Evaluating the effect of chlorpheniramine on patch test reactions amongst eczema patients sensitised to nickel

Discontinuing antihistamines for patch testing (PT) in allergic contact dermatitis (ACD) is more conventional than evidence based. Data suggests that non-sedating antihistamines do not interfere with PT. Investigating the effects of sedating antihistamines are more relevant as these are recommended for eczema. We aimed to evaluate the effect of chlorpheniramine on PT, to determine the prevalence of nickel sensitization and common sensitizing allergens. An open labeled cohort study was conducted at two dermatology clinics. Patients indicated for PT underwent standard protocol where antihistamines were discontinued. Patients sensitised to nickel were subjected to a second nickel PT while taking chlorpheniramine. Results were evaluated using the North American Contact Dermatitis Research Group (NACDRG) score, a Mexameter measured erythema and pruritus was assessed using a visual analogue score. A total 82 patients were recruited, 28 (34.1%) were sensitised to nickel. The mean age was 40 ± 17.7 years with 22(26.8%) males and 60 (73.2%) females. Indications for PT included suspected ACD (57.3%), hand and feet eczema (34.1%) and severe eczema with suspected superimposed ACD (6.1%). The commonest sensitizing allergens were methyldibromoglutaronitrile (40.2%) nickel sulphate (34.1%), potassium dichromate (29.3%) and formaldehyde (24.4%). A second PT was performed on 23 patients. There was no difference in the NACDRG score with chlorpheniramine or without chlorpheniramine (p=0.968). Pruritus score was reduced by 1.39 ± 2.9, p=0.031 with chlorpheniramine. The degree of erythema was 611.46 ± 21.59 with chlorpheniramine versus 613.87 ± 27.5 without chlorpheniramine, p=0.671. Chlorpheniramine did not affect PT based on clinical and objective scorings. It has the additional benefit of reducing test-induced itch

Cost analysis of psoriasis treatment modalities in Malaysian public hospitals

Psoriasis imposes a great economic burden as a result of higher expenditures for different interventions, diagnostic procedures, pharmaceuticals and loss of productivity. Less is known about the economic impact of psoriasis treatment in Asean region. The aim of this research was to calculate the costs associated with four psoriasis treatment modalities. A prospective cohort study was conducted in five hospitals involving 91 moderate to severe psoriasis patients. Costs were calculated from the societal perspective using the principle of Step Down and Activity Based Costing (ABC) within a six (6) months follow-up duration. The components of the costs borne by the provider were inpatient cost, cost of medication, laboratory investigation and radiology. Patient’s cost included out of pocket expenses, travelling cost and loss of productivity. Cost per patient per day was RM1,105.24 (inpatient) (US$315.94) and RM298.02 (outpatient) (US$85.19). Medication accounted for almost 90% (RM457,014.00) (US$130 638.45) of the total provider cost. Meanwhile, loss of productivity represented 84$47,862.80) of the total patient’s cost. Biologic treatment exhibited the highest cost which was RM342,377.00 (US$97,869.21), followed by systemic treatment (RM105,607.00) (US$30,187.99), topical treatment (RM38,280.00) (US$10,942.42) and topical phototherapy treatment (RM21,824.00) (US$6,238.44). Understanding the relationship between direct and indirect costs from both perspectives is important to accurately identify and evaluate effective treatment for psoriasis

Cost Analysis of Psoriasis Treatment Modalities in Malaysian Public Hospitals

Psoriasis menyebabkan beban ekonomi yang besar akibat perbelanjaan yang tinggi untuk rawatan, prosedur diagnostik, farmaseutikal dan kehilangan produktiviti. Maklumat berkenaan beban ekonomi amatlah terhad. Kajian ini bertujuan untuk mengira kos berkaitan dengan empat jenis rawatan psoriasis. Kajian prospektif kohort telah dijalankan di lima buah hospital melibatkan 91 pesakit psoriasis sederhana dan teruk. Kos dikira daripada perspektif masyarakat menggunakan prinsip “Step Down” dan “Activity Based Costing” dalam tempoh enam bulan rawatan susulan. Komponen kos yang ditanggung oleh pembekal adalah kos pesakit dalam, kos ubat ubatan, kos makmal penyiasatan dan radiologi. Kos pesakit pula adalah perbelanjaan poket untuk pengangkutan dan kehilangan produktiviti. Kos sehari bagi pesakit dalam adalah sebanyak RM1,105.24 (US$315.94) dan kos pesakit luar bagi setiap lawatan adalah RM298.02 (US$85.19). Ubat-ubatan menyumbang hampir 90% (RM457,014.00) (US$130,638.45) daripada jumlah keseluruhan kos pembekal. Sementara itu, kehilangan produktiviti menyumbang 84$47,862.80) daripada jumlah keseluruhan kos pesakit. Rawatan biologik menunjukkan kos yang paling tinggi iaitu sebanyak RM342,377.00 (US$97,869.21), diikuti oleh rawatan sistemik (RM105,607.00) (US$30,187.99), rawatan topikal (RM38,280.00) (US$10,942.42) dan rawatan fototerapi (RM21,824.00) (US$6,238.44). Memahami hubungan antara kos langsung dan tidak langsung dari kedua-dua perspektif adalah penting untuk mengenal pasti dan menilai rawatan yang paling berkesan untuk psoriasis