IMAGES IN MEDICINEAn 84-year-old Chinese man with stage IV non-small cell lung cancer was initiated on pembrolizumab, an antiprogrammed cell death (PD)-1 monoclonal antibody, 4 times per week. Seven weeks later, on the day of his third cycle, he developed a rash on his chest and right axilla, which subsequently resolved with 1% hydrocortisone cream, and there was no interruption to his immunotherapy. Eleven weeks after the initiation of pembrolizumab, the patient reported new pruritic, purpuric papules on his buttocks, forearms and legs. There were associated blisters seen on his feet. The rash progressively worsened despite topical steroids (Fig. 1).

No abstract

Vitiligo in Asian children: A retrospective reviewVitiligo is an acquired depigmenting disorder affecting 0.5-2% of the population worldwide, and as many as half of these cases develop before the age of 20 years. 1 There are few Asian studies characterising the epidemiology of paediatric patients with vitiligo. We aim to describe the clinical profile, prevalence, risk factors, association with other autoimmune conditions and response to treatment of paediatric vitiligo in two tertiary paediatric hospitals in Singapore.We conducted a retrospective cohort study of patients aged 18 years old and below, diagnosed with vitiligo at KK Women's and Children's Hospital and National University Hospital. We recruited patients from January 2013 to April 2017. Clinical response to treatment was determined as poor (0-<25% repigmentation), partial (25-<75% repigmentation) and good (75-100% repigmentation).Results are shown in Table 1. There was a total of 110 patients, with 58 males and 52 females. The mean age of onset was 5.5 AE 3.7 years (range: 3 months to 18 years). There were 53 Chinese, 16 Malay, 29 Indian and 12 patients of other ethnic minorities. The proportion of darker-skinned patients (Indians and Malays) was disproportionately higher than Singapore's ethnic distribution. None of the patients had a personal history of autoimmune disease. There were 5 (4.5%) patients with a family history of vitiligo and 5 (4.5%) with a family history of autoimmune thyroid disease. There were 64 patients (58.2%) with nonsegmental vitiligo and 46 patients (41.8%) with segmental vitiligo. With regard to anatomical distribution, in patients with non-segmental vitiligo, 19 (29.7%) had head and neck, 11 (17.2%) had truncal involvement and 7 (10.9%) had limb involvement. Seven (10.9%) patients had acrofacial vitiligo, and 20 (31.3%) patients had generalised vitiligo, defined as involvement of more than 1 body site. In patients with segmental vitiligo, 25 (71.7%) had head and neck involvement, 8 (17.4%) had truncal involvement and 3 (10.9%) had limb involvement. The patients with nonsegmental vitiligo had a mean body surface area (BSA) of 2.8% AE 3.5% (range: 1-30%). Thirty patients had thyroid function tests performed. Four patients were diagnosed with subclinical hypothyroidism.Of the 110 patients, 103 patients (93.6%) underwent treatment. The mean duration of symptoms prior to treatment was 12.1 AE 15.5 months (range: 1-96 months). The 7

A 69-year-old woman with a linear rash IMAGES IN MEDICINEA 69-year-old Chinese woman presented with pruritic lesions in the form of linear keratotic papules on the left inframammary region for the past 2 years. On examination, there were multiple oval to round, brown, firm, keratotic papules with distinct scaly edges separated from the surrounding healthy skin (Fig. 1). She was treated with mometasone furoate ointment every morning and topical calcipotriol ointment every night for about 7 months with mild improvement.