology Life Quality Index (DLQI) was used to assess the psychosocial impact of acne on affected individuals. The Global Acne Grading System (GAGS) was used to determine the severity of acne. Demographic data and clinical characteristics of acne were recorded.

RESULTS

A total of 582 students aged 16 to 25 years were recruited. The overall prevalence of acne vulgaris was 75.8% (n=441). The prevalence of acne was highest (85.5%) in the age group of 16-18 years. There was a significantly higher tendency for male students to have moderate to severe acne (p=0.010). A significantly higher proportion of female students had impaired quality of life (p<0.001) compared to male students. In comparison to male students, the mean DLQI scores were significantly higher in female students in the domains of 'Work and school' and 'Personal relationship' (p<0.05). There were 41 students who had a very large impact on the quality of life with a DLQI score of 11-20 and 34 (82.9%) of them had mild acne. There was a significantly higher proportion of students who had frequent insomnia in the group of students with acne compared to those without acne (11.6% vs. 4.3%, p=0.011). There was no significant association of acne vulgaris with dietary intakes, such as chocolates, sweets, potato chips, yoghurt, milk, fried chicken, ice cream, nuts and carbonated drinks (p>0.05). Of the 441 students with acne, 247 (56%) had not sought any medical attention.

CONCLUSION

Acne vulgaris impacts the quality of life similarly to psoriasis, atopic eczema, and chronic urticaria. In mild acne cases, the quality of life may be significantly affected. Therefore, acne education is required in high schools and colleges to ensure that students understand their disease and are aware of available treatments.

Human Immunodeficiency Virus-infected men who have sex with men with syphilis: A 5-year multicentre study in Malaysia

OBJECTIVES

High rates of syphilis have been reported worldwide among men who have sex with men (MSM). This study aims to describe the clinical pattern and treatment response of syphilis among human immunodeficiency virus (HIV)-infected MSM in Malaysia.

METHODS

This is a retrospective study on all HIV-infected MSM with syphilis between 2011 and 2015. Data was collected from case notes in five centres namely Hospital Kuala Lumpur, Hospital Sultanah Bahiyah, Hospital Umum Sarawak, University of Malaya Medical Centre and Hospital Sungai Buloh.

RESULTS

A total of 294 HIV seropositive MSM with the median age of 29 years (range 16-66) were confirmed to have syphilis. Nearly half (47.6%) were in the age group of 20-29 years. About a quarter (24.1%) was previously infected with syphilis. Eighty-three patients (28.2%) had other concomitant sexually transmitted infection with genital warts being the most frequently reported (17%). The number of patients with early and late syphilis in our cohort were almost equal. The median pre-treatment non-treponemal antibody titre (VDRL or RPR) for early syphilis (1:64) was significantly higher than for late syphilis (1:8) (p<0.0001). The median CD4 count and the number of patients with CD4 <200/μl in early syphilis were comparable to late syphilis. Nearly four-fifth (78.9%) received benzathine-penicillin only, 5.8% doxycycline, 1.4% Cpenicillin, 1% procaine penicillin, and 12.4% a combination of the above medications. About 44% received treatment and were lost to follow-up. Among those who completed 1 -year follow-up after treatment, 72.3% responded to treatment (serological non-reactive - 18.2%, four-fold drop in titre - 10.9%; serofast - 43.6%), 8.5% failed treatment and 17% had re-infection. Excluding those who were re-infected, lost to follow-up and died, the rates of treatment failure were 12.1% and 8.8% for early and late syphilis respectively (p=0.582).

CONCLUSION

The most common stage of syphilis among MSM with HIV was latent syphilis. Overall, about 8.5% failed treatment at 1-year follow-up.