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Biomedical subjects

C L Goh

Publications and source records attributed to C L Goh.

At least 19 recordsLinked to original sources
PubMed1995

Skin cancers at Tertiary Referral Skin Hospital in Singapore.

BACKGROUND: Skin cancer is the seventh most common cancer in Singapore. This study was performed to determine the pattern of skin cancers seen in a tertiary referral skin hospital. METHODS: Histologically confirmed skin cancers, seen between 1980 and 1991, were analyzed according to age, sex, race, site, and presence/absence of preexisting skin conditions. RESULTS: Of a total of 520 patients, the commonest skin cancer was basal cell carcinoma (BCC) (36.5%), followed by squamous cell carcinoma (SCC) (24.4%), Bowen's disease (16.7%), and mycosis fungoides (9.0%). Malignant melanomas (2.7%) were rare. The sharp increase (26.2%) in BCC in the recent 3 years was largely contributed by a fivefold increase of non-resident Caucasian patients with BCC. All types of skin cancers were more common in Chinese (78.1%) and less frequent in the more pigmented races (9.4%). The men to women ratio was 1.72:1. The peak age distribution was in the 51-70-year group, with the exception of mycosis fungoides (31-50 years). The commonest site involved in BCC was the head and neck (67.0%) and in Bowen's disease the trunk (33.3%). Squamous cell carcinoma was found on the head and neck and the lower extremities with equal frequency (29.3%) and 46.2% of all SCC on the lower extremities occurred in leprosy patients with chronic trophic ulcers. Of patients with Bowen's disease involving the nonsunexposed parts (trunk and upper extremities), 42.6% had probable arsenic exposure evident either from the history or clinical examination. Malignant melanomas were commonly located on the foot (71.4%). CONCLUSIONS: The commonest skin cancers seen were BCC, SCC, Bowen's disease, and mycosis fungoides. There were differences in the site distribution of SCC, Bowen's disease, and malignant melanomas in our study when compared to studies in Caucasians.

Adult↗
PubMed1995

Evaluation of enzyme immunoassay for the detection of anogenital infections caused by Chlamydia trachomatis.

BACKGROUND--Infection caused by Chlamydia trachomatis is now recognised as the most prevalent sexually transmitted disease in many parts of the world. Anorectal infections caused by C. trachomatis is not uncommon. Enzyme-linked immunoassay (EIA) detects an antigen lipopolysaccharide (LPS) of C. trachomatis directly in clinical specimens. OBJECTIVE--Our aim was to compare an enzyme immunoassay, Wellcozyme Chlamydia (WZ04) with cell culture for the diagnosis of chlamydial infection of the anogenital tract. METHOD--Rectal swabs were taken from 100 prostitutes (80 females and 20 males) for chlamydia culture, WZ04 and direct immunofluorescence (DIF). In addition, endocervical specimens were obtained from the females for the above three tests. MAIN FINDINGS--All the positive rectal specimens were from females. Nine patients had a positive chlamydia culture from the rectum but negative WZ04 and DIF. Two patients had false positive results by WZ04 but negative culture and DIF. For cervical specimens, WZ04 identified 43% (3/7) of the culture positive cases. Specificity was 98.6%. WZ04 identified an additional specimen as positive which was also confirmed as positive by DIF. CONCLUSION--Our study shows that in our hands enzyme-linked immunoassays such as Wellcozyme Chlamydia are neither sensitive nor specific in detecting C. trachomatis infection of the rectum. For cervical infections, the sensitivity of WZ04 was 43% and the specificity 98.6% as compared to culture, with a positive predictive value of 75% and a negative predictive value of 94.7%.

Adult↗
PubMed1994

Isotretinoin therapy in acne vulgaris: a 10-year retrospective study in Singapore.

BACKGROUND: The use of isotretinoin, a first generation synthetic retinoid, in the treatment of patients with severe acne vulgaris was a major therapeutic advance in dermatology. This 10-year retrospective study reviews the effectiveness of isotretinoin in patients with acne vulgaris seen in a skin clinic in Singapore. METHODS: The case records of 250 cases of severe inflammatory and nodulocystic acne treated with isotretinoin were analyzed with reference to the demographic data, response to isotretinoin, dosage and cost of isotretinoin used, adverse effects, clinical follow-up, and relapse. RESULTS: Two hundred and fifty patients, 171 men (68.4%) and 79 women (31.6%), with different types and grades of acne vulgaris were studied. The dose of isotretinoin used ranged from 0.33 to 1.0 mg/kg/day (median 0.5 mg/kg/day) for a period ranging from 1 to 12 months (median 4 months). Response was excellent in 127 (50.8%) patients, good in 86 (34.4%), fair in 30 (12.0%) and poor in 7 (2.8%). Relapse occurred in 14 (5.6%) patients over a 6-month follow-up period. Adverse effects were noted in 140 (56.0%) patients and were mild in most cases. Eighteen (7.2%) patients had to discontinue the drug due to significant side effects. CONCLUSION: This study confirms that isotretinoin is very effective for severe acne, and complete remission can be induced in more than 90% of cases even with lower dosage regimens. Significant clinical improvement can be achieved with the use of lower doses (mean 0.5 mg/kg/day) for an average of 4 months of treatment with lower risk of adverse effects.

Acne Vulgaris↗
PubMed1994

In vitro evaluation of griseofulvin, ketoconazole, and itraconazole against various dermatophytes in Singapore.

BACKGROUND: Superficial cutaneous fungal infection, principally dermatophytosis, is an extremely common skin disease. Various in vitro test systems have been developed in recent years to determine the antifungal activity of various drugs. The minimum inhibitory concentration (MIC) obtained may give an indication of the in vivo potency of the drugs. METHODS: One hundred patients (69 men and 31 women) with a clinical diagnosis of dermatophytosis were entered into the study. Direct microscopy and culture were done on all patients. The MICS were determined using the broth dilution method. RESULTS: The age range was 1-76 years. The most common diagnosis was tinea corporis (36%), followed by tinea cruris (22%), and tinea pedis (19%). The most common fungus isolated was T. rubrum (58%), followed by E. floccosum (14%), and T. mentagrophytes (10%). The majority of the isolates was sensitive to the three drugs tested (griseofulvin, ketoconazole, and itraconazole). Of the isolates, 82% were sensitive to griseofulvin, 78% to ketoconazole, and 81% to itraconazole, all at a concentration of < 0.25 micrograms/mL. For T. rubrum, there were four isolates that had an MIC of > or = 64 micrograms/mL to griseofulvin, seven isolates and nine isolates with an MIC > or = 64 micrograms/mL to ketoconazole and itraconazole, respectively. T. interdigitale was relatively resistant to the three drugs in vitro with four of seven isolates having an MIC > or = 4 micrograms/mL with griseofulvin, one of seven isolate with an MIC > or = 64 micrograms/mL with ketoconazole, and three of seven isolates with an MIC > or = 32 micrograms/mL with itraconazole. CONCLUSIONS: The in vitro antifungal activity of griseofulvin, ketoconazole, and itraconazole are similar against dermatophytes in Singapore. Griseofulvin may be given as the first-line drug for treating such infections in Singapore.

Adolescent↗
PubMed1994

Epidemiology of skin disease among children in a referral skin clinic in Singapore.

This retrospective epidemiologic study compared data of skin disease in children less than 16 years old with those of adults attending the same tertiary referral outpatient clinic. Of the 74,589 patients seen in this clinic, 9273 (12.4%) were children. There were significant differences in the types of skin disease between children and adults. In children, eczema was the most common (50%), followed by viral infection (7%), bacterial infection (5%), and insect bite reaction (5%), significantly higher proportions than in adults. In contrast, acne vulgaris (3%), fungal infection (3%), and psoriasis (1.1%) rates were significantly lower in children than in adults. Atopic eczema (51%), followed by endogenous handfoot eczema (9.6%) was the most common type of eczema in children. The number of children with atopic (including asteatotic eczema) and seborrhoeic eczema decreased with age, suggesting that these conditions tend to clear with age, whereas other endogenous eczemas, including hand-foot eczema, nummular eczema, and lichen simplex chronicus, tend to increase with age. Epidemiologic data are useful in monitoring changes in disease trends in children and planning health care programs for them.

Adolescent↗
PubMed1994

The incidence of cutting fluid dermatitis among metalworkers in a metal fabrication factory: a prospective study.

We compared the incidence of occupational dermatitis and transepidermal water vapour loss (TEWL) changes from cutting fluids (neat mineral oils) in 24 new machinists with 27 armed forces paramedics (controls) over a 6-month period. The cumulative incidence of occupational dermatitis in positive controls increased from 38% at week 3 to 77% at week 6. It then decreased to 50% at week 9 and thereafter remained constant at about 50% throughout the remaining study period. 2 workers sought medical treatment for their dermatitis. Only 1 worker had a job transfer because of his dermatitis. None of the paramedics developed dermatitis during the study period. The mean basal TEWL values on the hands of machinists and controls were 17.6 and 14.5 g/m2/h (n.s.) respectively. The mean TEWL values of machinists increased to 22 g/m2/h by week 3 and then remained fairly constant throughout the remaining study period. The mean TEWL of negative controls remained fairly constant (at about 14 g/m2/h) from the beginning to the end of the study period. The mean TEWL value of machinists was significantly higher than that of negative controls throughout the study period. There was no significant difference in the prevalence of cutting fluid dermatitis between machinists with high basal TEWL values (> or = 17 g/m2/h) and those with low basal TEWL values (< 17 g/m2/h).

Adolescent↗
PubMed1994

Efficacies of a barrier cream and an afterwork emollient cream against cutting fluid dermatitis in metalworkers: a prospective study.

We compared the point prevalence of cutting fluid dermatitis and transepidermal water vapour loss (TEWL) changes in groups of new machinists who (a) used a barrier cream; (b) used an afterwork emollient cream; and (c) did not use any cream (controls) over a 6-month period. All machinists handled cutting fluid (neat mineral oil) during their work. There was no significant difference in the prevalence of cutting fluid dermatitis in the 3 groups throughout the study period. The prevalence of cutting fluid dermatitis in all groups increased rapidly during the first 6 weeks and thereafter remained steady throughout the remainder of the study period. The prevalence of cutting fluid dermatitis was slightly lower in machinists using afterwork emollient cream compared to those using barrier cream and controls (not significant). The differences in the mean TEWL changes during the study period among the 3 groups were also not statistically significant. The mean TEWL values in the 3 groups increased rapidly during the first 6 weeks of exposure to cutting fluids and thereafter remained fairly constant throughout the remainder of the study period. Barrier cream and afterwork emollient cream did not appear to have any significant effect against either cutting fluid dermatitis or TEWL changes in machinists exposed to cutting fluid. However, afterwork emollient cream appeared clinically to help reduce the prevalence of cutting fluid irritation.

Adolescent↗
PubMed1994

A study of occupational skin disease in the metal industry (1986-1990).

A retrospective study of the epidemiology of occupational skin disease among metal workers showed that irritant contact dermatitis (75%) prevailed over allergic contact dermatitis. Most workers belonged to the age group 20 to 29 years. There was a slight preponderance of Malays and Indians compared to the working population of Singapore. Most presented for treatment within 10 days of their dermatitis. Ninety-five percent presented with dermatitis on the hands and arms. There was no significant difference in the prevalence of atopy between workers with irritant and allergic contact dermatitis. In most cases of allergic contact dermatitis from cutting fluid, the causative allergen in the cutting fluid cannot be identified.

Adolescent↗
PubMed1994

Common industrial processes and occupational irritants and allergens--an update.

This paper reviews the recent development of the industrial processes in the construction, electronics and metal industries which are the predominant industries in developing countries. Common occupational irritants and allergens are presented. The information is essential for occupational dermatologists and physicians managing patients with occupational skin diseases. In the construction industry, the prefabrication construction methods are now widely used. The commonest irritant is cement and the allergens are chromate, rubber chemicals and epoxy resins. In the electronics industry, the commonest irritants include soldering flux, solvent and fibreglass, and allergens include resins and metals, rubber chemicals and amines and colophony. Cutting fluid is the commonest occupational irritant in the metal industry. Biocides and metals in The electro-discharge machining process now widely used in the metal industry for precision engineering uses the electrodischarge machining fluids (EDM fluids) which are a strong skin irritant. Preventive measures including health education are most effective against occupational dermatitis.

Allergens↗
PubMed1994

Pattern of skin diseases in the elderly seen at the National Skin Centre (Singapore) 1990.

A retrospective study was conducted at the National Skin Centre (Singapore) for the period 1st January 1990 to 31st December 1990 to determine the pattern of skin disorders in the elderly. A total of 2,571 patients aged 65 years and above were studied. This constituted 6.4% (2,571/39,941) of patients seen at the Centre for that year. 38.1% of the elderly patients were aged 75 years or older. The male to female ratio was 1.3 to 1. There were differences in the pattern of skin problems when compared with the young. Xerosis and asteatotic eczema were distinctly common in the elderly. The most common dermatosis in the elderly was eczema. Endogenous eczema (including seborrhoeic dermatitis, lichen simplex chronicus, hand/feet eczema, stasis eczema, generalised exfoliative dermatitis), exogenous eczema (ie contact dermatitis) and dermatitis (not otherwise specified) formed 35.3% (907/2,571) of the skin disorders encountered at the National Skin Centre. Eczema, fungal, viral infections and psoriasis were on the whole less common in the elderly compared with the general population. Common skin infestations and infections were scabies, viral warts, monilial and bacterial intertrigo and tinea corporis. Urticaria, alopecia, insect bite reactions and post-inflammatory pigmentation were uncommon referral problems in the elderly.

Aged↗
PubMed1994

Lasers used in dermatology.

This review introduces the various lasers available for the treatment of dermatological conditions. The applications of various lasers used in dermatology, including the carbon dioxide, argon, Q-switch Nd:YAG, ruby, dye and metal vapour lasers are discussed. We present our experience with the use of the carbon dioxide laser, flashlamp pulse-dye laser and Q-switch Nd:YAG laser in the National Skin Centre, Singapore. Our experience indicated that the lasers if used selectively are useful tools in the management of numerous skin disorders. The carbon dioxide laser is a versatile tool, useful for vaporizing or destroying skin lesions. The treatment of vascular or pigmented (melanin) lesions requires lasers that emit wavelengths corresponding to the absorption spectrum of haemoglobin or melanin respectively. Choosing the right laser gives optimal cosmetic result whereas the wrong lasers can lead to a less satisfactory result and even severe scarring. It is important to note that there is no single laser system that is versatile enough to be used to treat all skin disorders. To provide full coverage in the treatment of skin disorders, a laser centre has to be equipped with many different laser systems. This makes using lasers in the treatment of skin disorders very expensive.

Humans↗
PubMed1993

Etretinate therapy for psoriasis and other keratinizing disorders: a 10-year retrospective study in Singapore.

BACKGROUND: Etretinate, a second generation retinoic acid, has been reported to be useful in the treatment of psoriasis and other keratinizing disorders. The effectiveness of etretinate for these disorders are studied in a 10-year retrospective study of all patients treated with etretinate in a skin clinic in Singapore. METHODS: The case records of 190 cases of psoriasis and other keratinizing disorders treated with etretinate were analyzed. Information collected included demographic data, dosage of etretinate taken, response and side effects, clinical follow-up, and relapse. RESULTS: Most of the cases (72.6%) had psoriasis (138/190). The others had different keratinizing disorders. The dose of etretinate used was 0.15 to 1 mg/kg/day (median 0.36 mg/kg/day), and the duration of the treatment varied from 1 to 120 months (median 6 months). Etretinate was coadministered with UVB (ReUVB) or PUVA (RePUVA) in 89 (46.8%) patients. In psoriasis, the response to treatment was excellent in 41.3% (57/138), good in 36.2% (50/138), fair in 15.9% (22/138), and poor in 6.5% (9/138) of the cases. Patients with plaque-type psoriasis did better with combination therapy than with monotherapy. Those with keratinizing disorders showed excellent, good, fair, and poor responses in 32.7% (17/52), 32.7% (17/52), 25.0% (13/52), and 9.6% (5/52) respectively. Adverse effects were noted in 102 (53.7%) cases and were generally mild and tolerable. Etretinate was discontinued in 24 (12.6%) patients due to significant toxicity. CONCLUSIONS: Etretinate is effective for treating psoriasis and other keratinizing disorders. Combination therapy is preferred in chronic plaque psoriasis. Adverse effects are common, but mild and tolerable.

Adolescent↗
PubMed1993

Contact dermatitis from dielectric fluids in electrodischarge machining.

We report an outbreak of irritant contact dermatitis in the aerospace industry from electrodischarge machining (EDM). 20 workers doing EDM developed irritant contact dermatitis from the dielectric fluid used in EDM, a form of precision metal machining that is widely used in mould making and precision engineering. Dielectric fluid contains hydrocarbons that are aromatic, paraffinic or naphthenic and are skin irritants. Irritant contact dermatitis from dielectric fluid has not been reported previously. EDM will become more widespread and occupational dermatitis from dielectric fluid is likely to become more prevalent in the future. Our experience was that irritant contact dermatitis from dielectric fluid can be prevented by simple preventive measures such as personal hygiene and health education.

Adult↗