No abstract

Background: Psoriasis patients have an increased risk for non-alcoholic fatty liver disease (NAFLD). Controlled attenuation parameter (CAP) on transient elastography is more sensitive than abdominal ultrasonography in detecting liver steatosis. Objectives: To determine the prevalence of NAFLD in psoriasis and to identify its predisposing factors. Methods: A cross-sectional study was performed involving 109 psoriasis patients aged > 18 years in two tertiary dermatology clinics in Kuala Lumpur. Patients on hepatotoxic drugs, had excessive alcohol intake, and other secondary causes of chronic liver diseases were excluded. Anthropometrics, blood pressure, Psoriasis Area and Severity Index (PASI), liver function test, lipid profile, and fasting blood glucose were obtained. CAP on transient elastography was performed to diagnose NAFLD. The clinical characteristics of psoriasis patients were compared between patients with and without NAFLD. Results: The prevalence of NAFLD was 85.3%. NAFLD in psoriasis patients was associated with a higher weight (P < 0.0005), body mass index (BMI) (P < 0.0005), waist circumference (P < 0.0005), and metabolic syndrome (P = 0.002). Fasting blood glucose (5.3

Hidradenitis suppurativa (HS) is a debilitating chronic inflammatory skin disease. Biological therapy has revolutionized it's the treatment. Paradoxical HS occur with various biological and targeted agents. We report a patient with juvenile rheumatoid arthritis who developed HS after 6 months of tofacitinib therapy. A comprehensive literature review identified 43 cases of paradoxical HS among patients on biological and targeted agents. Pooled analysis of the cases showed Crohn's disease 18(41.8%) and RA 9(20.9%) as commonest indications for biological therapy. Adalimumab 20(46.5%) followed by infliximab 9(20.9%) were the commonest offending agents. Duration of biological treatment prior to HS manifestation was 12(1-120) months. Smoking 21(48.8%) and overweight or obese 20(46.5%) were most frequent HS risk factors. Fourteen (32.6%) patients had a second paradoxical event, 11(25.6%) developed psoriasis and 4(9.3%) Crohn's disease. Presence of ≥1 risk factor for HS, continuation of the implicated biological agent and occurrence of more than one paradoxical event were factors associated with poor paradoxical HS outcome.

Introduction: The atopic march consists of atopic dermatitis (AD), allergic rhinitis or sinusitis (AR), allergic conjunctivitis (AC) and bronchial asthma (BA). The influence of concomitant atopic diseases on AD is under-explored. We determined the relationship between personal and family history of atopic diseases with AD severity and persistence. Methods: A cross sectional study involving AD patients was performed at dermatology clinics of two tertiary hospitals. Inclusion criterion was all patients diagnosed with AD. Demographic data, personal and family history of atopy (BA, AR and AC) were obtained by face-to-face interview. AD severity was evaluated using Investigator’s Global Assessment (IGA). AD was considered persistent if continued beyond age 12 years. Results: Sixty patients aged 21.6±17.2 participated. There were 25(41.7%) with concomitant AR, 16(26.7%) BA and 12(20%) AC. Forty seven (78.3%) patients had family history of atopy, 25(41.7%) had eczema, 24(40%) AR, 19(31.7%) BA and 2(3.3%) AC. Patients with BA [OR=3.8, 95%CI 1.04 to 14.4)], BA and AR [OR=9.74, 95%CI 1.13 to 83.67) and family history of BA [OR= 4.00, 95%CI 1.20 to 13.27) were more likely to exhibit moderate-severe AD. Personal AR, AC and family history of AD and BA were significantly more prevalent in patients with persistent AD. Conclusions: AR was the most common atopic disease associated with AD. Family history of eczema and AR were common. Personal BA, BA with AR and family history of BA were predictors of severe AD. Personal AR, AC and family history of AD and BA were associated with AD persistence.

Background: Local cutaneous change is one of the factors involved in the pathophysiology of skin manifestations in chronic kidney disease (CKD). Objectives: To determine the skin's biophysical parameters in different CKD stages and the relationship with biochemical and hematological parameter, pruritus severity, and body water content. Methods: A cross sectional study involving stage 1-5 CKD patients aged ≥ 50 years was performed. Transepidermal water loss (TEWL), hydration, pH and body water content were measured at eight sites. Results: A total of 83 patients aged 66.8 ± 8.4 years participated. There were no differences in TEWL, hydration, pH, and body water between the CKD stages and pruritus severity. Pruritus did not correlate with biophysical, haematological, and biochemical parameters.