Editorial
Evolving therapies for atopic dermatitis: Bridging guidelines and practice
Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin condition characterised by dysregulated type 2 immune responses, skin barrier dysfunction and intense pruritus (itching). The disease burden of AD is substantial, affecting at least 171 million individuals worldwide in 2019, representing 2.23% of the global population.1 Among skin diseases,...
Letter to the Editor
Traction alopecia in women: An under-recognised cause of hair loss
Dear Editor,
Alopecia ranks among the most common clinical complaints encountered by dermatologists.1 In particular, affected women often experience great psycho-emotional stress leading to a reduction in quality of life.2
We conducted a prospective epidemiological study conducted over 77 weeks from 1 August 2022 to 23 January 2024 at an outpatient...
Original Article
Trends in fluid overload-related hospitalisations among patients with diabetes mellitus: The impact of chronic kidney disease
Diabetes mellitus (DM) is a major global health problem, contributing to significant clinical disease burden, healthcare expenditure and societal costs.1 In Singapore, DM accounts for 2.9% of disability-adjusted life years and 4.3% of years lived with disability.2,3 By 2030, it is projected to cost approximately USD 1.89 billion in...
Letter to the Editor
HLA-B*5801 testing: Is it time to consider mandatory testing prior to prescribing allopurinol in Singapore?
Dear Editor,
Stevens-Johnsons Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe, life- threatening mucocutaneous reactions that most commonly occur as drug-related reactions.1 In recent years, several risk factors for the develop- ment of SJS/TEN, such as genetic factors, have been identified. Notably, carriers of the HLA-B*5801 and HLA-B*1502 alleles ...
Commentary
The potential of RNA therapeutics in dermatology
Graphic design by Liu Yujia
Ribonucleic acid (RNA) therapeutics involving, among others, microRNAs (miRNAs), small interfering RNAs (siRNAs) and/or antisense oligonucleotides (ASOs) hold great potential for the advancement of medical treatments in dermatology.
First, there are now novel ways to treat several dermatological conditions where existing treatments have been largely unsatisfactory....
Letter to the Editor
Outcomes of nurse-led cryotherapy treatment for viral warts
Dear Editor,
Cryotherapy is a cost-effective treatment that can be performed by non-dermatologists for viral warts, which are very common.1,2 The National University Hospital, Singapore runs a nurse-led wart clinic where nurses are trained to administer cryotherapy. This study reviewed eradication rates and side effects in patients treated at the...
Letter to the Editor
Rash characteristics of paediatric patients with COVID-19 in Singapore
Dear Editor,
Children with COVID-19 infection can present with a variable spectrum of clinical manifestations, and sometimes mucocutaneous manifestations can be the only manifestation of COVID-19 infection in children.1,2,3 We report 4 cases of paediatric patients who had COVID-19 with mucocutaneous involvement, admitted to a tertiary children’s hospital in Singapore....
Original Article
Concordance of self-reporting of diabetes compared with medical records: A comparative study using polyclinic data in Singapore
Approximately 422 million people worldwide have diabetes and 1.6 million deaths are attributed to diabetes each year,1 contributing to high economic costs worldwide. Diabetes education and awareness of the disease contribute significantly to minimising complications and reducing morbidity and mortality.2 In addition, there is also a strong impetus to...
Letter to the Editor
Association between self-care and chronic kidney disease in patients with type 2 diabetes mellitus
Dear Editor,
Chronic kidney disease (CKD) is one of the key complications occurring in 25–40% of patients with type 2 diabetes mellitus (T2DM).1 Our earlier study also showed that CKD was present in 53% of patients with T2DM recruited from a secondary care diabetes centre and primary care polyclinic...
Images in Medicine
Lichen planus pemphigoides after pembrolizumab immunotherapy in an older man
An 84-year-old Chinese man with stage IV non-small cell lung cancer was initiated on pembrolizumab, an anti-programmed cell death (PD)-1 monoclonal antibody, 4 times per week. Seven weeks later, on the day of his third cycle, he developed a rash on his chest and right axilla, which subsequently resolved...
Review Article
Drug interactions between common dermatological medications and the oral anti-COVID-19 agents nirmatrelvir-ritonavir and molnupiravir
In December 2021, an Emergency Use Authorisation was issued by the U.S. Food and Drug Administration (FDA) for the use of the orally active antiviral medications nirmatrelvir-ritonavir (NMV/r, PAXLOVID) and molnupiravir (LAGEVRIO) in the treatment of patients with mild COVID-19, who are at risk of developing severe disease resulting...
Editorial
Pharmacokinetic and pharmacogenomic considerations in managing use of nirmatrelvir-ritonavir and molnupiravir and dermatological treatments
The COVID-19 pandemic has been unprecedented in its impact on global health, economic, financial, psychosocial and political systems. The World Health Organization estimates approximately 627 million confirmed cases and 6.5 million deaths reported globally.1 In Singapore, the swift and prompt public health response of the government during the early...
Original Article
Non-alcoholic fatty liver disease screening in type 2 diabetes mellitus: A cost-effectiveness and price threshold analysis
Non-alcoholic fatty liver disease (NAFLD) is a growing epidemic and has become a major cause of liver-related mortality and indication for liver transplantations globally. It is estimated that nearly 25% of the world’s population and more than 60% of type 2 diabetes mellitus (T2DM) patients have NAFLD. A prior...
Images in Medicine
A man with bark-like skin
A 65-year-old Chinese man was admitted for evaluation of chronic anaemia. He had a history of hypertension and chronic kidney disease, and his regular medications were nifedipine and losartan. He was a retired cleaner who lived with friends and had no contact with his family.
He was referred to the...
Images in Medicine
TB or not TB? The axillary lump question
An 81-year-old woman of healthy weight presented with a 2-week history of a painless right axillary lump. Physical examination revealed a 2cm firm nodule with a central keratinous plug in the right axilla (Fig. 1). The surrounding skin was pigmented, non-tender and indurated. Sonography of the nodule demonstrated an...
Letter to the Editor
Safety and efficacy of combined antiplatelet and low-dose rivaroxaban in patients with chronic limb threatening ischaemia in Singapore
Dear Editor,
Peripheral artery disease (PAD) is characterised by the debilitating atherosclerotic occlusion of arteries in the lower extremities, with chronic limb threatening ischaemia (CLTI) representing the most advanced stage of this disease process. Left untreated, these sequelae will invariably progress to major lower extremity amputation (LEA) and premature death....
Original Article
Interaction of sex and diabetes in Asian patients with heart failure with mildly reduced left ventricular ejection fraction
Diabetes mellitus (DM) is a common comorbidity worldwide with global prevalence among adults above 18 years of age increasing from 4.7% in 1980 to 8.5% in 2014.1 DM has been shown to be a common comorbidity in heart failure (HF) patients ranging from 4.3–28%2 and when present, portends a...
Editorial
Impact of sex and diabetes in patients with heart failure with mildly reduced ejection fraction
With increasing global awareness of sex differences in the heart failure population and the new entity of heart failure with mildly reduced ejection fraction (HFmrEF), much has yet to be fully understood with regard to patient demographic, clinical presentation, response to guideline-directed heart failure therapies, and outcome across the...
Letter to the Editor
Change in hepatitis B virus DNA status in patients receiving chronic immunosuppressive therapy for moderate-to-severe skin disease
Dear Editor,
Hepatitis B virus (HBV) infection poses a global health burden. Clinically, patients may present with chronic HBV infection, occult HBV infection, and fulminant hepatic failure. In 2010, the hepatitis B surface antigen (HBsAg) seroprevalence in Singapore was 3.6%.1
Patients with dermatological conditions receive prolonged corticosteroid and other immunosuppressive therapy...
Others
Cutaneous Polyarteritis Nodosa: A Case Report and Literature Review
Cutaneous polyarteritis nodosa (CPN) is an uncommon form of vasculitis of the small-and medium-sized arteries in the reticular dermis and subcutaneous tissue. It remains limited and runs a chronic, benign course.
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Others
Sezary Syndrome: A Case Report and a Review of the Molecular Pathomechanism and Management
Our patient is a 64-year-old Malay man who first presented in July 1993 with a history of rash starting on the hands 1½ years earlier progressing to generalised eczema 5 months prior to consultation. He was diagnosed to have generalised exfoliative dermatitis (GED).
This article is available only as a...
Others
A Case Report of Neutrophilic Eccrine Hidradenitis in a Patient Receiving Chemotherapy for Acute Myeloid Leukaemia
Neutrophilic eccrine hidradenitis (NEH) is a neutrophilic dermatosis primarily affecting the eccrine glands and occurs most commonly in patients undergoing chemotherapy for a malignancy.
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Others
Rosai-Dorfman Disease with Primary Cutaneous Manifestations—A Case Report
In 1969, Rosai and Dorfman first described a newly recognised benign systemic histioproliferative disease characterised clinically by bilateral striking cervical lymphadenopathy, fever, leukocytosis, and pathologically by enlarged lymph nodal sinuses containing large histiocytes with intact phagocytosed lymphocytes (emperipolesis). They dubbed the entity “sinus histiocytosis with massive lymphadenopathy” (SHML or...
Others
Bullous Dermatomyositis Associated with Nasopharyngeal Carcinoma —A Case Report
Bullous dermatomyositis is a rare variant of dermatomyositis and has been reported in the literature. It is believed to be strongly associated with the presence of a malignancy.
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Others
Case Reports of Linear IgA Bullous Dermatosis of Childhood
Linear IgA bullous dermatosis of childhood (LADC) is an acquired subepidermal blistering disorder of young children which is characterised by the unique finding of linear deposits of IgA along the dermoepidermal junction. It usually occurs acutely in pre-school children and has been described in association with a variety of...
Others
Atypical Mycobacterium Infection with Sporotrichoid Spread in a Patient with Human Immunodeficiency Virus
Mycobacteria other than tubercle bacilli (MOTT) were shown to be agents of human disease in the 1950s. They are also known as atypical, environmental or opportunistic mycobacteria.
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Original Article
One-year Review of Pityriasis Rosea at the National Skin Centre, Singapore
Pityriasis rosea is a common, self-limited disorder of unknown but suspected viral aetiology, that develops abruptly with few or no prodromal symptoms. Classically, the first sign is the presence of a single lesion, 2 to 5 cm in diameter known as a “herald patch”.
This article is available only as...
Original Article
Repigmentation of Vitiligo with Autologous Blister-induced Epidermal Grafts
Treatment of vitiligo can sometimes be difficult and disappointing. Medical treatment includes topical or systemic steroids and psoralen with ultraviolet A light (PUVA).
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Others
Eccrine Porocarcinoma: A Case Report
Porocarcinoma is a rare malignant tumour, arising from the intra-epidermal ductal portion of the eccrine sweat gland, also known as “acrosyringium”.’ According to the histological typing of skin tumours, it is an eccrine carcinoma that may arise de nova or develop in eccrine poroma, its benign counterpart, as an...
Others
Retrospective Study of Behcet’s Disease seen at the National Skin Centre, Singapore
Behcet’s disease, first described by a Turkish dermatologist, Dr Hulusi Behcet, is a multisystem inflammatory disorder of unknown aetiology. The diagnosis of Behcet’s disease is based on clinical criteria because there are no pathognomonic laboratory features.
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Original Article
Use of Ligase Chain Reaction and Polymerase Chain Reaction on Urine Specimens to Detect Chlamydia trachomatis Infections in a Sexually Transmitted Diseases Clinic in Singapore
Infections caused by Chlamydia trachomatis are amongst the most common bacterial sexually transmitted diseases (STDs) in the world, causing substantial morbidity in young sexually-active people. C. trachomatis causes a variety of clinical syndromes in males (including urethritis and epididymitis), females (including cervicitis and pelvic inflammatory disease), and new-borns (including...
Others
A Case Report: Persistent Acantholytic Dermatosis in Chronic Renal Failure
A 70-year-old Chinese man with end-stage renal failure (ESRF), who has been on continuous ambulatory peritoneal dialysis for 6 months, was referred by the renal physician for pruritic rashes over the scalp and chest. The rashes were first noted about 3 months ago.
This article is available only as a...
Others
Squamous Cell Carcinoma arising in a Cutaneous Epidermal Cyst—A Case Report
Epidermal cysts are common benign subcutaneous lesions. Malignant transformation in epidermal cysts is a rare but recognised occurrence.
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Review Article
Diabetic Retinopathy
Diabetes mellitus affects some 9% of Singaporeans. Studies had shown that virtually all insulin dependent diabetes mellitus (Type 1) and 85% of non-insulin dependent diabetes mellitus (Type 2) patients would develop retinopathy after 20 years of disease.
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Original Article
Granuloma Annulare: A Review of 41 Cases at the National Skin Centre
Granuloma annulare (GA) is a benign, inflammatory disorder of the skin that has no proven aetiology or widely accepted theory of pathogenesis. There are several clinical manifestations, ranging from localised GA, which is the commonest form and is characterised by erythematous or flesh-coloured papules in an annular arrangement, to...
Others
A Case Report of Erythema Induratum of Bazin’s Disease
There are many dermatological manifestations of tuberculosis, ranging from distinct entities such as tuberculosis verrucosa cutis, lupus vulgaris, scrofuloderma, to tuberculides. The term tuberculide is applied to any of a group of eruptions which arise in response to an internal focus of tuberculosis and clear with anti-tuberculosis therapy.
This article...
Others
Hypoglycaemia from Islet Cell Hyperplasia and Nesidioblastosis in a Patient with Type 2 Diabetes Mellitus—A Case Report
A 57-year-old woman was admitted to our hospital for perforated left tubo-ovarian abscess and found to have newly diagnosed diabetes with an admission blood glucose of 23 mM and glycated haemoglobin value of 12% (reference range 4.6% to 6.4%). She denied past symptoms of thirst, polyuria or polydipsia.
This article...
Letter to the Editor
Re: One-year Review of Pityriasis Rosea at the National Skin Centre, Singapore
I refer to a paper published in the Annals Vol. 28 No. 6 November 1999 titled “One-year review of pityriasis rosea at the National Skin Centre, Singapore” by Drs Y K Tay and C L Goh. I would like to point out that a prospective study on pityriasis rosea...
Others
Treatment of Chronic Urticaria with Thyroxine in an Euthyroid Patient with Thyroglobulin and Microsomal Antibodies
Chronic urticaria is defined as daily outbreaks of urticaria of at least 6 weeks duration. Despite being a common disorder, the cause of chronic urticaria is often obscure and not easily treatable.
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Others
An Unusual Case of Cutaneous Vasculitis
A 49-year-old Chinese man presented at the Tan Tock Seng Hospital with painful gangrene of the right second and left third and fourth toes for 6 weeks, purple discolouration of the toes for 3 months and arthritis of the left knee for 3 months.
This article is available only as...
Others
A Case Report of Aspergillus Hypersensitivity Syndrome with Obstructing Bronchial Aspergillosis
The spectrum of pulmonary aspergillosis includes saprophytic colonisation, hypersensitivity syndromes and invasive lung disease. There has been a tendency to classify these syndromes as separate entities but clinical overlap occurs.
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Original Article
Classical and Amyopathic Dermatomyositis seen at the National Skin Centre of Singapore: A 3-year Retrospective Review of their Clinical Characteristics and Association with Malignancy
Polymyositis/dermatomyositis is a connective tissue disorder with inflammatory muscle disease resulting in muscle weakness. When there is only muscle involvement, the term polymyositis is used.
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Original Article
A Rational Alternative for the Diagnosis of Diabetes Mellitus in High Risk Individuals
The “gold standard” for the diagnosis of diabetes mellitus has all along been the oral glucose tolerance test (OGTT). As diabetes mellitus defines a group of individuals at high risk for macrovascular and microvascular disease, it is essential that the diagnosis be made promptly.
This article is available only as...
Others
Neonatal Lupus Erythematosus: Our Local Experience
Neonatal lupus erythematosus (NLE) is related to the transplacental passage of anti-Ro antibodies from mother to foetus. The commonest manifestations involve the skin and the heart.
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Others
Lichen Amyloidosus: A Bullous Variant
Systemic amyloidosis, first reported in 1886, is characterised by deposits of amyloid in various organs including the skin, which may manifest as skin purpura, papules, nodules and occasionally bullae (termed bullous amyloidosis in the literature), predominantly distributed over the periorbital and intertriginous areas. In contrast, lichen amyloidosus is solely...
Others
Traditional Indian Systems of Medicine
Traditional medicine includes the knowledge and practices that rely exclusively on practical experience and observations handed down from generations to generations, either verbally or in writing. Traditional systems of medicine in India are culturally acceptable and usually inexpensive.
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Letter to the Editor
Systemic antibiotic prophylaxis for recurrent infective flares in children and adolescents with atopic dermatitis
Dear Editor,
Atopic dermatitis (AD) is a chronic inflammatory skin disease, affecting approximately 20% of children in Singapore.1 It is associated with skin barrier defects2 and increased skin colonisation with Staphylococcus aureus, which can trigger infective flares, especially in more severe disease. Strategies to reduce S. aureus colonisation and infection...
Others
Human Immunodeficiency Virus Infection Presenting with Chronic Actinic Dermatitis: A Case Report
A 40-year-old Chinese man of skin phototype III (Table I), formerly a welder in a shipyard, presented with pruritic papules on his face, neck and arms of 3 years’ duration. He had noted sun-aggravation and had ceased working for 3 months.
This article is available only as a PDF. Please...
Others
Comparison of Allergic Contact Dermatitis Cases in the Private and Subsidised Clinics in the National Skin Centre, Singapore
Allergic contact dermatitis is a common clinical problem seen in our dermatology outpatient clinics, comprising 0.5% of patients seen in 1999. In addition to our contact dermatitis clinic and occupational dermatosis clinic which caters to subsidised patients, many patients have also been worked up and patch tested in the...
Others
A Rare Cause of Syncope in a Patient with Diabetes Mellitus—A Case Report
Hypoglycaemia is a common medical emergency. It presents either with symptoms of neuroglycopaenia, such as episodes of visual blurring, confusion, convulsions and sometimes coma or with symptoms caused by excess of counterregulatory hormones like catecholamines, such as palpitations, sweating and tremulousness. It is most commonly seen in patients with...
Original Article
A Retrospective Study of Incontinentia Pigmenti Seen at the National Skin Centre, Singapore Over a 10-year period
Incontinentia pigmenti, called Bloch-Sulzberger syndrome, is a rare X-linked dominant disorder involving ectodermal structures. It is a multisystem disorder with cutaneous, ocular, dental, cerebral and skeletal manifestations.
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Original Article
A Retrospective Study of Melanocytic Naevi at the National Skin Centre
Melanocytic naevi are benign proliferation of melanocytes of congenital and acquired types which usually appear during adolescence or early adult life. Naevi are of three common subtypes i.e. junctional, compound and intradermal melanocytic naevi, with characteristic clinical appearance that aids in clinical diagnosis.
This article is available only as a...
Original Article
Antibiotic Sensitivity of Propionibacterium acnes Isolates from Patients with Acne Vulgaris in a Tertiary Dermatological Referral Centre in Singapore
In Southeast Asia, there have been few studies on the emergence of antibiotic-resistant strains of Propionibacterium acnes on the skin of patients with acne vulgaris. We previously reported the effect of short courses of antibiotics on the minimum inhibitory concentrations (MICs) of P. acnes.
This article is available only as...
Original Article
Clinical Utility of Polymerase Chain Reaction in the Detection of Mycobacterium tuberculosis in Different Types of Cutaneous Tuberculosis and Tuberculids
Laboratory confirmation of cutaneous tuberculosis has remained difficult using conventional techniques which include the demonstration of acid-fast bacilli (AFB) on histopathologic examination and culture. In tuberculosis verrucosa cutis and lupus vulgaris which are paucibacillary, direct microscopy and tissue cultures lack the specificity and/or sensitivity for the detection of Mycobacterium...
Original Article
A Retrospective Study on the Characteristics of Androgenetic Alopecia among Asian Races in the National Skin Centre, a Tertiary Dermatological Referral Centre in Singapore
Androgenetic alopecia is hair thinning or balding due to the influence of androgens in males and females. Androgenetic alopecia is reported to affect 50% of the population by the age of 50 years in males and a decade later in females.
This article is available only as a PDF. Please...
Others
Current Therapeutic Strategies for Type 2 Diabetes Mellitus
Type 2 diabetes mellitus is now recognised as a metabolic syndrome and although the treatment paradigm has shifted from one that focuses solely on glycaemic control to one addressing global cardiovascular risk factors in a particular individual, glycaemic control remains one of the key challenges that the physician faces...
Others
A Review of Cutaneous Granulomas and Lupus Vulgaris Following BCG Vaccination in a Skin Hospital in Singapore
BCG vaccines are live vaccines derived from a strain of Mycobacterium bovis that was attenuated by Calmette and Guerin at the Pasteur Institute in Lille, France. In Singapore, all newborn babies are given the vaccination at birth, and until recently, a second vaccination was given to children at the...
Original Article
The Epidemiology and Treatment of Anogenital Warts in Singapore: A Retrospective Evaluation
Anogenital warts are caused by specific subtypes of the human papillomavirus (HPV), of which serotypes HPV 6 and 11 are the most common. There are 3 types of HPV infection:
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Original Article
Sexually Transmitted Diseases in the Older Population in Singapore
Sexually transmitted diseases (STDs) in persons older than 50 years are rarely studied because STDs are more common in young people. There is very little published data focussing on this group of patients which is relevant to Singapore or this part of the world.
This article is available only as...
Others
Allopurinol Hypersensitivity Syndrome and Acute Myocardial Infarction—Two Case Reports
Allopurinol hypersensitivity syndrome is an idiosyncratic drug reaction characterised by an acute and severe multiorgan disease. It usually begins 2 to 6 weeks (up to 3 months) after starting allopurinol.
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Original Article
Bullous Pemphigoid Seen at the National Skin Centre: A 2-year Retrospective Review
Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disorder affecting mainly the elderly. It is characterised by autoantibodies to the basement membrane zone (BMZ), which are detectable on immunofluorescent studies.
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Others
Clinical Profile and Treatment Outcome of Livedoid Vasculitis: A Case Series
Livedoid vasculitis is a clinicopathological entity that has variously been referred to as atrophie blanche, livedoid vasculopathy or segmental hyalinising vasculitis. It presents with purpuric lesions and recurrent, painful ulcerations of the lower limbs which result in depressed, atrophic white scars.
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Others
A Case of Penicillamine-induced Dermopathy
D-penicillamine is a copper chelator used primarily in Wilson’s disease and cystinuria. Other long-term indications include rheumatoid arthritis, scleroderma and primary biliary cirrhosis.
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Others
Sweet’s Syndrome Associated with Mycobacterium chelonae and Herpes Simplex Virus Infections: A Case Report
Sweet’s syndrome is an acute febrile neutrophilic dermatosis. An association with malignancy is well recognised.
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Images in Medicine
An intensely pruritic disseminated skin eruption
A 64-year-old man presented to the dermatology outpatient clinic with a 4-month history of pruritic papules. He had a significant medical history of thyrotoxicosis, which was diagnosed 1 year prior and well controlled on carbimazole. He had no history of dyslipidaemia or underlying malignancy. The cutaneous eruption had first...
Original Article
Novel transdermal device for delivery of triamcinolone for nail psoriasis treatment
Psoriasis is a chronic immune mediated inflammatory skin condition that affects about 2–4% of the Western populations, with rising incidence over the years.1,2 The presentation of psoriasis varies from mild localised plaques to more severe erythrodermic forms, with plaque-type psoriasis being the most common. It frequently affects the skin...
Others
Oral Pemphigus Vulgaris: A Case Report and Literature Update
Autoimmune blistering conditions are an uncommon cause of chronic ulceration of the oral mucosa. Nevertheless, it is important to diagnose these conditions early and institute treatment as soon as possible, as they can lead to serious involvement in other mucosal and cutaneous sites and even death.
This article is available...
Review Article
Melanocytic Lesions of the Face: Diagnostic Pitfalls
Cutaneous melanocytic lesions are amongst the commonest tumours in all races but are more common in Caucasians with fair skin. Although most are benign melanocytic naevi that are readily diagnosed clinically, melanocytic lesions are commonly excised because of the concern that they may represent a melanoma or because of...
Others
A Case of Recurrent Erythema Multiforme and its Therapeutic Complications
Recurrent erythema multiforme (EM) is a disabling condition with a specific diagnosis and certain diagnostic criteria. Systemic corticosteroid therapy is frequently used to treat this condition.
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Review Article
A Review: The Location, Molecular Characterisation and Multipotency of Hair Follicle Epidermal Stem Cells
There have been significant advances in the understanding of keratinocyte stem cells since the 1970s, when the concept of interfollicular epidermis was initially proposed; later much work was focused on the specific region of the hair follicle outer root sheath, especially the bulge region (Fig. 1). Hair follicle stem...
Original Article
Serum Interleukin-2, Interleukin-6, Tumour Necrosis Factor-Alpha and Nitric Oxide Levels in Patients With Behçet’s Disease
Behçet’s disease (BD) is characterised by oral aphthous lesions, genital ulcerations and eye inflammation. The disease was first described by Hulusi Behçet in 1937. Despite the diverse inflictions in different organ systems, vasculitis is perceived as the common basic pathological process in BD.
This article is available only as a...
Others
Cutaneous Mycobacterium haemophilum Infections in Immunocompromised Patients in a Dermatology Clinic in Singapore
Mycobacterium haemophilum is a nontuberculous mycobacterium (NTM) that is increasingly recognised as a cause of cutaneous, joint, or pulmonary infections in immunocompromised patients and lymphadenitis in children. To date, less than 100 patients with this infection have been reported worldwide.
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Others
A Case of Nephrogenic Fibrosing Dermopathy
Nephrogenic fibrosing dermopathy (NFD) is a recently described and recognised fibrosing disorder occurring in patients with renal disease. The condition resembles scleromyxoedema clinically and histologically, and was originally termed “scleromyxoedema-like illness of haemodialysis”.
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Original Article
How Much do Diabetic Patients Know About Diabetes Mellitus and its Complications?
Diabetes mellitus (DM) is a common and growing healthcare problem in Singapore with a prevalence of 9% in 1998. Since the 1990s, the Ministry of Health, Singapore has identified DM as a priority condition for disease control.
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Others
Dapsone Hypersensitivity Syndrome Masquerading as a Viral Exanthem: Three Cases and a Mini-Review
Dapsone hypersensitivity syndrome (DHS) is a rare condition mostly occurring in leprosy patients on multidrug therapy. Dapsone is also combined with pyrimethamine as maloprim (Beacons Chemicals Pte Ltd, Singapore), a fairly effective chemoprophylactic agent in the management of malaria.
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Original Article
Cyclosporin in the Treatment of Severe Atopic Dermatitis: A Retrospective Study
Cyclosporin is a potent immunosuppressant that inhibits cell-mediated immunity, mainly via inhibition of T helper cells. It has been used successfully in the treatment of severe atopic dermatitis in children and adults, producing a rapid and highly significant improvement in terms of disease activity, pruritus and sleep disturbance.
This article...
Original Article
Salivary Immunoglobulin A and Lysozyme in Patients with Psoriasis
The pathophysiological mechanisms in psoriasis are still unclear. Many factors, such as infection, trauma and stress, could cause psoriasis.
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Others
Lymphomatoid Papulosis Associated with Recurrent Cutaneous T-Cell Lymphoma
Lymphomatoid papulosis is a self-healing recurrent popular eruption often exhibiting a chronic course. It is associated with malignant lymphomas in 10% to 20% of cases.
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Others
Extensive Calcinosis Cutis in Relapsed Acute Lymphoblastic Leukaemia
Calcinosis cutis is characterised by the aberrant deposition of calcium salts in the skin. In metastatic calcinosis cutis, calcium salts are precipitated in normal tissue as a result of an underlying defect in calcium and/or phosphate metabolism.
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Others
Delusional Parasitosis: Case Series of 8 Patients and Review of the Literature
Delusional parasitosis (DP), or delusional infestation, is a condition in which a person has the unshakeable and mistaken belief of being infested with parasites. Originally described in 1894, it has been previously referred to as dermatophobia, parasitophobic neurodermatitis, parasitophobia or entomorphobia.
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Original Article
Laser Doppler Perfusion Imaging (LDPI) and Transepidermal Water Loss (TEWL) Values in Psoriatic Lesions Treated with Narrow Band UVB Phototherapy. Dermal Vascularity may be useful Indicator of Psoriatic Activity
Non-invasive techniques have become useful procedures in measuring skin physiology and skin response to treatment. This study attempts to objectively measure physiological changes in transepidermal water loss (TEWL), an indicator of skin barrier function, and laser Doppler perfusion imaging (LDPI), an indicator of dermal vascularity, of psoriatic skin lesions...
Original Article
Familial Risk of Allergic Rhinitis and Atopic Dermatitis among Chinese Families in Singapore
Family history has been shown to be a risk factor for the development of allergic rhinitis (AR) and atopic dermatitis (AD). However, the increase in prevalence has also been attributed to the changes in lifestyle and urbanisation in developed countries.
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Original Article
Comparison of Completely versus Incompletely Excised Cutaneous Squamous Cell Carcinomas
Non-melanoma skin cancer is the most common skin cancer worldwide and its incidence has risen in the last few decades. Approximately 80% of non-melanoma skin cancers are basal cell carcinomas and the rest are squamous cell carcinomas (SCCs).
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Original Article
Viral Warts in Children Seen at a Tertiary Referral Centre
Viral warts are a common affliction in children. It is caused by the human papilloma virus, of which there are more than 80 serotypes.
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Others
Presumed Dapsone-induced Drug Hypersensitivity Syndrome Causing Reversible Hypersensitivity Myocarditis and Thyrotoxicosis
A 22-year-old Malay soldier doing his National Service was warded with a 6-day history of an itchy generalised rash associated with fever and lymphadenopathy. Prior to this episode, he was well and not known to have any major illnesses.
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Original Article
A Study on the Knowledge, Attitudes and Practices of Southeast Asian Dermatologists in the Management of Atopic Dermatitis
Atopic dermatitis (AD) is a chronic and pruritic inflammatory skin disorder that occurs worldwide. Several guidelines on the management of AD have been published in the literature.
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Review Article
Diabetes as a Risk Factor for Periodontal Disease: Current Status and Future Considerations
Diabetes mellitus (DM) is a common and growing global health problem. It is highly prevalent in Asian communities. Hong Kong, Pakistan, and Singapore are among the countries with the highest prevalence of diabetes in the adult population.
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Original Article
Diabetic Retinopathy in Type II Diabetics Detected by Targeted Screening Versus Newly Diagnosed in General Practice
The epidemic of type II diabetes mellitus is now recognised worldwide. In India, it has been estimated that the population with type II diabetes would increase by 150% in 2025. As the population with type II diabetes increases, so does the prevalence of diabetic retinopathy and other microvascular complications.
This...
Others
Delayed Hypersensitivity Reaction After Intravenous Glucagon Administered for a Barium Enema: A Case Report
A 74-year-old Chinese woman presented with a 1-week history of an itchy rash on the trunk and legs. A barium enema was performed a day before the rash started.
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Original Article
Bruch’s Membrane Abnormalities in Dome-shaped and Mushroom-shaped Choroidal Melanomas
Uveal melanoma is the most common primary intraocular malignancy and is diagnosed chiefly in the fifth to seventh decades of life. The choroid is the most common site for its development, and choroidal melanomas grow as dome-shaped or mushroom-shaped tumours.
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Original Article
Electrocardiographic Changes in Patients with Cutaneous Leishmaniasis Treated with Systemic Glucantime
Antimonial compounds are regarded as the treatment of choice for cutaneous leishmaniasis (CL). The efficacy of sodium stibogluconate (pentostam) and the other compound of antimoniate meglumine antimoniate (glucantime) were reported in 1937 and 1946, respectively.
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Letter to the Editor
Cutaneous Leishmaniasis Mimicking Squamous Cell Carcinoma
Leishmaniasis is a parasitic infection caused by different species of the obligate intracellular protozoa Leishmania. This disease is transmitted through the bite of an infected female sandfly.
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Original Article
A Comparative Study of Polymerase Chain Reaction Detection of Clonal T-cell Receptor Gamma Chain Gene Rearrangements Using Polyacrylamide Gel Electrophoresis versus Fluorescence Capillary Electrophoresis
Cutaneous T-cell lymphomas (CTCL) are a heterogeneous group of malignancies of skin-homing T-cells, of which mycosis fungoides (MF) is the most common form. CTCL can be difficult to diagnose, especially in the early stages or in cases with atypical clinical presentation.
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Commentary
Sociodemographic Factors Influencing the Effectiveness of Public Health Education – A Comparison of Two Studies in Singapore
Public health education is a cornerstone in the primary prevention of chronic diseases. In the United States, for example, studies have shown that cardiovascular public health education contributed to increased hypertension detection and control as well as a decline in smoking, thus contributing significantly to the major reduction in...
Original Article
Diabetes and Associated Cardiovascular Risk Factors in Iran: The Isfahan Healthy Heart Programme
The incidence and prevalence of diabetes mellitus (DM) worldwide is increasing, due almost exclusively to an increase in non-insulin-dependent (type 2) DM, which represents more than 90% of all cases of diabetes.1 Presently, there is a global pandemic of type 2 DM and its clinical sequelae. The World Health...
Letter to the Editor
Mohs micrographic surgery in Singapore: A long-term follow-up review
Dear Editor,
Mohs micrographic surgery (MMS) has become the treatment of choice for high-risk non-melanoma skin cancers (NMSC) worldwide.1 Unlike wide local excision, MMS enables precise microscopic removal of tumour foci while allowing maximal tissue preservation, thereby maintaining cosmesis and anatomical function.1 The MMS service in Singapore started in...
Letter to the Editor
Lamotrigine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in Singapore: A case series
Dear Editor,
With the advancements in pharmacogenetics, potential genetic associations with severe cutaneous adverse drug reactions (SCAR)—which include Stevens- Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)—have been proposed. Lamotrigine is one of the 2 anticonvulsants found to be highly associated with SJS/TEN from the 2008 EuroSCAR study. Several...
Letter to the Editor
Cutaneous Angiosarcoma Associated with the Kasabach–Merritt Syndrome
Angiosarcoma is a rare tumour commonly affecting elderly men, usually occurring on the head and neck region. The tumour usually presents as ecchymosis-like plaques, and less commonly with haemorrhage, oedema, ulceration and recurrent facial angioedema.
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Original Article
Impact of Depression on Health Related Quality of Life in Patients with Diabetes
Diabetes Mellitus (DM) is a serious chronic illness that imposes significant morbidity and mortality and has a major impact on the quality of life of the individuals suffering from this illness. Singapore, a multi-ethnic country in Southeast Asia, with Chinese, Malay and Indian as the three main ethnic groups,...
Original Article
Epidemiology of Skin Diseases in Renal Transplant Recipients in a Tertiary Hospital
Various types of skin lesions are more common in renal transplant recipients compared to the general population, mainly attributable to post-transplant immunosuppression. The well-documented drug-specific skin manifestations include cyclosporine-related hypertrichosis, gingival hypertrophy, steroid-induced acneiform eruption and striae.
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Letter to the Editor
Bosentan – A Previously Unrecognised Cause of Facial Telangiectasia
Bosentan is an endothelin-1 (ET-1) receptor antagonist approved for the treatment of pulmonary artery hypertension (PAH). Although flushing is a documented side effect of bosentan, the diagnosis can mimic other drug rashes and medical conditions where facial telangiectasis and/or flushing are prominent presentation.
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Letter to the Editor
Blistering Eruption Following a Rubefacient Rub for Shoulder Discomfort
A 96-year-old woman was referred as an emergency with a suspected allergic reaction to Deep Heat® rub (Mentholatum Company Ltd, East Kilbride, Scotland). Five days before referral, she developed pain and stiffness of her left neck and shoulder.
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Original Article
An 11-year Review of Dermatomyositis in Asian Patients
Dermatomyositis (DM) is an acquired multisystem inflammatory disease with prominent, characteristic cutaneous manifestations and proximal muscle myopathy. A clinically distinct amyopathic variant with typical skin signs but no muscle disease had been described as well.
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Original Article
Epidemiology and Management of Surgical Upper Limb Infections in Patients with End-stage Renal Failure
Hand infections are common in the general population, and their management is usually uncomplicated. Several papers have noted that patients with diabetes mellitus have more severe infections, a different spectrum of bacteriology and a worse outcome. In our experience, of all patients with upper limb infections, those with end-stage...
Images in Medicine
An Exanthem with An Annular Pattern in a 2-year-old Girl
A 2-year-old Chinese girl was seen in clinic with an erythematous annular itchy rash which began on the thighs and had spread to the trunk and hands. The parent’s concern was the rash’s duration and association with 2 episodes of fever.
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Letter to the Editor
Levofloxacin-induced Toxic Epidermal Necrolysis Treated with Intravenous Immunoglobulin
Toxic Epidermal Necrolysis (TEN) is a rare, fulminating rash with a mortality rate of 35%.1 It is predominantly medication-induced; allopurinol, ampicillins, anticonvulsants and non-steroidal anti-inflammatory drugs are commonly implicated.
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Original Article
Surgical Metastasectomy in AJCC Stage IV M1c Melanoma Patients with Gastrointestinal and Liver Metastases
The prognosis of patients with stage IV melanoma or recurrent melanoma is poor with an estimated median survival period of 6 months. The recent revised version of the American Joint Committee on Cancer (AJCC) staging system for cutaneous melanoma has further sub-divided melanoma metastatic sites to 3 specific categories;...
Editorial
Personalised Medicine for Psoriasis: A Real Possibility Ahead
In the last decade, our understanding of psoriasis has increased by leaps and bounds, resulting in many new targeted therapies being introduced for those with recalcitrant psoriasis. However, despite the plethora of new treatment options and biologics to treat the most difficult cases of psoriasis, dermatologists are still confronted...
Images in Medicine
Erythematous Plaques in a Filipino Man
Three years after emigrating from Philippines to Singapore, a 34-year-old, otherwise healthy man presented with a progressive erythematous eruption on his lower limbs. Six months prior to presentation he noticed a few rythematous plaques on his right lower limb, which were gradually increasing in size and later spread to...
Others
Inflammatory Tinea Capitis: Non-healing Plaque on the Occiput of a 4-year-old Child
Tinea capitis is a fungal infection of the hairs of the scalp. Although commonly described in children, it is uncommonly seen in Singapore.
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Original Article
Eighteen-Month Clinical Safety and Efficacy Outcomes of Sirolimus-, Paclitaxel- and Zotarolimus-drug Eluting Stents in Diabetic Patients Undergoing Percutaneous Coronary Intervention for Complex Coronary Artery Stenosis
Patients with diabetes mellitus (DM) have higher incidence of cardiovascular morbidity and mortality compared with non-diabetic patients. The underlying mechanism is due to the more diffuse and accelerated form of atherosclerosis and endothelial dysfunction which lead to diffuse coronary lesions, small vessel disease, multi-vessel involvement, larger plaque burden as...
Original Article
Framingham Risk Score Inadequately Predicts Cardiac Risk in Young Patients Presenting with a First Myocardial Infarction
Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. The Framingham Risk Score (FRS) was derived from the Framingham Heart Study (FHS) cohort and was designed to predict 10-year risk of hard coronary events, including mortality due to coronary heart disease and non-fatal myocardial infarction (MI)...
Images in Medicine
Subungual Nodule of the Right Fourth Finger
A 14-year-old, otherwise healthy boy presented with a skin nodule for the past 3 years which slowly lifted up the right fourth fingernail. The lesion was tender to palpation. He denied any previous trauma and there was no family history of similar lesions.
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Review Article
The Relevance of the Metabolic Syndrome
Metabolic syndrome describes a constellation of interrelated metabolic risk factors, in which components coexist more frequently in a given individual than could be expected by chance alone. These risk factors include hypertension, hyperglycaemia, dyslipidaemia and obesity. The underlying pathophysiology is as yet unclear, but has been closely linked to...
Images in Medicine
Chronic Truncal Plaques and Palmoplantar Keratotic Lesions in an Elderly Man
A 70-year-old gentleman with a significant past history of using traditional medication presented to our clinic with multiple dysplastic lesions of varying severity on the covered areas of his chest and back and ketatotic lesions on his palms and soles for 2 years. We present 3 clinical photographs and...
Original Article
Health-related Quality of Life is Associated with Diabetic Complications, but not with Short-term Diabetic Control in Primary Care
Type 2 diabetes mellitus is a major chronic disease globally. With increasing life expectancy, long-term complications of diabetes mellitus leading to significant morbidity and mortality have great impact on each patient’s health. Health-related quality of life refers to a person’s self-perceived functioning and well-being, and is increasingly used to...
Original Article
Incidence and Risk Factors for Development of New-onset Diabetes after Kidney Transplantation
The development of new-onset diabetes after transplantation (NODAT) is a serious metabolic complication of kidney transplantation that predisposes patients to graft dysfunction, cardiovascular disease and death. Although NODAT has been recognised for many years, the true incidence has been difficult to establish due to inconsistencies in the definition of...
Original Article
Geriatric Syndromes and Depressed Mood in Lower-income Singaporeans with Diabetes: Implications for Diabetes Management and Health Promotion
The prevalence of diabetes mellitus (henceforth referred to as diabetes) has increased significantly in the last decade and it is reaching epidemic levels worldwide due to ageing population, urbanisation, obesity and sedentary lifestyles. In Singapore, the National Health Survey 2004 revealed that 8.2% of the population aged 18 to...
Images in Medicine
Lower limb nodules
A 45-year-old Chinese woman with no medical history or regular medications presented with painful nodules on her left shin that progressed to involve her right shin, thighs and lower back over a period of 3 months. There was associated lower limb joints stiffness. Systemic review revealed constitutional symptoms of...
Letter to the Editor
Dermatological Disorders at the Emergency Department of a Tertiary Hospital in Singapore
Skin disorders pose a frequent diagnostic challenge for emergency physicians due to their broad spectrum and varied clinical manifestations. The diagnosis of acute dermatologic diseases may be challenging for junior doctors working in a busy emergency department (ED), many of whom may have inadequate clinical exposure or supervised training...
Original Article
Kidney Cancer and Diabetes Mellitus: A Population-Based Case-Control Study in Taiwan
Kidney cancer accounts for 3% to 4% of all cancers. In a systematic review by Mathew and et al,2 the incidence of kidney cancer was the highest in France (16.1 per 100,000
man-years) and the lowest in India (0.9 per 100,000 woman-years) during 1988 to 1992. A trend analysis in...
Letter to the Editor
Pyoderma Gangrenosum Mimicking Early Acute Infection Following Total Knee Arthroplasty
Pyoderma gangrenosum (PG) is an ulcerative neutrophilic dermatosis of uncertain aetiology. Known associations include inflammatory bowel disease, myeloproliferative disease and various arthritides. There have been 4 published cases of PG following total knee arthroplasty (TKA)
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Original Article
Anti-BP180 NC16A IgG Titres as an Indicator of Disease Activity and Outcome in Asian Patients with Bullous Pemphigoid
Bullous pemphigoid (BP) is a subepidermal blistering dermatosis characterised by circulating autoantibodies targeting BP180 and BP230 hemidesmosomal proteins. Anti-BP180 NC16A IgG antibodies have been demonstrated to be directly pathogenic in blister formation. Anti-BP180 IgG titres were noted to parallel disease activity in several case series, as well as reflect...
Letter to the Editor
Localised Dermatitic Nodules but No Itch
In 1909, Hyde first described nodular prurigo as pruritic nodules on the extensor surfaces of the lower extremities in middle-aged women. Thus, nodular prurigo is also known as Hyde’s prurigo. As the name suggests, nodular prurigo is a chronic dermatosis characterised by an intensely pruritic, papulonodular eruption. We describe...
Images in Medicine
Acquired hypohidrosis following a drug reaction
A 44-year-old Chinese man presented with a 3-week history of heat intolerance and a reduced ability to sweat even upon strenuous physical exertion. His medical history was significant for HIV infection on treatment with efavirenz and lamivudine/zidovudine. He also had drug reaction with eosinophilia and systemic symptoms (DRESS) to...
Editorial
Recurrent vascular events in ischaemic stroke patients with diabetes
Stroke is a major cause of death and disability globally, with 6.55 million deaths (95% uncertainty interval 6.00–7.02 million), 101 million prevalent cases (95% UI 93.2–111 million) and 143 million disability adjusted life years lost (DALYs) (95% UI 133–153 million) in 2019. The impact is even higher in...
Letter to the Editor
Adipsic diabetes insipidus and SGLT2 inhibitor: A perplexing conundrum
A 70-year-old man with poorly controlled type 2 diabetes mellitus (DM), hypertension, hypercholesterolemia and alcohol dependence presented intoxicated, with occipital scalp lacerations after a fall. A brain computerised tomography (CT) revealed occipital skull fracture with bilateral subarachnoid haemorrhages, subdural haemorrhages and parenchymal contusions. He was admitted for close observation...
Letter to the Editor
Primary cutaneous umbilical melanoma
A 59-year-old woman with a pre-existing asymptomatic pigmented nevus on the umbilicus for the past 20 years was seen in the outpatient dermatology clinic for a 2-week history of a raised, bleeding pigmented papule overlying the nevus. Physical examination showed a 7 x 7mm ulcerated papule overlying a 2.2...
Commentary
A clinico-pathological approach to management of atopic dermatitis
Recent research in atopic dermatitis (AD) has identified it to be a heterogeneous inflammatory skin disorder of different endotypes (immune polarisation of T-cell subsets and genetic mutations) underlying various phenotypes (age of onset, ethnicity, disease severity, etc.). The corresponding heterogeneity in underlying patho-mechanisms of the disease may explain the...
Original Article
Long-term outcomes of ischaemic stroke patients with diabetes in a multi-ethnic cohort in Singapore
Asia faces an epidemic of diabetes. The prevalence of diabetes in Asia is projected to grow from 114 million in 2007 to 180 million by 2025, driven in part by marked economic and epidemiologic transition in recent decades.1 In China, the prevalence of diabetes rose from 1% in 1980...