Sequential appearance of four clinical delayed drug hypersensitivity in the same patient

This patient had a two-month history of four clinical manifestations of drug hypersensitivity reactions (DHR): maculo papular eruption, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP) and toxic epidermal necrolysis (TEN). The eliciting drugs were rifampicin, possibly gabapentin, levofloxacin, meropenam and/or colistin. Thus, the patient might develop a multiple drug hypersensitivity syndrome. The TEN-like lesion appeared after stopping drugs for two days. A different manifestation of DHR in dependence of drug use suggests that the distinct manifestations of DHRs are due to the stimulation of T cells with distinct functions. The simultaneous appearance of AGEP and DRESS symptoms might be due to the simultaneous stimulation of two (or more) different T cell subsets, which are functionally dominant. Lastly, the appearance and further propagation of symptoms after therapy-stop is a common but somewhat neglected problem in DHR, which raises questions regarding the cause of persisting T cell activation

Validity, reliability and interpretability of the Thai version of the urticaria control test (UCT)

Background The Long Form and Short Form of the German (original) version of the Urticaria Control Test (UCT) have shown to be valid and reliable instruments for assessing patients with all types of chronic urticaria (CU). The cutoff scores for identifying patients with well-controlled disease were ≥ 24 and ≥ 12 for Long and Short Forms, respectively. However, the sensitivity to change and minimal clinically important difference (MCID) of the UCT have never been systematically evaluated. This study aimed to investigate the validity, reliability, screening accuracy, sensitivity to change and MCID of the linguistically validated translation of the UCT into the Thai language for assessing CU in the Thai population. Methods A structured translation and pre- testing were done to cross-culturally adapt the UCT for the Thai language. All measurement properties of both forms of the Thai UCT were validated in 169 patients with CU. Results There were strong correlations between the Thai UCT score and disease activity, health-related quality of life impairment, and disease control (all correlations ≥ 0.7). Good internal consistency and excellent intra-rater reliability were demonstrated. The same cutoff scores to define patients with well-controlled disease should be used as those recommended for the original UCT version. MCIDs equated to increase in scores of 6 and 3 for the Long and Short Forms, respectively, of the Thai UCT should be used to identify patients who had minimal responses. Score increments of ≥10 and ≥ 6 for Long and Short Forms, respectively, should be used to define patients who had marked responses. Conclusions This study confirmed the applicability of the UCT for use in Thailand, a country that has a very different language and cultural setting than that of Germany and the United States. Further studies are required to examine the suitability of the UCT for use in the pediatric population

Diagnostic criteria for atopic dermatitis in adult Thai population

Context: Atopic dermatitis is a common disease that is diagnosed by use of Hanifin, Lobitz and Rajka′s criteria based on patient history and clinical features. However these criteria are not suitable for population-based studies. Aims: The purpose of this study is to develop a minimum list of diagnostic criteria for atopic dermatitis that is sensitive, specific, reproducible, noninvasive, applicable to adult Thai population and easy to perform in population-based studies. Settings and Design: This study was conducted at Department of Dermatology, Faculty of Medicine Siriraj Hospital Mahidol University, Bangkok, Thailand. Materials and Methods: The new cases of typical mild to moderate atopic dermatitis and exactly age-matched and sex-matched controls presenting with an inflammatory skin disease other than atopic dermatitis were selected from Department of Dermatology, Faculty of Medicine Siriraj Hospital. Each subject was examined with reference to 31 clinically diagnostic features of atopic dermatitis proposed by Hanifin and Rajka. One hundred and forty patients (70 cases and 70 controls) were studied. Statistical Analysis Used: Sensitivity and specificity of each criterion was calculated using the dermatologist′s diagnosis as the standard. Regression techniques were then used to derive a minimum set of diagnostic criteria. Results: Using multiple logistic regression techniques, a minimum set of diagnostic criteria for atopic dermatitis was derived: visible flexural dermatitis, history of flexural dermatitis, duration of rash> 6 months and visible dry skin. Conclusions: A minimum list of diagnostic criteria for atopic dermatitis was derived that should be of use in Thai population-based studies

Clinical Features of Adult Male Acne in a Tropical Country: A Prospective Cross-sectional Study

Objective: To evaluate the characteristics of post-adolescent male patients with acne in terms of the onset of the condition, its clinical course and severity, and the behaviors associated with its severity. Materials and Methods: A prospective, cross-sectional study was conducted on adult males with acne who visited Siriraj Hospital, Thailand. All male acne patients aged 21 years and older were enrolled. Diagnoses and physical examinations were performed by dermatologists. Results: Seventy-two patients (mean age, 26.9 [± 4.3] years) were included. Persistent acne, relapse acne, and late-onset acne (onset at age ≥ 21 years) were reported in 62.5%, 33.3%, and 4.2% cases, respectively. Persistent acne tended to subside at 26 years of age, whereas late-onset acne tended to start at 28 years of age. The acne severity was mild in most cases. Pimple-picking, followed by frequent face washing, were common habits among male acne patients. Shaving influenced the severity in some adult male with acne. Conclusion: Adult male acne commonly presented as inflammatory lesions and comedones on the cheeks. They commonly had an onset earlier than 21 years old and continued into adulthood, but the post-adolescent severity tended to be mild. While several factors have been reported elsewhere to be involved in the severity of acne, this study found that only shaving influenced severity

Relationship between vitamin D and chronic spontaneous urticaria: a systematic review

Abstract Background Vitamin D has been reported to be associated with many allergic diseases. There are a limited number of the studies of vitamin D supplementation in patients with chronic spontaneous urticaria (CSU). This study aims to study the relationship between vitamin D and CSU in terms of serum vitamin D levels, and the outcomes of vitamin D supplementation. Methods A literature search of electronic databases for all relevant articles published between 1966 and 2018 was performed. The systematic literature review was done following Preferred Reporting Items for Systematic Reviews and Meta-analysis recommendations. Results Seventeen eligible studies were included. Fourteen (1321 CSU cases and 6100 controls) were concerned with serum vitamin D levels in CSU patients. Twelve studies showed statistically significant lower serum vitamin D levels in CSU patients than the controls. Vitamin D deficiency was reported more commonly for CSU patients (34.3–89.7%) than controls (0.0–68.9%) in 6 studies. Seven studies concerned with vitamin D supplementation in CSU patients showed disease improvement after high-dosages of vitamin D supplementation. Conclusion CSU patients had significantly lower serum vitamin D levels than the controls in most studies. However, the results did not prove causation, and the mechanisms were not clearly explained. Despite the scarcity of available studies, this systematic review showed that a high dosage of vitamin D supplementation for 4–12 weeks might help to decrease the disease activity in some CSU patients. Well-designed randomized placebo-controlled studies are needed to determine the cut-off levels of vitamin D for supplementation and treatment outcomes

Omalizumab therapy for treatment of recalcitrant chronic spontaneous urticaria in an Asian population

Objectives: There are limited data regarding omalizumab in the treatment of recalcitrant chronic spontaneous urticaria (CSU) in Asian populations. This study evaluated the effectiveness and the proper dosage of omalizumab for Asian CSU patients in a real-life setting. Methods: We retrospectively reviewed recalcitrant CSU patients seeking treatment at the Skin Allergy Clinic, Siriraj Hospital during the 3-year period. All patients were treated with omalizumab as an add-on therapy. Standard seven-day urticaria activity score (UAS7) and medication score were used to assess omalizumab response. Results: Of 13 patients, 9 patients (70%) responded well to 150 mg omalizumab injection every month, whereas 4 patients requiring updosing to 300 mg. In the 150 mg group, one patient achieved complete symptom control without antihistamine intake. Most of them required antihistamines without prednisolone and ciclosporin. Onset of omalizumab was fast, usually within the first week. Though only two patients in the 300 mg group achieved complete absence of symptoms, ciclosporin and oral corticosteroids could be discontinued. No patients reported adverse effects. Conclusions: Omalizumab at an initial dosage of 150 mg was effective in the treatment of recalcitrant CSU among Asians. Updosing to 300 mg was required to achieve satisfactory outcomes