Original Article
Prevalence of complexity in primary care and its associated factors: A Singapore experience
As Singapore’s population ages, the incidence of non-communicable chronic diseases will rise in tandem.1 There exists a subset of individuals, oftentimes elderly with multiple chronic conditions, whose care needs are particularly complex.2 While there is no universal definition of a person with complex needs, these individuals have been found...
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...
Editorial
Journey towards a smoke-free nation
“A journey of a thousand miles begins with a single step.” Singapore’s journey towards a smoke-free society started early in the 1970s when legislations were introduced to restrict smoking in certain public spaces and ban tobacco advertising.1 The National Smoking Control Programme was launched in 1986 with important objectives...
Original Article
Factors influencing smoking cessation: Insights from Singapore’s nationwide health and lifestyle survey
The global prevalence of smoking has declined over the years. According to authors utilising data from the Global Burden of Disease, Injuries, and Risk Factors Study, from 1990 to 2020, the number of male smokers fell by 27.2%, whereas female smokers fell by 37.9%.1 Moreover, the decline in smoking...
Letter to the Editor
Evolving landscape of sports injuries and recommendations on injury preventions: A retrospective analysis in Singapore
Dear Editor,
Sports have become increasingly integral to the daily lives of Singaporeans. According to the National Sport and Exercise Participation Survey, the percentage of Singaporeans exercising weekly rose from 54% in 2015 to 73% in 2023.1 While this surge in sports activities brings numerous health benefits, it also results...
Letter to the Editor
Seroprevalence of cytomegalovirus over the last 2 decades (2001–2020): A retrospective data analysis from a single laboratory in Singapore
Dear Editor,
Cytomegalovirus (CMV) is ubiquitous and infects human of all ages, where it remains latent after primary infection and can reactivate upon various triggers.1 Reactivated CMV may cause complications and end organ damages in immunocompromised hosts, leading to increased morbidity and mortality.2 In addition, the presence of actively replicating...
Original Article
Prevalence of consumption of illicit drugs and associated factors from a nationwide epidemiological survey: The Singapore Health and Lifestyle Survey
Substance use disorders (SUDs) are characterised by the uncontrolled use of a substance by an individual despite its harmful consequences.1,2 The prevalence of consumption of substances and SUDs varies widely across countries. This difference in prevalence can be attributed to factors such as study methodology (the substance included in...
Editorial
Illicit drug consumption in Singapore: Where are we in the fight against drugs?
Illicit drug consumption is associated with significant negative health, financial and social consequences. Yet, illicit drug consumption remains highly prevalent and continues to be a growing problem worldwide. In 2021, 1 in 17 people aged 15–64 in the world had used a drug in the past 12 months. Notwithstanding...
Letter to the Editor
Patient’s degree of adherence, challenges & preferences towards medicine taking (PACT) in Singapore
Dear Editor,
Medication nonadherence is a prevalent public health problem that compromises patients’ health outcomes and increases healthcare expenditures.1 Studies in Singapore showed that 25.7%–38.9% of patients are nonadherent.2,3 Studies investigating the association between patients’ reasons for nonadherence and their preferences towards adherence enablers are limited. We aimed to (1)...
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....
Editorial
Direct oral anticoagulant: Looking beyond convenience
Since the 2010 Food and Drug Administration approval of Dabigatran as the first non-vitamin-K antagonist oral anticoagulants or direct oral anticoagulants (DOACs) as it is now more commonly referred to, there has been much development in the field with increasing availability of different DOACs and an expansion in indications...
Commentary
Call for a Singapore National Action Plan for Sepsis (SNAPS): Stop sepsis, save lives
Sepsis is a life-threatening organ dysfunction syndrome caused by a dysregulated host response to an infection.1 It affects up to 48.9 million people globally every year and causes 11 million sepsis-related deaths, accounting for 1 in every 5 deaths worldwide.2 The huge disease burden leads to significant consumption of...
Letter to the Editor
Knowledge, attitudes and practices of doctors on constipation management in Singapore
Dear Editor,
Constipation is a common gastrointestinal disorder, affecting about 15% of the global population and severely impacting patients’ quality of life.1 The global constipation treatment market is estimated to worth USD22.93 billion in 2025. Patients with functional constipation had the highest treatment dissatisfaction at 63.4%. Poor satisfaction was reported...
Commentary
Singapore’s experience in managing the COVID-19 pandemic: Key lessons from the ground
In the early days of the pandemic when information on COVID-19 infection was lacking, all COVID-19 positive patients were admitted into acute hospitals for isolation and monitoring. With the exponential increase in the number of infections, COVID-19 Treatment Facilities (CTFs) were set up to help hospitals manage in-patient loads....
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...
Original Article
Risk and protective factors of mental health during the COVID-19 pandemic: A cross-sectional study in Singapore
The COVID-19 pandemic has significantly impacted people’s well-being globally.1 Individuals faced several stressors during the pandemic, including fear of contracting the disease, experiencing severe symptoms of COVID-19, losing loved ones to the disease, financial insecurity, and social isolation. Furthermore, children and youths experienced disruption to their usual routine such...
Editorial
Self-esteem and positive body image to overcome female sexual dysfunction
Human sexuality is arguably one of the main pillars of health, like nutrition and sleep. Improvements in diagnostic and therapeutic biotechnologies have enabled focus on not only deadly diseases, but also on the quality of life and sexual functions of men and women. Digital media also play a considerable...
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....
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...
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
Antiphospholipid and other autoantibodies in COVID-19 patients: A Singapore series
Dear Editor,
Thrombosis is an unexpected complication of COVID-19 initially reported in 3 patients from China.1 These patients tested positive for immunoglobulin (Ig) A anticardiolipin (ACA), IgG anti-β2-glycoprotein I antibodies (aβ2GPI) and IgA aβ2GPI, though not for the lupus anticoagulant (LAC).
In a Singapore study comprising 47,527 patients, 19 (0.04%) developed...
Letter to the Editor
High burden of respiratory viral infection-associated mortality among critically ill children
Dear Editor,
Acute lower respiratory infections (ALRIs) are a leading cause of under-5 mortality globally—two-thirds could be attributable to respiratory viral infections (RVIs).1,2 The burden of paediatric RVIs in settings of tropical climate with year-long virus circulation is relatively underreported.3,4 Previous studies in these areas have estimated that around 8–11%...
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...
Original Article
Global monkeypox outbreak 2022: First case series in Singapore
Monkeypox has been declared a public health emergency of international concern. Up until 2022, most cases of monkeypox have been reported in parts of Africa. On 7 May 2022, a returning traveller from Nigeria to the UK was confirmed to have contracted monkeypox. By the end of May 2022,...
Editorial
The global emergence of monkeypox
Monkeypox is so named because the poxvirus was first identified in 2 outbreaks among cynomolgus monkeys housed at the Statens Serum Institut, Denmark, in 1958.1 Both outbreaks occurred approximately 2 months after the monkeys arrived by plane from Singapore.1 However, the natural reservoir of the virus is not monkeys...
Letter to the Editor
Perception of disease, well-being and financial burden by patients with chronic hepatitis B: A self-reported assessment
Dear Editor,
Chronic hepatitis B (CHB) infection affects approximately 248 million individuals in the world1 and 3.6% of the Singapore population.2 Given the natural history of CHB, regular surveillance with blood tests is necessary to ensure early detection of complications such as cirrhosis and hepatocellular carcinoma in patients. Our study...
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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Original Article
Glaucoma Pattern Amongst the Elderly Chinese in Singapore
Glaucoma is a major cause of world blindness in developing and developed nations. The WHO Global data on blindness show that over half of the blind due to glaucoma reside in Asia, the majority being Chinese.
This article is available only as a PDF. Please click on “Download PDF” on...
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...
Original Article
Patients Admitted to an Intensive Care Unit for Poisoning
The study of poisoning has been relatively neglected in Singapore. A check through the Infogate database of the National University of Singapore Library revealed only seven papers on the epidemiology of poisoning since 1975 (the earliest year covered by the database) and none targeting those severe enough to require...
Others
A Case Series of Paget’s Disease of Bone: Diagnosing a Rather Uncommon Condition in Singapore
Sir James Paget’s description in 1877 of “a form of chronic inflammation of bones” which now bears his name was based entirely on clinical and pathological observations in patients with advanced disease. Today, more than a century later, advanced imaging techniques and biochemical tests have allowed us to identify...
Others
9th Seah Cheng Siang Memorial Lecture: Gastric Cancer—Where are we now?
The last two decades have witnessed dramatic changes in the understanding of gastric cancer: a rapid decline in global incidence, its association with Helicobacter pylori gastritis, and the new information regarding its molecular biology. Nevertheless, gastric cancer remains the second commonest cancer in the world in terms of morbidity...
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
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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Original Article
Cross-Sectional Study of Near-work and Myopia in Kindergarten Children in Singapore
Myopia is the commonest eye disease worldwide, and is especially prevalent in certain Asian countries such as Taiwan, Japan and Hong Kong. Physiologic myopia is thought to be a multifactorial disease with both genetic and environmental factors.
This article is available only as a PDF. Please click on “Download PDF”...
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...
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
Myopia: Gene-environment Interaction
Myopia affects up to 70% of adults in Singapore, Taiwan, Hong Kong and Japan. The prevalence rates in these Asian countries are higher than those among Caucasians and Blacks in the United States and Europe.
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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...
Original Article
Incidence of Ischaemic Heart Disease and Stroke in Chinese, Malays and Indians in Singapore: Singapore Cardiovascular Cohort Study
Comparisons of disease frequency in different ethnic groups help to unravel the contributions of nature and nurture in their aetiology and to identify environmental or lifestyle factors that may be involved. This is aided when the ethnic groups live in the same country, so that differences in completeness and...
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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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...
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...
Original Article
Malignant Melanoma Seen in a Tertiary Dermatological Centre, Singapore
Unlike in Caucasians, primary malignant melanoma is an uncommon skin malignancy in Singapore. There have been little published data on cutaneous melanoma in Southeast Asia.
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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
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
Paediatric Extracranial Germ Cell Tumours: A Retrospective Review
Germ cell tumours (GCTs) in children account for 2% to 3% of childhood malignancies. They arise from primordial germ cells and constitute a heterogeneous group of tumours.
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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 Update on Osteoporosis
Fractures, the most serious complication of osteoporosis, are increasing and constitute an evolving public health problem in terms of disability, mortality and cost. A paradigm shift in the management of osteoporosis has resulted from the development of techniques which can diagnose osteoporosis before fractures occur, and effective medications which...
Review Article
An Asian Perspective to the Problem of Osteoporosis
Osteoporosis is regarded as an important public health problem in many Caucasian populations. Much of the research on epidemiology, diagnosis, treatment, genetic and molecular aspects has been carried out in the West.
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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.
This article is available only as a PDF. Please...
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...
Letter to the Editor
Patterns and predictors of sound levels in hospital rooms
Dear Editor,
Excessive sound levels in the hospital can impair the work performance of healthcare professionals and affect patient well-being.1 Previous studies have also linked excessive sound levels with sleep disturbances and cardiovascular morbidity.2 While there have been data published regarding noise levels in the intensive care unit (ICU),3...
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.
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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
Behcet’s Disease: Experience in a Tertiary Rheumatology Centre in Singapore and a Review of the Literature
The only published study on Behcet’s disease in Singapore by Tan E et al (34 patients at the National Skin Centre) found that only 15% had arthritis and 6% had eye complications with no other systemic manifestations. These findings are different from epidemiological studies from other countries published in...
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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Original Article
Twin Births in Singapore: A Population-Based Study Using the National Birth Registry
Twin studies are regarded as one of the better ways to study the effects and significance of gene, environment and interactions of both. The study of monozygotic (MZ) and dizygotic (DZ) twins allows for an estimation of the relative importance of genes and environment.
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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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Original Article
Eye Injuries in Singapore – Don’t Risk It. Do More. A Prospective Study
The issue of ophthalmic trauma is a major cause for concern. An estimated 55 million eye injuries occur each year worldwide, leaving 1.6 million patients blind from their injuries.
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Review Article
Community-associated Methicillin-resistant Staphylococcus aureus: Overview and Local Situation
The emergence and spread of methicillin-resistant Staphylococcus aureus (MRSA) isolates from the community that are distinct from their archetypal healthcare-associated counterparts (HA-MRSA) marked a critical evolutionary milestone for the organism. In less than 2 decades, particularly in the last 3 years, this initially sporadic phenomenon of community-associated methicillin-resistant Staphylococcus...
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
Modelling the Utility of Body Temperature Readings From Primary Care Consults for SARS Surveillance in an Army Medical Centre
There has been increasing interest in building surveillance systems capable of detecting outbreaks of infectious diseases, at the stage where clinical presentation would still be undifferentiated. The thrust of such systems is to detect both intentionally induced and naturally occurring outbreaks in their earliest stages, and if possible, at...
Original Article
A Review of Clinical Pathway Data of 1663 Total Knee Arthroplasties in a Tertiary Institution in Singapore
Total knee arthroplasty (TKA) has been established as an effective treatment modality for patients with symptomatic knee arthritis. It provides predictable decrement in pain, correction of deformity and improved functional outcomes.
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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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Original Article
Diabetic Retinopathy in Diabetics Referred to a Tertiary Centre from a Nationwide Screening Programme
Diabetic retinopathy (DR) is a leading cause of vision loss in Asia. Singapore has one of the highest prevalence rates of diabetes mellitus (DM) worldwide, with 8.2% of Singapore adults between the ages of 18 and 69 having diabetes and there is little data on the prevalence of diabetic...
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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Original Article
Survival of Small-cell Lung Cancer and its Determinants of Outcome in Singapore
Lung cancer is the leading cause of cancer mortality around the world.1 Small-cell lung cancer (SCLC) constitutes about 15% to 25% of all lung cancer cases in North America and Europe.2,3 In contrast, SCLC constitutes a smaller percentage of lung cancer cases in Asian countries. In a Taiwanese hospital,...
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...
Original Article
Lack of Awareness amongst Community Patients with Diabetes and Diabetic Retinopathy: The Singapore Malay Eye Study
Diabetes is a major public health problem, and diabetic retinopathy is the leading cause of blindness in working-aged people.1 Previous studies have documented poor attainment of guidelines of glycosylated haemoglobin (HbA1c) and blood pressure control2 and eye care utilisation3-6 in the prevention of diabetic retinopathy. Studies have also documented...
Original Article
Pain Prevalence in Singapore
Population studies on pain prevalence are useful in determining the impact that chronic pain has on the society. It draws the attention of healthcare administrators to chronic pain as a problem and direct healthcare spending accordingly. Previous studies performed using variations in definitions and methodology, yielded rates between 10%...
Original Article
An Update of Paediatric Intussusception Incidence in Singapore: 1997-2007, 11 Years of Intussusception Surveillance
This is an update to the previously published paper by Boudville et al1 on 8 years of intussusception (IS) surveillance in Singapore. IS is a rare but serious gastrointestinal disease in infants and young children.2,3 The focus on natural rotavirus infection as a potential cause of IS followed the...
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
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
Venous Thromboembolism at the National Healthcare Group, Singapore
Venous thromboembolism (VTE) is a potentially fatal disease which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). About 30% of patients with VTE die within 30 days while 20% suffer sudden death from pulmonary embolism.1 Risk factors commonly seen in hospitalised patients, include immobilization, acute medical illness and...
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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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...
Original Article
Evaluation on the Effectiveness of the National Childhood Immunisation Programme in Singapore, 1982-2007
Singapore has a comprehensive National Childhood Immunisation Programme (NCIP) which first covered smallpox (1862), followed by diphtheria (1938), tuberculosis (TB) (1957), poliomyelitis (1958), pertussis and tetanus (1959) and measles and rubella (1976). In October 1985, hepatitis B vaccination was introduced into the programme for babies born to hepatitis B...
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
Outbreak of Novel Influenza A (H1N1-2009) Linked to a Dance Club
Influenza A (H1N1-2009) is a novel strain of influenza virus. The infection is thought to have first occurred in Mexico in March 2009, and then spread worldwide, resulting in the first influenza pandemic of the 21st century.
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Original Article
An Epidemiological Study of 1348 Cases of Pandemic H1N1 Influenza Admitted to Singapore Hospitals from July to September 2009
On 17 April 2009, the US Centers for Disease Control (CDC) determined that febrile respiratory illness occurring in 2 children residing in adjacent counties in southern California was caused by a novel influenza A (H1N1) virus. The virus is thought to be a re-assortment of 4 known strains of...
Original Article
Outbreak of Pandemic Influenza A (H1N1-2009) in Singapore, May to September 2009
The first cases of infection with a novel influenza A (H1N1) strain were reported in 6 cases in California and 2 cases in Texas in the United States in late April 2009. This was linked to outbreaks of influenza in Mexico, which included reports of large numbers of cases...
Original Article
Prevalence of Metabolic Syndrome by the Adult Treatment Panel III, International Diabetes Federation, and World Health Organization Definitions and their Association with Coronary Heart Disease in an Elderly Iranian Population
Coronary heart disease (CHD) is one of the most common causes of morbidity and mortality in different communities.1,2 Despite the lack of accurate data, there is evidence to indicate that CHD is increasing in magnitude in Iran.3 While age-adjusted mortality from CHD is gradually decreasing in developed countries,2,4 this...
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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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...
Commentary
Policy Implications of The Singapore Mental Health Study
Mental health issues have taken on greater importance with the growing awareness among policy makers of the importance of mental health for the development of human, social and economic capital of a country and the realisation that it is illogical to introduce health-sector reforms without paying due attention 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...
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...
Original Article
Risk Factors for Severe Adenovirus Infection in Children during an Outbreak in Singapore
Human adenoviruses (HAdVs) are well known pathogens that cause a variety of human illnesses. They are non-enveloped, linear double-stranded deoxyribonucleic acid (DNA) viruses. More than 50 distinct serotypes have been identified since the early 1950s. The wide spectrum of symptoms includes upper respiratory tract illness, pneumonia, conjunctivitis, cystitis and...
Original Article
Impact of unemployment on mental disorders, physical health and quality of life: Findings from the Singapore Mental Health Study
Several reviews and meta-analyses have established an association between unemployment and psychological distress. This relationship between unemployment and mental health is complex and likely bidirectional. On the one hand, unemployment may lead to psychological distress and mental disorders (social causation), but on the other, those with poor mental health...
Original Article
Health-seeking behaviour of foreign workers in Singapore: Insights from emergency department visits
Singapore employs a large foreign worker (FW) population, defined as non-Singapore citizens and non-permanent residents working locally. Holders of “work permit” (WP), the work pass issued to semiskilled workers, comprise 26.0% of Singapore’s entire labour force. Two other work passes held by FWs, “S pass” and “employment pass”, are...
Original Article
Accuracy of self-reported height, weight and BMI in a multiethnic Asian population
Overweight and obesity continue to be one of the most critical public health issues worldwide. Body mass index (BMI) derived from height and weight has been directly linked to a number of debilitating diseases, including diabetes, heart disease and cancer, and has gained increased popularity as a measure of...
Original Article
Incidence and trends of ophthalmic cancer in Singapore: Data from Singapore Cancer Registry
Ophthalmic cancers are commonly encountered in clinical practice and are an important cause of morbidity and mortality. Globally, the incidence of ophthalmic cancers have been increasing in the past 2 to 3 decades.3-6 Data on recent incidence of primary ophthalmic cancers, comprising intraocular and extraocular cancers, have not been...
Review Article
COVID-19 and Singapore: From Early Response to Circuit Breaker
The COVID-19 pandemic first broke out in Wuhan, China, in December 2019, where a cluster of pneumonia cases was reported and the novel coronavirus later identified. Since then, the virus has spread rapidly across the world, registering a total of 85000 reported cases across 53 countries/territories by 29 February...
Original Article
Comparative Analysis of Symptomatic and Asymptomatic SARS-CoV-2 Infection in Children
Singapore confirmed its first case of COVID-19 on 23 January 2020 in a Chinese national from Wuhan, and its first paediatric case on February 4, 2020. As of 24 July 2020, Singapore has reported 49,071 cases of COVID-19. Singapore initiated a comprehensive surveillance, testing and contact tracing strategy as...
Review Article
Coronavirus Disease 2019 (COVID-19): The Singapore Experience. A Review of the First Eight Months
Singapore reported its first imported case of COVID-19 on 23 January 20201 and its first COVID-19 deaths on 21 March 2020.2 The WHO declared COVID-19 to be a pandemic on 11 March 2020;3 as of 27 October 2020, there have been more than 42 million confirmed cases and 1.1...
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...
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...