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Yew Y.W.,National Skin Center Singapore
Journal of the European Academy of Dermatology and Venereology | Year: 2016

Bullous pemphigoid (BP) is a chronic, autoimmune vesiculobullous disease that frequently occurs in the elderly population. Previous epidemiological studies have suggested an association between BP and neurological diseases; some studies, however, showed conflicting results. This study aimed to investigate if patients with BP have significantly higher risks for neurological disorders, compared to controls. A comprehensive search was performed using MEDLINE, EMBASE and Cochrane library databases. Case-control and cohort studies that assessed the relationship between BP and neurological diseases were included. DerSimonian and Laird random-effects models were utilized to calculate the pooled relative risks (RRs). Publication bias was evaluated qualitatively by constructing a funnel plot and quantitatively by conducting Egger's test. Fourteen studies, with 23 369 BP cases and 128 697 controls were included in this meta-analysis. Patients with BP were significantly more likely to have stroke (RR 2.68, 95% CI: 2.07-3.46), Parkinson's disease (PD; RR 3.42, 95% CI: 3.01-3.87), dementia (RR 4.46, 95% CI: 3.23-6.16), epilepsy (RR 2.98, 95% CI: 1.42-6.28), multiple sclerosis (RR 12.40, 95% CI: 6.64-23.17) and any aforementioned neurological disease (RR 4.93, 95% CI: 3.62-6.70), compared to controls. Moderate to high heterogeneity were observed for analyses of most neurological diseases, except for PD and multiple sclerosis. This study provided support for a significant association between BP and neurological diseases. Clinicians should be aware of this association and manage modifiable risk factors for neurological diseases accordingly. © 2016 European Academy of Dermatology and Venereology.


Tan E.S.T.,National Skin Center Singapore | Ee M.,National University of Singapore | Shen L.,National University of Singapore | Chua H.,Agency for Science, Technology and Research Singapore | And 2 more authors.
Australasian Journal of Dermatology | Year: 2014

Background/Objectives: Susceptibility to and clinical presentation of basal cell carcinoma (BCC) differ in Asian and Caucasian populations. This study aims to evaluate the epidemiological and clinicopathological characteristics of BCC in a multiracial Singaporean population, with a secondary comparative analysis between Chinese and Caucasian patients. Methods: We prospectively studied patients with newly diagnosed, histologically confirmed BCC at the National Skin Centre, Singapore from 2004 to 2008. Results: In total, 274 BCC from 260 patients were studied, with 19 patients having two or more tumours. Their mean age was 67.5 years and 54% were male. Chinese comprised 80% and Caucasians 14%. The Chinese were 1.8-fold as likely as Caucasians to be older than 60 years, and experienced itch thrice more frequently. Caucasians developed multiple BCC threefold and truncal or upper limb BCC 2.9-fold more frequently than the Chinese. In terms of tumour subtype, morphoeic BCC was 2.7-fold more common in Caucasians. Pigmented BCC occurred 2.7-fold more often in the Chinese, most frequently on the head and neck of elderly Chinese. Conclusions: Compared to the Chinese, BCC occurred more often in younger Caucasians, with a predilection for the trunk and upper limb, suggesting a greater role for recreational sun exposure as a risk factor. Pigmented BCC more commonly occurred on the head and neck of elderly Chinese and may be reflective of cumulative sun exposure as a risk factor. Aggressive morphoeic BCC was more common in Caucasians than in Singaporean Chinese patients. © 2014 The Australasian College of Dermatologists.


Tee S.I.,National Skin Center Singapore | Lim Z.V.,National Skin Center Singapore | Theng C.T.,National Skin Center Singapore | Chan K.L.,Khoo Teck Puat Hospital Singapore | Giam Y.C.,National Skin Center Singapore
Journal of the European Academy of Dermatology and Venereology | Year: 2016

Background: Psoriasis has a negative psychological impact on patients, and may have repercussions on treatment outcomes. Despite this, the degree to which psoriatic patients suffer from psychiatric disorders has not received much attention in Singapore. Objective: This prospective cross-sectional study was conducted to determine the frequency of anxiety and depression in a cohort of Singaporean patients with psoriasis, and explore its relationship with regards to physical disease severity and subjective quality of life. Methods: 100 patients aged 21-60 years old who visited the National Skin Centre, Singapore from 2008 to 2009 were enrolled into the study. Anxiety and depression were quantified using the Hospital Anxiety and Depression Scale (HADS). Disease severity was quantified with the Psoriasis Area Severity Index (PASI) and quality of life measured with the Short Form (36) Health Survey (SF-36). Results: Using the HADS, the mean score for anxiety was 6.9 and that for depression was 4.7. An anxiety disorder was suggested in 17%, while a depressive disorder was suggested in 15% of the study population. All eight domains of the SF-36 were significantly correlated with both anxiety and depression scores. Patients with moderate or severe psoriasis (on PASI) had worse depression scores than those with mild psoriasis. No association was found between anxiety scores and PASI. Neither was any significant correlation seen between anxiety and depression scores vs. patients' age, monthly income and duration of psoriasis. Conclusion: This study demonstrates the strong psychiatric morbidity in patients with psoriasis, for which further psychiatric evaluation should be considered. Journal of the European Academy of Dermatology and Venereology © 2016 European Academy of Dermatology and Venereology.


Mok Z.R.,National University Hospital Singapore | Tan E.S.-T.,National Skin Center Singapore | Chong W.-S.,National Skin Center Singapore
Australasian Journal of Dermatology | Year: 2015

Cutaneous plasmacytosis (CP) is an uncommon chronic disease of unknown aetiology, reported mainly in middle-aged patients of Asian descent. It is diagnosed by a constellation of physical, laboratory, radiological and histopathological findings. We report a patient with CP who demonstrated a favorable and promising response to mask-bath PUVA. © 2015 The Australasian College of Dermatologists.


Lim J.H.-L.,National Skin Center Singapore | Choo W.,National Skin Center Singapore | Chang J.H.,National Skin Center Singapore | Tey H.L.,National Skin Center Singapore | Chong W.-S.,National Skin Center Singapore
Skin Research and Technology | Year: 2015

Background: Hypohidrosis is defined as diminished sweating in response to an appropriate thermal or sympathetic stimulus. When encountered in a clinical setting, it necessitates an accurate documentation of its pattern and extent to prognosticate the risk of associated heat-related illnesses. This can be achieved by thermoregulatory sweat testing which includes a starch-iodine sweat test that can be administered via various methods. Objective: To describe and evaluate the effectiveness and safety of a novel method of using an atomizer spray gun in administering the starch-iodine test. Methods: We describe the administration of the starch-iodine test via an atomizer spray gun (Series 700 Lab Model; Mitsuba Systems, Mumbai, India). The method was utilized for the evaluation of 30 individuals who presented with symptoms of hypohidrosis. Results: Application of iodinated starch powder prepared in-house with the atomizer spray gun achieved a lightweight and homogeneous coat on our patients' skin which allowed for clear visualization of the sweating pattern in areas of anhidrosis. The sharp demarcation of the pathological regions enabled the precise calculation of the affected body surface area of impaired sweating. Unlike the starch-iodine tests using the Minor and Wada methods, neither staining of the skin nor irritation was detected in this method. Conclusion: We report a novel method of using an atomizer spray gun to perform the starch-iodine test in a rapid, reproducible, effective, and safe manner suitable for use in the clinical evaluation of hypohidrosis. © 2015 John Wiley & Sons A/S.


Gan E.Y.,National Skin Center Singapore | Chio M.T.-W.,National Skin Center Singapore | Tan W.P.,National Skin Center Singapore
Australasian Journal of Dermatology | Year: 2014

Background/Objectives: Cutaneous metastases occur in up to 10% of all visceral malignancies. This study aims to determine the clinico-epidemiological characteristics of patients diagnosed with cutaneous metastases at a leading Asian tertiary dermatological centre. Methods: A retrospective chart review was carried out on all patients diagnosed with cutaneous metastases from 2001 to 2010, identified through the National Skin Centre's clinical and histological databases. Results: In all, 35 patients were diagnosed with cutaneous metastases at a mean age of 65 years, with a female: male ratio of 3:2 and with most (97%) being Chinese. Cutaneous metastases were the first presentation of cancer in 34% of patients (n=12). The two commonest primaries were breast (49%, n=17) and lung (9%, n=3). Most had cutaneous metastases on the chest (37%, n=13) followed by the pelvis (17%, n=6) and 20% (n=7) had skin lesions on multiple sites. Clinically, 46% of patients (n=16) presented with nodule(s), 26% (n=9) with plaque(s) and 20% (n=7) with heterogeneous morphologies. Cutaneous metastases were suspected in 72% of patients (n=25), attributed to clinical features (46%, n=16) or the presence of active metastatic disease elsewhere (26%, n=9). All lesions appeared dermal in origin. Conclusions: Cutaneous metastases are highly variable in presentation and a high index of suspicion is required for prompt diagnosis, especially in patients with a history of cancer, regardless of stage of treatment of the primary tumour. © 2014 The Australasian College of Dermatologists.


Irwansyah I.,Nanyang Technological University | Li Y.-Q.,Nanyang Technological University | Shi W.,Nanyang Technological University | Qi D.,Nanyang Technological University | And 4 more authors.
Advanced Materials | Year: 2015

An experiment was conducted to demonstrate that Fmoc-phenylalanine (Fmoc-F) can be used as a novel hydrogelator to form supramolecular hydrogels by taking advantage of the intermolecular π? πstacking and hydrogen bonding. Fmoc-amino acids were dissolved in sodium carbonate solution, and the gel phase was transformed using a heating and cooling process. Prior to the preparation of designed antimicrobial hydrogel, the potential of Fmoc-F as a hydrogelator was first investigated. In testing six types of commercial hydrophobic Fmoc-amino acids, self-supporting hydrogel was only formed when Fmoc-F was used as a hydrogelator. The viscoelastic properties of the formed Fmoc-F hydrogel were then assessed using oscillatory rheology. The co-assembled (F+L) supramolecular hydrogel exhibited selective gram-positive bactericidal activity via a mechanism involving cell wall and membrane disruption while is biocompatible with normal mammalian cells. In addition, it shows great potential as antimicrobial coatings in clinical devices, wound dressings, or topical agents for the treatment of clinical skin and wound infections mainly caused by gram-positive bacteria of S. aureus.


Li Y.-Q.,Nanyang Technological University | Zhu B.,Nanyang Technological University | Li Y.,Nanyang Technological University | Leow W.R.,Nanyang Technological University | And 5 more authors.
Angewandte Chemie - International Edition | Year: 2014

Despite the advanced detection and sterilization techniques available today, the sensitive diagnosis and complete elimination of bacterial infections remain a significant challenge. A strategy is reported for efficient bacterial capture (ca. 90-%) based on the synergistic effect of the nanotopography and surface chemistry of the substrate on bacterial attachment and adhesion. The outstanding bacterial-capture capability of the functionalized nanostructured substrate enables rapid and highly sensitive bacterial detection down to trace concentrations of pathogenic bacteria (10 colony-forming units mL-1). In addition, this synergistic biocapture substrate can be used for efficient bacterial elimination and shows great potential for clinical antibacterial applications. Stuck fast: A strategy for efficient bacterial capture was developed based on the synergistic effect of surface nanotopography and surface chemistry on bacterial attachment. Packed silicon nanowires were functionalized with bacteria-binding molecules. The capture efficiency of the resultant substrate was greatly enhanced compared to surface-modified flat silicon, thus enabling highly sensitive detection and efficient elimination of bacterial pathogens. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.


Tan A.W.M.,National Skin Center Singapore | Sen P.,National Skin Center Singapore | Chua S.H.,National Skin Center Singapore | Goh B.K.,National Skin Center Singapore
Australasian Journal of Dermatology | Year: 2016

Background/Objectives: Melasma is a common acquired hyperpigmentary disorder, particularly among Asians and Hispanics, but its exact pathomechanism is poorly understood. Tranexamic acid has been found to lighten melasma by interfering with the interaction of melanocytes and keratinocytes by inhibiting the plasminogen/plasmin system. The aim was to evaluate the therapeutic effects of oral tranexamic acid in the treatment of melasma refractory to topical skin-lightening agents. Methods: This retrospective study analyses patients with melasma recruited from a tertiary dermatological centre in Singapore between 1 August 2009 and 31 March 2011. The patients chosen had refractory melasma treated with oral tranexamic acid 250 mg twice daily in addition to pre-existing combination topical therapy. Objective assessment using the physician's global assessment and melasma area and severity index (MASI) scores were performed based on a post-hoc analysis of photographic records by three independent physicians. A paired t-test was used to evaluate the changes in the MASI scores pre-therapy and post-treatment. Statistical significance was defined as P < 0.05. Results: Altogether 25 patients were treated with tranexamic acid for a mean period of 3.7 ± 0.33 months, in addition to combination topical therapy. Their mean age was 47.2 ± 1.61 years. The mean MASI scores after tranexamic acid treatment (2.7 ± 1.6) were significantly lower (P < 0.01) than those prior to treatment (8.8 ± 4.2). The mean improvement in scores was 69%. The follow-up period was up to 6 months. Conclusion: Low-dose oral tranexamic acid can serve as a safe and useful adjunct in the treatment of refractory melasma. © 2016 The Australasian College of Dermatologists.


PubMed | National Skin Center Singapore
Type: Journal Article | Journal: Singapore medical journal | Year: 2011

The Department of Sexually Transmitted Infections (STI) Control (DSC) Clinic is the only public STI clinic in Singapore. This study aimed to determine patients perception of the clinic as well as the factors that may influence their choice of DSC Clinic over other medical facilities. The concerns of certain risk groups were also assessed.Self-administered anonymous questionnaires were offered to Singaporeans and Permanent Residents over 18 years of age who were seeking treatment at the DSC Clinic. 1,000 responses were collected over a period of four weeks in May 2009.More than two-thirds of the patients had a positive experience at the DSC Clinic and would recommend the clinic to their family and friends. Positive attributes included competence of staff and the convenience of a one-stop treatment facility. The patients visits to the DSC Clinic also prompted them to engage in safer sexual practices. Stigma was surprisingly not an issue among more than three-quarters of the patients. Confidentiality of medical records was a major concern, with more than half of the patients unwilling to share their records with other healthcare providers, employers or insurance companies. The majority of patients would like to see the provision of clinics catering to special groups such as young people, women as well as men-who-have-sex-with-men.The majority of patients were satisfied with the health services provided at the DSC Clinic. Confidentiality in consultation was of prime importance to patients.

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