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Biomedical subjects

Y H Leow

Publications and source records attributed to Y H Leow.

At least 19 recordsLinked to original sources
PubMed2005

Not all pustules are infective in nature: acute generalised exanthematous pustulosis causing pustular eruptions in an elderly woman.

Acute generalised exanthematous pustulosis (AGEP) is an adverse drug reaction that can occur in any age group. It is commonly mistaken as pustular psoriasis or cutaneous infection, resulting in unnecessary commencement of medications such as methotrexate and antibiotics that can cause harm to the patient or interact and adversely affect the efficacy of other medications. Early diagnosis of AGEP avoids unnecessary investigations and treatment, which not only can harm the patient but also escalate health care, as the condition is self-limiting. This case report illustrates AGEP secondary to Cefaclor occurring in a 72-year-old Chinese woman. Although the literature has documented the occurrence of AGEP with Cefaclor, the unique feature of this case is the occurrence of AGEP following repeated uneventful courses of Cefaclor. This case highlights that AGEP must never be forgotten in the work-up for pustular eruptions in an elderly patient.

Acute Disease↗
PubMed2005

Latex sensitisation in healthcare workers in Singapore.

INTRODUCTION: Epidemiological data on latex sensitisation among Asian healthcare workers is lacking. The aim of the study is to determine the rate of latex sensitisation in our healthcare workers. MATERIALS AND METHODS: We recruited 313 healthcare workers, of which 46.6% were operating theatre staff and 53.4% were non-operating theatre staff. Seventy-one administrative staff served as controls. All participants answered a self-administered questionnaire relating to latex exposure and glove-related symptoms. Latex sensitisation was determined by skin prick testing to latex and latex-specific IgE detection. RESULTS: The prevalence of latex sensitisation among healthcare workers was 9.6%, with no difference between operating theatre and nonoperating theatre staff. Glove-related symptoms were reported in 13.7% of all healthcare workers, of which 22.9% were sensitised to latex. Only 26.7% of latex-sensitised healthcare workers had glove-related symptoms while the rest were asymptomatic. The most common symptoms were itch and hand eczema but the most important discriminating symptom was contact urticaria. Personal history of atopy was more common in sensitised healthcare workers (40.0%) compared to non-sensitised workers (31.8%). Only 1 out of 9 (11.2%) symptomatic latex-sensitised subjects had sought previous medical attention for the problem. CONCLUSIONS: Latex sensitisation among healthcare workers in Singapore should be considered a significant occupational health risk, as it is in the West. Increased screening and awareness of this problem is essential to identify those at risk.

Adult↗
PubMed2003

Sweet's syndrome associated with Mycobacterium chelonae and herpes simplex virus infections: a case report.

INTRODUCTION: We report a case of Sweet's syndrome associated with Mycobacterium chelonae and herpes simplex virus infection. CLINICAL PICTURE: A 56-year-old Chinese woman presented with a granulomatous subglottic mass and right lung nodules, which responded to a 9-month course of anti-tuberculous treatment. Subsequently, she developed genital herpes simplex virus infection, which was followed by a cutaneous eruption with vesicular plaques associated with fever, bilateral cervical lymph nodes and neutrophilia. Mycobacterium chelonae was isolated from lymph node cultures. The cutaneous presentation of Sweet's syndrome was confirmed on skin biopsy. There was no evidence of underlying immunosuppression, malignancy or connective tissue disease. TREATMENT: She was treated with rifampicin, clarithromycin and oral prednisolone. OUTCOME: There was complete resolution of her cutaneous lesions and cervical lymphadenopathy. CONCLUSION: The association between Sweet's syndrome and Mycobacterium chelonae as well as herpes simplex virus, though rare, should be considered in all patients presenting with Sweet's syndrome.

Female↗
PubMed2001

Occupational allergic contact dermatitis in Singapore.

Singapore has a resident population of 3,000,000 and a workforce of 1,780,000. Most are employed in manufacturing, services and commerce (245,000). From 1996 to 1998, 3472 cases were notified to the Ministry of Manpower and confirmed as occupational diseases. Noise-induced hearing loss accounted for 82% of cases, while only 11% of cases were industrial dermatitis. Occupational allergic contact dermatitis was not common, comprising approximately one third of the 369 cases of industrial dermatitis that were notified. However, we believe that the majority of cases are not notified to the authorities. The main occupational contact allergens were chromates, nickel, rubber chemicals, cutting fluids and resins. Most affected workers were from the construction, electronics and metalworking industries. Case series of occupational dermatoses among electronics and metal workers have been published. Of the cases of occupational dermatoses among electronics workers seen at a tertiary dermatological centre, 41% of 149 had allergic contact dermatitis (ACD). The commonest allergens were nickel, resins and rubber chemicals. In another case series of 252 metalworkers seen at the same dermatological centre, 23% suffered from ACD. The common allergens were metals and cutting fluids. Besides the common causes of ACD, unusual allergens have also been described. One example is ACD to grasses, which is seen mainly among military personnel. Population studies have been conducted in several industries. A survey of 2567 electronics workers revealed a 2% point prevalence of ACD. Of the occupationally relevant cases, 46 were nickel sensitive, 7 reacted to colophony, and 1 case to epoxy resin. A study of 272 prefabrication construction workers showed a 14% prevalence rate of occupational dermatitis. Of the 38 cases, 42% were ACD to chromates and rubber chemicals. Occupational ACD in Singapore is not as uncommon as the reported statistics suggest. Population-based reports, which overcome the problem of under-notification, show that the prevalence is variable in different industries.

Chemical Industry↗
PubMed2000

A review of inpatients with adverse drug reactions to allopurinol.

Allopurinol is still an effective uric-acid lowering drug since its introduction in 1963. However it has been frequently incriminated for severe adverse drug reactions. From our retrospective review of 13 inpatients with allopurinol adverse reactions seen over 3 years, fever and rash were the commonest presenting symptoms, occurring several weeks after initiation of the drug. Other associated abnormalities included leukocytosis (62% of patients), eosinophilia (54%), renal impairment (54%) and liver dysfunction (69%). Although 12 patients (92%) met the criteria for allopurinol hypersensitivity syndrome, there was no mortality recorded. The indications for initiating allopurinol therapy were frequently unclear. In view of the severe adverse reactions experienced with allopurinol, we propose that it should only be prescribed when truly indicated.

Adult↗
PubMed1999

A study of the sensitization rate to sesquiterpene lactone mix in Singapore.

We report a study of the sensitization rate to sesquiterpene lactone (SL) mix at the National Skin Centre, Singapore. This is a retrospective review of 1256 patients who were patch tested to SL mix (0.1%) from January 1995 to December 1997. 18 out of 1256 patients (1.43%) reacted positively to SL mix. Their ages ranged from 13 to 58 years (average 33.8 years). There were 15 Chinese, 2 Indian and 1 Malay patients. There was a female preponderance, with a female: male ratio of 3.5:1. The most common clinical presentation were dermatitis of the hands (8; 44%), face (5; 28%), and generalized involvement (5; 28%). After extensive evaluation, only 2 patients had a positive patch test reaction that was of current clinical relevance. 13 patients had concomitant sensitization to other allergens. The 3 commonest concomitant allergens were nickel, balsam of Peru and fragrance mix. In our series, SL allergy is observed to be more common in females and the mean age is lower compared to the classical Compositae dermatitis. The sensitization rate is comparable to other studies, although the clinical relevance is only 11%.

Adolescent↗
PubMed1999

The therapeutic efficacy of mometasone furoate cream 0.1% applied once daily vs clobetasol propionate cream 0.05% applied twice daily in chronic eczema.

BACKGROUND: Mometasone furoate [9a, 21-dichloro-llb, 17dihydroxy-16a-methyl-pregna-14-dione-3, 20-dione-17-(2furoate)] is a synthetic, 17-heterocyclic corticosteroid which has been shown to be highly effective as an anti-inflammatory agent which is approximately half as potent is suppressing hypothalamic-pituitary-adrenal (HPA) axis function as betamethasone valerate. METHOD: The present open, randomised, third party blinded, left-right sided study was designed to compare the therapeutic efficacy of mometasone furoate cream 0.1% with clobetasol propionate cream 0.05% applied twice daily in chronic eczema following a 3-week course of therapy. PATIENTS/RESULTS: Sixty consecutive patients with moderate to severe bilateral chronic eczema on the limbs were recruited into the study. The mean scores of various signs/symptoms including erythema, induration, crusting, scaling, excoriation and pruritus before and after 3 weeks treatment with mometasone furoate (MF) and clobetasol propionate (CP) cream, were compared. The baseline scores for MF and CP treated sites were almost identical. There was significant decrease in the mean scores of all signs/symptoms after 3 weeks treatment with MF and CP. There was also a significant difference in the mean scores between MF and CP treated sites after 3 weeks of treatment. The mean scores were significantly lower for CP treated sites than MF treated sites. More CP treated sites achieved "cleared" or "marked improvement" response than MF treated sites. There were more "excellent" or "good" grades on CP treated sites than MF treated sites at the end of 3 weeks of treatment. None of the patients showed any side-effects after 4 weeks of treatment. CONCLUSION: Overall, 53% of patients considered the MF treated sites to be good or excellent vs 88% for CP treated sites.

Administration, Topical↗
PubMed1999

Contact allergy in Singapore.

Contact allergy, viz. allergic contact dermatitis, photo-allergic contact dermatitis and contact urticaria, is a well-studied sub-specialty of dermatology in Singapore. Over the years, numerous studies and anecdotal reports on the subject have been published in both international and local refereed journals. This article reviews the epidemiological data on patch testing and photo-patch testing in Singapore. It also summarizes published clinical reports on important contact allergens that are found in both non-occupational and occupational setting.

Adult↗
PubMed1998

Human barrier recovery after acute acetone perturbation: an irritant dermatitis model.

The efficacy of a topical agent in barrier recovery was evaluated after acetone-induced acute water loss barrier disruption in vivo in humans. The upper back of several volunteers was rubbed with acetone-soaked cotton balls until elevated rates of transepidermal water loss (TEWL) occurred (> 20 g/m2h, or greater). The topical agent was then applied to the acetone-treated skin sites once daily for 5 days. Resolution evaluation used TEWL measurements and the data were expressed as the percentage recovery in water barrier function. In comparison with placebo control the topical agent significantly enhanced barrier recovery, especially within the first 72 h (P < 0.05). This model offers a simple method of examining chemicals accelerating (or inhibiting) repair of this form of acute skin damage in man.

Acetone↗
PubMed1998

Allergic contact dermatitis to epoxy resin in a hemodialysis cannula.

A patient with chronic renal failure on hemodialysis presented with dermatitis, particularly over the arteriovenous fistulae sites on the forearm. Patch testing revealed a positive reaction to epoxy resin present in the glue that fixed the needle of the hemodialysis cannula.

Allergens↗
PubMed1998

Corticosteroid contact hypersensitivity screening in Singapore.

BACKGROUND: Topical corticosteroids have been in use since 1957. Two percent to 5% of patients attending patch test (PT) clinics have problems with corticosteroid contact hypersensitivity. Controversies abound with regard to the choice of steroids in the standard battery, the method of patch testing and reading, and the ideal concentration and vehicle. OBJECTIVE: To assess betamethasone 17-valerate (1% pet.), fluocinolone acetonide (0.25% petrolatum [pet.]), and tixocortol pivalate (1% pet.) used in the authors' standard battery. METHODS: Data were analyzed for patients seen between January 1994 and December 1996 who had positive PT reactions to one or more of these steroids. RESULTS: 3,603 patients had standard PTs, of which 20 had positive reactions to one or more of these steroids. There were three positive reactions to betamethasone 17-valerate, 17 to tixocortol, and none to fluocinolone. On further patch testing to the authors' steroid battery, only one tixocortol-positive patient had a positive reaction to hydrocortisone (1% ethanol/ dimethyl sulfoxide [DMSO]). CONCLUSIONS: Corticosteroid allergy is found to be relatively uncommon in Singapore on the basis of this screening series. The frequency of negative reactions to fluocinolone acetonide is sufficiently low for this corticosteroid to be excluded from the authors standard series. The significance of positive tixocortol reactions remains unknown. From the review of other relevant literature, the authors recommend that budesonide be added to their present series. Testing betamethasone 17-valerate in 1% ethanol may yield more positive allergic reactions. Individuals with a positive allergic PT reaction to one corticosteroid should subsequently be tested to a full corticosteroid series.

Administration, Topical↗
PubMed1997

Malignancy in adult dermatomyositis.

BACKGROUND: Dermatomyositis has been reported to be associated with malignancies in 15%-34% of patients in Western countries, but in as many as two-thirds of patients in Singapore. The aim of this study was to determine whether a diagnostic measure could be helpful in the diagnosis of a malignancy in patients with dermatomyositis. METHODS: This is a retrospective study on 38 adult patients with dermatomyositis that were seen over a 6-year period from 1989 to 1994. RESULTS: All the patients presented with cutaneous features that suggest the clinical diagnosis of dermatomyositis; however, not all cases show all the key features of the disease. Of the studied patients, 86.8% were noted to have photosensitivity as a key cutaneous presentation. Thirty (78.9%) of our patients were above the age of 40 years, and 12 (31.6%) of these were found to have an associated malignancy. Nasopharyngeal carcinoma was the most commonly associated malignancy (38.4%) in our study population. CONCLUSIONS: In our study population, otorhinolaryngologic screening is an essential investigation for the evaluation of dermatomyositis in association with malignancy.

Adolescent↗
PubMed1996

A report of 31 cases of porokeratosis at the National Skin Centre.

Porokeratosis is a well-recognised disorder of keratinization with distinctive clinical features and histological hallmark of cornoid lamella. There are at least 4 different clinical variants, with malignant transformation reported in almost all types of porokeratosis. This is a retrospective study on all cases of porokeratosis seen at the National Skin Centre, Singapore from 1990 to 1993. There was a total of 31 patients diagnosed to have porokeratosis during the study period. They can be classified into 4 main clinical variants: (1) disseminated superficial actinic porokeratosis (41.9%), (2) classical porokeratosis of Mibelli (35.5%), (3) porokeratosis palmaris, plantaris et disseminatum (9.7%), and (4) linear porokeratosis (12.9%). Our typical patient is in his/her early forties, who noticed asymptomatic porokeratotis lesion on sun-exposed skin. Various treatment modalities were used, with no one method being more superior to another. None of our patients had malignant transformation of pre-existing skin lesions during the short follow-up period from less than one year to three years. Patients should be advised to avoid excessive sunlight, to use sunscreen and go for periodic examination by a dermatologist with a view to close skin malignancy surveillance.

Adolescent↗