Malaysian Journal Of Dermatology
Volume 21 August 2008 ISSN: 1511-5356Malaysian Journal ofDermatologyJURNAL DERMATOLOGI MALAYSIAPE RS AT U A N D ERMATOLOGI MALAYSI ADERM ATOLOGI CAL SOCI ETY OF M AL AYSIAwww.dermatology.org.my
Malaysian Journal Of Dermatology Jurnal Dermatologi MalaysiaNotice to AuthorsThe Malaysian Journal of Dermatology welcomes manuscripts on allaspects of cutaneous medicine and surgery in the form of original articles,research papers, case reports and correspondence. Contributions areaccepted for publication on condition that they are submitted exclusivelyto the Malaysian Journal of Dermatology. The Publisher and Editorscannot be held responsible for errors or any consequences arising from theuse of information contained in this journal; the views and opinionsexpressed do not necessarily reflect those of the publisher and Editors,neither does the publication of advertisements constitute anyendorsement by the publisher.Manuscripts should be submitted via email: bbfoong@pc.jaring.myQuestions regarding the Malaysian Journal of Dermatology can be sentto:Henry Foong Boon Bee, MBBS, FRCPEditor-in-ChiefFoong Skin Specialist Clinic33A Persiaran Pearl, Fair Park, Ipoh 31400, MalaysiaTel: 60 5 5487416 Fax: 60 5 5487416Email: bbfoong@pc.jaring.myTables, diagrams, and selected figures are often helpful. The length is leftto the judgment of the author, although it generally should not exceed5000 words. Topics may include updates in clinically relevant basic scienceand cutaneous biology.*No abstract requiredManuscripts should include a title page bearing the title of the paper, theauthor(s)' name(s), degrees, and affiliation(s), the category of the article,the number of figures and tables, and three key words for indexingpurposes. The name and full postal address (including a street address),phone and fax numbers and an email address of the corresponding authorwho will be responsible for reading the proofs must also be given on thetitle page. The author(s) must also declare any affiliation or significantfinancial involvement in any organizations or entity with a direct financialinterest in the subject matter or materials discussed in the manuscript onthis page.All measurements should be according to the metric system. If confusioncould result, please include other measurement systems in parentheses.Refer to patients by number or letters; names or initials should not beused.Contributions should be written for one of the following categories:Case Report*A report of 400-600 words, illustrated by no more than three illustrations.This category offers a means for rapid communication about a singlesubject.Clinical TrialAn article of 700-1200 words concerning a drug evaluation. This categoryprovides rapid publications and is meant to be a succinct presentation witha minimum of graphs and tables.Commentary*An editorial 700-1200 words in length with approximately five references.The author may express his or her opinion without completedocumentation.Clinicopathological ChallengeA photographic essay that includes both clinical and pathologicalphotographs in color. The diagnosis and legends for the photographsshould be listed after the references in the article. The article should be nomore than 2-3 pages in length.Correspondence*Letters to the editor and short notes. Contributions should not exceed600 words, two figures, and 10 references.Dermatological SurgeryAn article relating to the surgical aspects of treatment. Article types mayinclude Review, Report or Case Report Format.Original ArticleAn original article including, whenever possible, an Introduction,Materials and Methods, Results, Comment, and References. AStructured Abstract of not more than 240 words must be included. Itshould consist of four paragraphs, labeled Background, Methods, Results,and Conclusions. It should describe the problem studies, how the studywas performed, the main results, and what the author(s) concluded fromthe results.ReviewBy invitation only. A major didactic article that clarifies and summarizesthe existing knowledge in a particular field. It should not be an exhaustivereview of the literature, and references should not exceed 100 in number.References must be listed in the order in which they appear in themanuscript. References from journals should include: (1) name(s)followed by the initials of the author(s), up to four authors: if more thanfour authors, include the first three authors followed by et al.; (2) title ofpaper; (3) title of the journal as abbreviated in the Index Medicus; (4) yearof publication; (5) volume number; (6) first and final page numbers of thearticle.For example:Foong H, Ibrahimi O, Elpern D, Tyring S, Rady P and Carlson JA.Seborrhoeic keratosis-like lesions in a young woman withepidermodysplasia verruciformis. Int J Dermatol 2008; 47(5):476-8References to books should include: (1) author(s) or editor(s);(2) chapter (if any) book titles; (3) edition, volume, etc.; (4) place ofpublication; (5) publisher; (6) year; (7) page(s) referred to.For example:Foong H. Transcontinental Dermatology: Virtual Grand Rounds.In: Wootton R and Oakley A, editors. Teledermatology. London.Royal Society of Medicine 2002. p.127-134.The author is responsible for the accuracy and completeness of allreferences; incomplete references may result in a delay to publication.Tables should be typed, double-spaced with a heading, each on a separatesheet, and should only include essential information. Drawings, graphs,and formulas should be submitted on separate pages.Send illustrations as tiff or jpeg files. In the case of photomicrographs, thestain type and original magnification should be stated. Each figure shouldbear a reference number corresponding to a similar number in the text.To minimise the publication time of your manuscript it is important thatall electronic artwork is supplied to the Editorial Office in the correctformat and resolution.DisclaimerThe Publisher and Editors cannot be held responsible for errors or anyconsequences arising from the use of information contained in thisjournal; the views and opinions expressed do not necessarily reflect thoseof the publisher and Editors, neither does the publication ofadvertisements constitute any endorsement by the publisher and Editorsof the products advertised.
Malaysian Journal of DermatologyJurnal Dermatologi MalaysiaThe Official Publication for Persatuan Dermatologi MalaysiaEditorial BoardEditor-in-ChiefHenry Foong Boon Bee, MBBS, FRCPEditorial OfficeFoong Skin Specialist Clinic33A Persiaran PearlIpoh 31400 MalaysiaEmail : bbfoong@pc.jaring.myAssociate EditorsChoon Siew Eng, MBBS, FRCPGangaram Hemandas, MBBS, FRCPAgnes Heng Yoke Hui, MBBS, MRCPTing Hoon Chin, MBBS, MRCPFounding EditorSteven Chow Kim Weng, MBBS, FRCPI (1987-1993)Editors EmeritusRoshida Baba, MBBS, FRCP (1994-1998)Madziah Alias, MD, MMed (1999-2002)Koh Chuan Keng, MBBS, MRCP (2003-2004)Najeeb Ahmad Mohd Safdar, MBBS, MRCP (2005-2006)Persatuan Dermatologi MalaysiaPresidentAllan Yee Kim Chye, MBBS FRCPTreasurerNajeeb Ahmad Mohd Safdar, MBBS MRCPVice PresidentMadziah Alias, MD MMedImmediate Past PresidentGangaram Hemandas, MBBS FRCPSecretaryKoh Chuan Keng, MBBS MRCPCommittee MembersAgnes Heng Yoke Hui, MBBS MRCPOng Cheng Leng, MBBS MRCPHenry Foong Boon Bee, MBBS FRCPPublished by PERSATUAN Dermatologi Malaysia - Dermatological, Society of MalaysiaPrinted by Cetak Sri Jaya, 11, Jalan Ambong Kanan 3, Kepong Baru, 52100 Kuala Lumpur, MalaysiaTel / Fax : 603-6275 9514 Email : cetak s j@yahoo.com.my 2008 Persatuan Dermatologi Malaysia. All rights reserved.No part of this journal can be reproduced without written permission from the editorial board
Malaysian Journal ofDermatologyJURNALDERMATOLOGIMALAYSIAVOLUME 21 AUGUST 2008 ISSN: 1511-5356Contents13913EditorialShould dermatologists perform moredermatologic surgery?Henry B.B. Foong, MBBS, FRCP41Lepra reactions: A 10-year retrospectiveanalysisTan WC, MD, MRCP andLo Kang SC, MD, MRCP47Comparison of multiple drug therapyin leprosyYap FBB, MRCP, Awang T andPubalan M, MRCP53Granular cell tumour - A case series of9 patients and literature reviewYT Pan, MBBS, MRCP,HL Tey, MBBS, MRCP andChan YC, MBBS, MRCP, FAMS57Use of cyclosporine in the treatment ofpsoriasisMM Tang, MD, MRCP,LC Chan, MD, MMed andA Heng, MBBS, MRCPReviewSkin rejuvenation procedures - An updateGoh Chee Leok, MBBS, MD, FAMS, FRCPEvidence-based dermatology - A briefintroductionDavid A Barzilai, MD, PhDOriginal ArticlesTreatment of naevus of Ota withQ-switched 1064nm Nd:YAG laserMM Tang, MBBS, MRCP,HB Gangaram, MBBS, FRCP andSH Hussein, MBBS, FRCP19A retrospective study of Q-switchedNd:YAG laser in the treatment of Hori’snaevusYY Lee, MD, MRCP, MMed,HB Gangaram, MBBS, FRCP andSH Hussein, MBBS, FRCP63Predictive values of 10% potassiumhydroxide examination for superficialfungal infection of the skinYap FBB, MD, MRCP,Wahiduzzaman M, MBBS andPubalan M, MBBS, MRCP23Acute generalized exanthematouspustulosis: A histologic study offorty-five casesMai P Hoang, MD,Meera Mahalingam, MD, FRCPath,Jag Bhawan, MD, Payal Kapur, MD andWhitney A High, MD67Epidemiological characteristics ofcommon secondary bacterial skininfection from patients with atopicdermatitisS T Sim, H B B Foong, MBBS, FRCP andE M Taylor, MBBS, GDFPD7535A 4-year retrospective study ofStevens-Johnson syndrome and toxicepidermal necrolysisYap FBB, MD, MRCP,Wahiduzzaman M, MBBS andPubalan M, MBBS, MRCPCutaneous tuberculosis in Penang:A 12-year retrospective studyTan WC, MD, MRCP, Ong CK, MD, MRCP,Lo Kang SC, MD, MRCP andAbdul Razak M, MBBS, MMed, MSc, FCCP,AMi
8187Comparison of BBL chromagar MRSA toconventional media for the detection ofmethicillin resistant staphylococcus aureusin surveillance nasal swabsN Mohd Noor, MBBS, MRCP,S Thevarajah, MBBS, MMed,Zubaidah Abdul Wahab, MBBS, MPath andS H Hussein, MBBS, FRCPCase ReportsD-penicillamine-induced pemphigus in apatient with Wilson’s diseaseLoh LC, MBChB, MRCP,Goh KL, MBBS, FRCP and Rosnah Zain109Pyoderma gangrenosum associated withmalignancy: A report of three casesHuma K, MBBS, Dip Derm,KE Tey, MD, MRCP, MMed, AM andSE Choon, MBBS, FRCP113Incontinentia pigmenti: Report of 3 casesfrom SarawakLeong KF, MRCPCH, Pubalan M, MRCP andYap FBB, MRCP117Primary cutaneous anaplastic large celllymphoma in a young womanYap FBB, MRCP and Pubalan M, MRCP121Cutaneous tuberculosis confirmed byPCR in a patient with culture negative formycobacterium tuberculosisLee YY, Loh LC, MBChB, MRCP and SC Peh91Cutaneous B-cell pseudolymphoma:Case reports and literature reviewTang JJ, MBBS, Chan LC, MD, MMed andHeng A, MBBS, MRCP95Ectodermal dysplasia in a pair of siblingsSM Wong, MBChB, MRCP andLC Loh, MBChB, MRCP125CommentaryManagement of naevus of OtaTing Hoon Chin, MBBS, MRCPAn unusual case of naevus of Ota and Itoassociated with port wine stainChong YT, MD, MRCP,Tey KE, MD, MMed, MRCP andChoon SE, MBBS, FRCP127CorrespondenceTemptations of dermatologistsOng Cheng Leng, MBBS, MRCP99127ii103Lepromatous leprosy - The deceptive andthe obviousKader B Mohamed, MBBS, Dip Derm105Cutis laxa associated withxanthogranulomaKE Tey, MD, MRCP, MMed, AM andSE Choon, MBBS, FRCP, AMCutaneous manifestations of lymphomas:Report of 3 casesKader B Mohamed, MBBS, Dip Derm
Malaysian Journal Of Dermatology Jurnal Dermatologi MalaysiaEditorialShould dermatologists perform more dermatologicsurgery?The clinical practice of dermatology has changed during thepast 25 years. Dermatologists are performing more skinsurgeries than before1. When I was a medical studentattending the skin clinic in University Hospital, we sawmainly patients with medical dermatology problems.Today, if one visits a modern dermatology centre, one wouldbe able to see an array of dermatologic procedures. It is notsurprising since dermatologists have been pioneers indermatologic surgery for many years. They have not onlycreated Mohs micrographic surgery but have developed andenhanced many new technologies including cryosurgery,botulinum toxin injection, laser surgery, soft tissueaugmentation, tumescent liposuction, hair transplant andreconstructive surgery for skin cancers. Over the last 25years, new technologies have change dramatically the waydermatologists practice. They use laser to treat nevus of Otaand tattoos, botulinum toxin injection to improve wrinklesand fractional resurfacing laser to treat acne scars. They alsouse intense pulsed light (IPL) to rejuvenate the face, radiofrequency devices to tighten skin, hyaluronic acid injectionto replace volume loss in the photoaging skin and manyothers not to mention microdermabrasion, chemical peels,hyfrecating seborrheic keratosis and applying topical acidsto treat xanthelasma.In fact dermatologists perform more surgical procedures onthe skin than any other specialty based on data from theCentre for Medicare and Mediaid services in UnitedStates2. Mohs micrographic surgery remains the ‘goldstandard” as a technique that has the highest cure rate forthe treatment of most skin cancers. They result in smallerscars for defects that are important in functional andcosmetic areas of the face. These data are interestingbecause they show that the incidence of skin cancers areprobably increasing. Reported incident rates vary, but in theUnited States the combined incidence for basal cellcarcinoma, squamous cell carcinoma, and melanoma isreported to be about 1 million new cases in 2007.Dermatology is broadly recognized as a comprehensiveorgan based specialty and this include training in thefundamental understanding of the structure, function andpathophysiology of the skin. Despite the increase in skinsurgeries, training program in the country has not evolvedat the same rate. In fact, dermatopathology is generallygiven more emphasis for differential diagnosis and regardedas more important than skin surgery during training anddifferential diagnosis is usually regarded as the heart andcore of dermatologic training. Dermatologic surgery topicsare usually relegated to the last chapter of any multivolumetext of dermatologyHowever, for better or for worse, dermatology is now amedical and surgical field3. The issue is not whetherdermatologists perform such procedures but whether theycontinue to train, educate and research in the surgicalaspects of dermatology. As such, it is important thattraining and research in dermatologic surgery should playan important role in the academic program of dermatology.All dermatology trainees must become competent toperform basic dermatologic surgery upon graduation fromtheir training. Good surgical skills must be taught early intheir training to ensure that, in the absence of adequateguidance, they do not habituate to poor technique which issubsequently difficult to alter. Patients may be better servedby a dermatologist with surgical skills who is able to provideall their dermatologic care, thus eliminating the need forfrequent referrals to a surgeon. Finally, if excellent surgicaltraining were the norm in dermatology education, patientswould regard their dermatologists as the expert in skincancers and skin surgeries. There is no doubt that the trueexperts in any field of medicine are those that do the sameprocedure over and over again. High-risk surgeries arebetter done by surgeons who do lots of them4.Henry B.B. Foong, MBBS, FRCP EdinEditor-in-ChiefMalaysian Journal of DermatologyIpoh, MalaysiaReferences1.2.3.4.Roenigk RK. Dermatologists Perform More Skin Surgery ThanAny Other Specialist: Implications for Health Care Policy,Graduate and Continuing Medical Education. Dermatol Surg2008; 34 : 293-300.Physician/Supplier Procedure Summary Master File. Centers forMedicare & Medicaid Services, U.S. Department of Health &Human Services.Alam M. Dermatologic surgery training during residency: roomfor improvement. Dermatol Surg 2001; 27 : 508-9.Alam M. The Case for Procedure-Specific Volume Requirements.Dermatol Surg 2001; 27 : 2-41
2
Malaysian Journal Of Dermatology Jurnal Dermatologi MalaysiaReviewSkin rejuvenation procedures - An updateGoh Chee Leok MBBS MD FAMS FRCPNational Skin Centre, SingaporeCorrespondenceGoh Chee Leok MBBS, MD, FAMS, FRCPSenior Consultant DermatologistNational Skin Centre1 Mandalay Road, SingaporeEmail: cheeleok@yahoo.com.sgIntroductionSkin aging, presenting with rhytides/sagging andphotodamage, and scarring from severe acne, surgery, ortrauma are cosmetic disfigurements which may causepsychologic damage and prompt patients to seek adviceabout treatment. Solar damage of the skin leads toepidermal abnormalities, such as lentigenes and actinickeratoses, and the degeneration of collagen, which results inthe formation of rhytides and telangiectasias. A variety ofdifferent treatments have been used for the rejuvenation ofsun-damaged skin, including topical retinoids, bleachingagents, chemical peeling, dermabrasion, lasers and lightdevices. The optimum resurfacing laser provides precise skinvaporization with minimal postoperative morbidity, whichdepends significantly on the depth of ablation and energyfluence.The ablative lasers era:In the early 1980s, the CO2 laser was the most commonlyused ablative laser in dermatology practice. It was initiallyused for the treatment of benign tumours, and soon gainedpopularity as a resurfacing technique for correctingphotodamaged skin including wrinkles, dyspigmentationand scars1. Ablative lasers including the CO2 laser andEr:YAG lasers resurfacing remains the most effectivetreatment for photodamage and intrinsic wrinkling, acnescars, chickenpox scars and traumatic scars to date. It hasbeen used for many years since the introduction of scannersthat allow resurfacing of large skin areas. These traditionalablative laser resurfacing procedures offer reliable andpredictable positive outcome2. Unfortunately, CO2 ablativelasers are associated with unacceptable morbidity andcomplications e.g. severe pain, prolong erythema,postinflammatory hyperpigmentation (especially in Asians),late onset hypopigmentation and scarring. Transienterythema is the result of the natural healing process of theresurfaced skin. On the other hand, persistent erythema is atroublesome complication to the patient and laser surgeon,as the patient wishes to return to normal activities in theshortest possible time. HSV Infections is a dreadedcomplication as it may cause severe scarring. Downtime islong and patient requires long leave to recover from theablative laser procedures. Another major disadvantage ofablative laser resurfacing is the need of local or generalanaesthesia. As a result, over the last few years, ablative laserbecame less popular among patients3,4.The pulsed Er:YAG laser with the unique feature ofmaximal water absorption (water absorption coefficient 16times greater than the CO2 laser), and therefore minimaloptical penetration depth and thermal damage, has beenshown to be efficacious in the treatment of mild tomoderate superficial rhytides and scars2. This infraredspectrum (2940 nm), has been shown to provide veryprecise ablation, because of its high selectivity to tissuewater and negligible thermal damage. The characteristics ofa wavelength with maximal water absorption, a sufficientlyshort time duration ( 1 ms), and sufficient energy fluenceplace the Er:YAG laser as the optimum ablative device forfine and superficial resurfacing of the skin. Pinpointbleeding appears after several passes (4-5 passes dependingon the spot size and energy fluence) with exposure of thedermo-epidermal junction, and the laser treatment isusually stopped. Therefore, bleeding is a problem in thetreatment of deeper wrinkles with the Er:YAG laser5. Themain advantages of the Er:YAG over the CO2 laser are thereduced thermal damage, shorter recovery time, lesspostoperative erythema, and fewer anesthesia requirements.The absence of thermal damage using the Er:YAG lasermeans less profound clinical and histologic improvement inphotodamaged skin. In a bilateral comparison study of 20patients using the CO2 and Er:YAG lasers in the tre
Malaysian Journal Of Dermatology Jurnal Dermatologi Malaysia. Editorial Board Editor-in-Chief Henry Foong Boon Bee, MBBS, FRCP Editorial Office Foong Skin Specialist Clinic . MBBS, FRCP Review 3 Skin rejuvenation procedures - An update Goh Chee Leok, MBBS, MD, FAMS, FRCP 9 Evidence-
42 PRACTICAL DERMATOLOGY MARCH 2022 DERMATOLOGY'S T VE The past decade witnessed consolidation within the dermatology and aesthetics market, and the . Dermatology Consultants of South Florida; 01/2019 Pharos Capital Sona Dermatology & MedSpa Charlotte, NC; 2015 Alpine Investors Optima Dermatology Portsmouth, NH; 2018
Color Atlas of Clinical Dermatology Atif Hasnain Kazmi World Clinics Dermatology - Acne (December 2013 Volume 1 Number 1) Neena Khanna Step By Step Chemical Peels Niti Khunger A Manual of Dermatology Zohra Zaidi & Shernaz Walton Color Atlas of Differential Diagnosis in Dermato-pathology Loren E Clarke, et al. The Pocket Doctor Dermatology Arun .
Dermatology The Newsletter of the University of Mississippi Medical Center Department of Dermatology Winter 2019. Patient Centered Subspecialty Care. Nancye McCowan, MD. Program Director, Complex Medical Dermatology and Cosmetic Dermatology. Kimberley Ward, MD. Cosmetic, Medical and Surgical
Dermatology Clinics of Southwest Virginias was formerly known as Derm One, PLLC. The company was founded in 1994 and is based in Bluefield, Virginia. 57 Dermatology Consultants, P.C. Private Dermatology Consultants, P.C., a dermatology practice, provides
This Malaysian Standard is the first revision of MS ISO 9001, Quality management systems - Requirements. This Malaysian Standard is identical with ISO 9001:2008, Quality management systems - Requirements, published by the International Organization for Standardization (ISO). However, for the purposes of this Malaysian Standard, the following apply:
Suzanne Sirota Rozenberg, D.O. FAOCD Program Director St. John’s Episcopal Hospital October 16, 2015. Objectives Review osteopathic tenets Review the connection of tenets to dermatology Role of OMM in dermatology Review specific disease states. OMM and Dermatology
this study suggest evaluation of dermatology curriculum nationwide.1 While our PA program provides roughly 29 hours of didactic education in dermatology, mastery of dermatology concepts cannot be achieved without practice.3 There is a discrepancy between learned knowledge in medical education and application of that
Government of Andhra Pradesh Department of School Education State Council of Educational Research & Training DSC SGT – SECOND GRADE TEACHER SYLLABUS 1. G.K & current Affairs - - 10M 2. Perspectives in Education – 05M 3. Educational Psychology – 10M 4. Content & Methodologies - 75M (50 25) Total - 100 M PART - I I. General Knowledge And Current Affairs (Marks: 10) PART - II II .
