Day 1 (2nd April 2011)
11:00 am Registration & Booth Visit
12:30 pm Lunch Symposium “Urticaria in Children”
2:00 pm Hair Loss in Children
2:40 pm Fever and Rash in Children
3:20 pm Coffee Break and Booth Visit
3:40 pm Psoriasis in Children
4:20 pm Ten Should Know Skin Disorders In Children (Quiz)
5:00 pm Adjourn
Day 2 (3rd April 2011)
8:30 am Registration and Booth Visit
9:00 am Neonatal Dermatoses: When to be concern
9:40 am Cutaneous Vascular Lesions in Children: When to Intervene!
10:20 am Coffee Break & Booth Visit
10:50 am Life Threatening Paediatric Skin Disorders
11:30 am Pigmentary Disorder In Children
12:10 pm Lunch symposium “The do’s & don’ts in The Management of Atopic Eczema
2:00 pm Autoimmune Blistering Disorder in Children
2:40 pm Paediatric Skin Nursing (Demonstration)
3:40 pm Genodermatoses: What Can We Offer?
4:20 pm Adjourn (Evaluation & Coffee Break)
Sunday, February 20, 2011
Penang Dermatology Symposium 2011
Theme: Paediatric Dermatology
Department of Dermatology, Penang General Hospital will organise Penang Dermatology Symposium 2011 at Auditorium, Ambulatory Care Center (ACC) Penang General Hospital on 2nd – 3rd April 2011 (Saturday-Sunday).
In collaboration with
Post Graduate Medical Education Society (PGMES)
Dermatological Society of Malaysia (PDM)
Faculty of Dermatology, Academy of Medicine Malaysia
The aims for this event are to provide a regular continuous medical education (CME) programme in dermatology for practicing practitioners and to provide an update of various topics in dermatology / paediatric dermatology.
WHO SHOULD ATTEND THE UPDATE
All physician, paediatrician and
primary care practitioners
For further enquiries, kindly contact the secretariat
CONTACT
Mr Kong Tau Chin
Sister Salmi Bt Ismail
Call: 04-2225250 / 2225247
Fax: 04- 2281737 / 2225246
Mail: Dept of Dermatology, Hospital Pulau Pinang
Closing Date: 14 March 2011
Tuesday, January 4, 2011
Discrepancies Often Found Between Young Adults' Self-Reported Sexual Histories and Their STDs
A significant proportion of adolescents and young adults who test positive for sexually transmitted diseases report not having had any sexual activity in the past year, according to a Pediatrics study.
Some 14,000 young adults (mean age, 22) were interviewed in their homes about their sexual activity and provided urine specimens to test for chlamydia, gonorrhea, and trichomoniasis. Roughly 12% of those who tested positive for an STD said they had not had sex the past 12 months, and 6% of the STD-positive participants reported never having had sex. No sociodemographic factors were associated with discrepancies between self-reported history and STD results.
The authors say that relying solely on self-reported penile/vaginal sexual activity to assess STD risk could be imprecise and problematic. They conclude: "If pediatricians and adolescent medicine physicians do not test all young people, there are likely a substantial number of missed cases ... that will go undiagnosed, untreated, and spread to future sex partners."
Some 14,000 young adults (mean age, 22) were interviewed in their homes about their sexual activity and provided urine specimens to test for chlamydia, gonorrhea, and trichomoniasis. Roughly 12% of those who tested positive for an STD said they had not had sex the past 12 months, and 6% of the STD-positive participants reported never having had sex. No sociodemographic factors were associated with discrepancies between self-reported history and STD results.
The authors say that relying solely on self-reported penile/vaginal sexual activity to assess STD risk could be imprecise and problematic. They conclude: "If pediatricians and adolescent medicine physicians do not test all young people, there are likely a substantial number of missed cases ... that will go undiagnosed, untreated, and spread to future sex partners."
Thursday, December 16, 2010
A New Rapid Test for Detection of HIV
December 13, 2010 | Rochelle P. Walensky, MD, MPH
Published in Journal Watch HIV/AIDS Clinical Care December 13, 2010
Citation(s):
FDA approves bioLytical Laboratories' INSTITM rapid HIV test [press release]. Vancouver, British Columbia, and Chicago, Illinois: bioLytical Laboratories; Dec 1 , 2010. (http://www.biolytical.com/media.html)
The INSTI HIV-1 antibody test delivers results in as little as 60 seconds.
FDA approved INSTI, a new rapid point-of-care HIV-1 antibody test that can provide results from blood and plasma specimens in as little as 60 seconds, with a minimum sensitivity of 99.8% and a minimum specificity of 99.5%. Previously approved rapid HIV tests take 10 to 20 minutes to generate results.
Positive results on any rapid HIV test require confirmation, which usually takes 1 to 2 weeks using standard Western blot or enzyme-linked immunosorbent assay. However, because this new test was generated using different antigens than those used to develop other rapid tests, it opens the door to the possibility of a "rapid/rapid" algorithm, in which one rapid test is used to detect infection and another to confirm it.
Comment:
INSTI offers the unique attribute of faster test processing with nearly immediate delivery of results. Having results within a minute or two alleviates many of the logistical concerns related to patient flow that have challenged clinic-based point-of-care HIV screening programs.
Other tests will probably still have a role, however; the OraQuick rapid HIV test is currently under FDA review for over-the-counter use.
Published in Journal Watch HIV/AIDS Clinical Care December 13, 2010
Citation(s):
FDA approves bioLytical Laboratories' INSTITM rapid HIV test [press release]. Vancouver, British Columbia, and Chicago, Illinois: bioLytical Laboratories; Dec 1 , 2010. (http://www.biolytical.com/media.html)
The INSTI HIV-1 antibody test delivers results in as little as 60 seconds.
FDA approved INSTI, a new rapid point-of-care HIV-1 antibody test that can provide results from blood and plasma specimens in as little as 60 seconds, with a minimum sensitivity of 99.8% and a minimum specificity of 99.5%. Previously approved rapid HIV tests take 10 to 20 minutes to generate results.
Positive results on any rapid HIV test require confirmation, which usually takes 1 to 2 weeks using standard Western blot or enzyme-linked immunosorbent assay. However, because this new test was generated using different antigens than those used to develop other rapid tests, it opens the door to the possibility of a "rapid/rapid" algorithm, in which one rapid test is used to detect infection and another to confirm it.
Comment:
INSTI offers the unique attribute of faster test processing with nearly immediate delivery of results. Having results within a minute or two alleviates many of the logistical concerns related to patient flow that have challenged clinic-based point-of-care HIV screening programs.
Other tests will probably still have a role, however; the OraQuick rapid HIV test is currently under FDA review for over-the-counter use.
Monday, December 6, 2010
Novel Drugs with Novel Reaction Patterns
Marta R, Philippe-Jean B, Pascal D. Curr Opin Allergy Clin Immunol. 2010;10(5):457-462.
New Risk Factor:
1. Sex
Current studies continue to argue in favor of the female sex as a risk factor for
developing ADRs.
Zopf Y, Rabe C, Neubert A, et al. Gender-based differences in drug
prescription: relation to adverse drug reactions. Pharmacology 2009; 84:333–339.
Macy E, Poon K-YT. Self-reported antibiotic allergy incidence and prevalence: age
and sex effects. Am J Med 2009; 122:778.e1–778.e7.
2. Atopy
May be a risk factor for developing sensitization to beta-lactam antibiotics in
tertiary hospital nurses.
Choi IS, Han ER, Lim SW, et al. Beta lactam antibiotic sensitization and its
relationship to allergic diseases in tertiary hospital nurses. Allergy Asthma
Immunol Res 2010; 2:114–122.
Recent findings Traditional and complementary alternate medicines are also causes of adverse drug reactions, and many of them are cataloged as allergy.
Jacobsson I, Jönsson AK, Gerdén B, et al. Spontaneously reported adverse
reactions in association with complementary and alternative medicine substances in Sweden. Pharmacoepidemiol Drug Saf 2009; 18:1039–1047.
The study showed that 1.2% of the total reports concerned suspected ADRs were related to 175 different CAM products.
The main reactions were urticaria (8.3%), exanthema (7.4%) and contact dermatitis (5.7%).
The most reported were purple coneflower (Echinacea purpurea) (8.1%), Siberian ginseng (Eleutherococcus senticosus), malabar nut (Adhatoda vasica) (7.3%) and ginkgo leaf (Ginkgo biloba) (6.7%).
Zeng ZP, Jiang JG. Analysis of the adverse reactions induced by natural
product- derived drugs. Br J Pharmacol 2010; 159:1374–1391
Three thousand one hundred twenty-two cases involving 140 different drugs were analyzed. Herba houttuyniae and Shuanghuanglian were the most common drugs involved.
Research in the field of skin and drug provocation test to antibiotics such as beta-lactams and carbapenems has allowed the understanding of cross-reactivity reactions and permitted the use of well tolerated alternate drugs in cases of proper negative drug allergy work-up.
Cross-reactions between Imipenem/Cilastatin and Penicillins
Atanasković-Marković M, Gaeta F, Gavrović-Jankulović M, et al. Tolerability of imipenem in children with IgE-mediated hypersensitivity to penicillins. J Allergy Clin Immunol 2009; 124:167–169.
Work on cross-reactivity between penicillins and carbapenems in children with proven IgE-mediated allergy to penicillins.
The rate of cross-reactivity to imipenem/cilastatin detected by skin tests and drug provocation was 0.8%.
Schiavino D, Nuecera E, Lombardo C, et al. Cross-reactivity and tolerability
of imipenem in patients with delayed-type, cell-mediated hypersensitivity to beta-
lactams. Allergy 2009; 64:1644–1648.
Work on cross-reactivity in proven cell-mediated allergy to beta-lactams.
They found a 5.5% rate of cross-reactivity.
These studies open the opportunity to administer imipenem/cilastatin to those patients with proven allergy to penicillins after performing skin tests(immediate and delayed readings) and drug provocation tests.
Many unique cases have been reported, including diverse drugs as infliximab, succinylcholine, hydroxychloroquine, that widen the spectrum of clinical manifestations of drug hypersensitivity to various drugs.
Summary
As new and old drugs continue to be used, new reports regarding new and known drug hypersensitivity manifestations are made. Advances in mechanisms are enhanced by the use of new in-vitro techniques to detect specific antibodies or T cells. Research in the field of skin and provocation tests has allowed the use of well tolerated alternate drugs in individuals with proven drug allergy.
New Risk Factor:
1. Sex
Current studies continue to argue in favor of the female sex as a risk factor for
developing ADRs.
Zopf Y, Rabe C, Neubert A, et al. Gender-based differences in drug
prescription: relation to adverse drug reactions. Pharmacology 2009; 84:333–339.
Macy E, Poon K-YT. Self-reported antibiotic allergy incidence and prevalence: age
and sex effects. Am J Med 2009; 122:778.e1–778.e7.
2. Atopy
May be a risk factor for developing sensitization to beta-lactam antibiotics in
tertiary hospital nurses.
Choi IS, Han ER, Lim SW, et al. Beta lactam antibiotic sensitization and its
relationship to allergic diseases in tertiary hospital nurses. Allergy Asthma
Immunol Res 2010; 2:114–122.
Recent findings Traditional and complementary alternate medicines are also causes of adverse drug reactions, and many of them are cataloged as allergy.
Jacobsson I, Jönsson AK, Gerdén B, et al. Spontaneously reported adverse
reactions in association with complementary and alternative medicine substances in Sweden. Pharmacoepidemiol Drug Saf 2009; 18:1039–1047.
The study showed that 1.2% of the total reports concerned suspected ADRs were related to 175 different CAM products.
The main reactions were urticaria (8.3%), exanthema (7.4%) and contact dermatitis (5.7%).
The most reported were purple coneflower (Echinacea purpurea) (8.1%), Siberian ginseng (Eleutherococcus senticosus), malabar nut (Adhatoda vasica) (7.3%) and ginkgo leaf (Ginkgo biloba) (6.7%).
Zeng ZP, Jiang JG. Analysis of the adverse reactions induced by natural
product- derived drugs. Br J Pharmacol 2010; 159:1374–1391
Three thousand one hundred twenty-two cases involving 140 different drugs were analyzed. Herba houttuyniae and Shuanghuanglian were the most common drugs involved.
Research in the field of skin and drug provocation test to antibiotics such as beta-lactams and carbapenems has allowed the understanding of cross-reactivity reactions and permitted the use of well tolerated alternate drugs in cases of proper negative drug allergy work-up.
Cross-reactions between Imipenem/Cilastatin and Penicillins
Atanasković-Marković M, Gaeta F, Gavrović-Jankulović M, et al. Tolerability of imipenem in children with IgE-mediated hypersensitivity to penicillins. J Allergy Clin Immunol 2009; 124:167–169.
Work on cross-reactivity between penicillins and carbapenems in children with proven IgE-mediated allergy to penicillins.
The rate of cross-reactivity to imipenem/cilastatin detected by skin tests and drug provocation was 0.8%.
Schiavino D, Nuecera E, Lombardo C, et al. Cross-reactivity and tolerability
of imipenem in patients with delayed-type, cell-mediated hypersensitivity to beta-
lactams. Allergy 2009; 64:1644–1648.
Work on cross-reactivity in proven cell-mediated allergy to beta-lactams.
They found a 5.5% rate of cross-reactivity.
These studies open the opportunity to administer imipenem/cilastatin to those patients with proven allergy to penicillins after performing skin tests(immediate and delayed readings) and drug provocation tests.
Many unique cases have been reported, including diverse drugs as infliximab, succinylcholine, hydroxychloroquine, that widen the spectrum of clinical manifestations of drug hypersensitivity to various drugs.
Summary
As new and old drugs continue to be used, new reports regarding new and known drug hypersensitivity manifestations are made. Advances in mechanisms are enhanced by the use of new in-vitro techniques to detect specific antibodies or T cells. Research in the field of skin and provocation tests has allowed the use of well tolerated alternate drugs in individuals with proven drug allergy.
Sunday, November 21, 2010
Psychocutaneous Disorder
The Current Management of Delusional Parasitosis and Dermatitis Artefacta
Caroline S. Koblenzer, MD
Skin Therapy Letter. 2010
Introduction:
Patients who present with delusional parasitosis or dermatitis artefacta are not easy for dermatologists to work with, whose treatment requires the use of drugs unusual to the dermatologist and a significant investment of the clinician's time.
Each is a skin manifestation of a psychiatric disorder that represents a psychological defense - a way for the patient to avoid the acknowledgment of psychiatric pathology.
Delusions of Parasitosis
The delusions seen in dermatology are "systematized" or non-bizarre - i.e., they are fixed beliefs that, though false, control the patient's feelings and behavior in ways that are wholly consistent with the content of those beliefs. Delusions of parasitosis associated with cutaneous dysesthesia.
The delusional patient is often defensive, angry, and distrusting. The patient desperately wants answers. "We do not know the cause, but we have treatments that are effective" or "We have seen other patients with similar symptoms, and whatever is the cause, there are changes in the skin that we can treat" are possible answers.
Intensive topical measures are helpful (e.g., tar or bleach baths, emollients, and antibiotics as indicated). Topical agents, such as pramoxine hydrogen chloride cream or lotion, may be used to provide temporary relief of any dysesthesia.
Antipsychotic drugs are the first-line treatment (Much smaller doses than those used). Pimozide has long been the drug of choice. Risperidone and aripiprazole are preferable to olanzapine.
50–90% of patients are reported to have near or full symptom resolution, with improved functioning and any psychiatric and physical comorbidities tend to improve in parallel.
Dermatitis Artefacta
Dermatitis artefacta refers to skin lesions produced by the patient, under the veil of secrecy, to satisfy an unconscious need to be taken care of.
Lesions that are morphologically bizarre, often geometric in outline, destructive, and reportedly of sudden, mysterious yet fully formed appearance. Patients with neurotic excoriations usually have depression or anxiety with obsessive-compulsive features; those with Munchausen's syndrome have a sociopathic personality, while patients with dermatitis artefacta are most commonly diagnosed with the borderline personality disorder.
Dermatologic support is important, borderline patients are best treated psychiatrically, though a recommendation for psychiatric referral must be approached very judiciously. The antipsychotics are the drugs of choice and aripiprazole has an advantage in that it also has antidepressant properties.
Discussion:
Because patients with delusional parasitosis and dermatitis artefacta do not accept the need for psychiatric treatment, they fall either to the lot of the dermatologist or receive no help at all.
An optimal approach includes frequent short clinic visits, expression of empathy, affirmation that the skin itself is involved, and low dose antipsychotic drugs. With compliance, remissions of varying length occur, but both disorders are likely to last life-long.
Caroline S. Koblenzer, MD
Skin Therapy Letter. 2010
Introduction:
Patients who present with delusional parasitosis or dermatitis artefacta are not easy for dermatologists to work with, whose treatment requires the use of drugs unusual to the dermatologist and a significant investment of the clinician's time.
Each is a skin manifestation of a psychiatric disorder that represents a psychological defense - a way for the patient to avoid the acknowledgment of psychiatric pathology.
Delusions of Parasitosis
The delusions seen in dermatology are "systematized" or non-bizarre - i.e., they are fixed beliefs that, though false, control the patient's feelings and behavior in ways that are wholly consistent with the content of those beliefs. Delusions of parasitosis associated with cutaneous dysesthesia.
The delusional patient is often defensive, angry, and distrusting. The patient desperately wants answers. "We do not know the cause, but we have treatments that are effective" or "We have seen other patients with similar symptoms, and whatever is the cause, there are changes in the skin that we can treat" are possible answers.
Intensive topical measures are helpful (e.g., tar or bleach baths, emollients, and antibiotics as indicated). Topical agents, such as pramoxine hydrogen chloride cream or lotion, may be used to provide temporary relief of any dysesthesia.
Antipsychotic drugs are the first-line treatment (Much smaller doses than those used). Pimozide has long been the drug of choice. Risperidone and aripiprazole are preferable to olanzapine.
50–90% of patients are reported to have near or full symptom resolution, with improved functioning and any psychiatric and physical comorbidities tend to improve in parallel.
Dermatitis Artefacta
Dermatitis artefacta refers to skin lesions produced by the patient, under the veil of secrecy, to satisfy an unconscious need to be taken care of.
Lesions that are morphologically bizarre, often geometric in outline, destructive, and reportedly of sudden, mysterious yet fully formed appearance. Patients with neurotic excoriations usually have depression or anxiety with obsessive-compulsive features; those with Munchausen's syndrome have a sociopathic personality, while patients with dermatitis artefacta are most commonly diagnosed with the borderline personality disorder.
Dermatologic support is important, borderline patients are best treated psychiatrically, though a recommendation for psychiatric referral must be approached very judiciously. The antipsychotics are the drugs of choice and aripiprazole has an advantage in that it also has antidepressant properties.
Discussion:
Because patients with delusional parasitosis and dermatitis artefacta do not accept the need for psychiatric treatment, they fall either to the lot of the dermatologist or receive no help at all.
An optimal approach includes frequent short clinic visits, expression of empathy, affirmation that the skin itself is involved, and low dose antipsychotic drugs. With compliance, remissions of varying length occur, but both disorders are likely to last life-long.
Tuesday, November 9, 2010
Rebound of plasma viremia following cessation of antiretroviral therapy despite profoundly low levels of HIV reservoir
Chun T-W et al. Rebound of plasma viremia following cessation of antiretroviral therapy despite profoundly low levels of HIV reservoir: Implications for eradication. AIDS 2010 Oct 19.
The persistence of HIV in CD4 cells despite full virologic suppression in plasma renders the prospect of viral eradication highly unlikely, at least with present strategies. However, initiation of antiretroviral therapy (ART) very early during acute HIV infection limits the size of the viral reservoir, and some studies suggest that it may deplete the pool of HIV-infected CD4 cells over time. In this study, researchers further explore whether early, long-term administration of potent ART might eliminate viral reservoirs.
Using quantitative real-time polymerase chain reaction, the researchers measured genomic HIV DNA in highly purified CD4 cells obtained from 44 patients who had achieved long-term suppression on ART without any episodes of detectable viremia.
Nine of the patients had started ART <6 months after acquiring HIV. These patients were found to have significantly lower levels of HIV proviral DNA (mean, 4.6 copies per million CD4 cells) than the patients who started ART later, and four of them had no proviral DNA detected.
One such patient was found to have an extremely low level of virus after 10.5 years of ART (1 infected cell per 1.7 billion CD4 cells). Under close follow-up, this patient discontinued ART. For 7 weeks, he had no virus detected in his plasma, but then his plasma HIV RNA level rebounded to 1593 copies/mL.
It spontaneously returned to an undetectable level for a brief period, only to rebound again during week 20, reaching 8684 copies/mL. At that time, ART was restarted.
Comment:
In this study and others, initiating long-term effective ART very early rather than later was associated with lower levels of residual HIV. Nonetheless, this seemingly favorable combination of very early ART, long-term consistent virologic suppression, and a very limited viral burden in the reservoir of CD4 cells did not prevent HIV recurrence after withdrawal of ART.
Although reemergence of the virus took longer in the patient described here than in patients in other studies who had less favorable circumstances, viral rebound still occurred in <2 months. Long-term virologic suppression without ART will require novel strategies to target the rare infected cells that rekindle the infection systemically.
The persistence of HIV in CD4 cells despite full virologic suppression in plasma renders the prospect of viral eradication highly unlikely, at least with present strategies. However, initiation of antiretroviral therapy (ART) very early during acute HIV infection limits the size of the viral reservoir, and some studies suggest that it may deplete the pool of HIV-infected CD4 cells over time. In this study, researchers further explore whether early, long-term administration of potent ART might eliminate viral reservoirs.
Using quantitative real-time polymerase chain reaction, the researchers measured genomic HIV DNA in highly purified CD4 cells obtained from 44 patients who had achieved long-term suppression on ART without any episodes of detectable viremia.
Nine of the patients had started ART <6 months after acquiring HIV. These patients were found to have significantly lower levels of HIV proviral DNA (mean, 4.6 copies per million CD4 cells) than the patients who started ART later, and four of them had no proviral DNA detected.
One such patient was found to have an extremely low level of virus after 10.5 years of ART (1 infected cell per 1.7 billion CD4 cells). Under close follow-up, this patient discontinued ART. For 7 weeks, he had no virus detected in his plasma, but then his plasma HIV RNA level rebounded to 1593 copies/mL.
It spontaneously returned to an undetectable level for a brief period, only to rebound again during week 20, reaching 8684 copies/mL. At that time, ART was restarted.
Comment:
In this study and others, initiating long-term effective ART very early rather than later was associated with lower levels of residual HIV. Nonetheless, this seemingly favorable combination of very early ART, long-term consistent virologic suppression, and a very limited viral burden in the reservoir of CD4 cells did not prevent HIV recurrence after withdrawal of ART.
Although reemergence of the virus took longer in the patient described here than in patients in other studies who had less favorable circumstances, viral rebound still occurred in <2 months. Long-term virologic suppression without ART will require novel strategies to target the rare infected cells that rekindle the infection systemically.
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