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Biomedical subjects

C L Goh

Publications and source records attributed to C L Goh.

At least 37 records · Page 2Linked to original sources
PubMed2002

A retrospective study on the characteristics of androgenetic alopecia among Asian races in the National Skin Centre, a tertiary dermatological referral centre in Singapore.

OBJECTIVE: To study the characteristics and psychosocial impact of androgenetic alopecia among Asian races. METHODOLOGY: A retrospective telephone interview study of patients managed for androgenetic alopecia in 1997 in a tertiary dermatological referral centre in Singapore. RESULTS: Two hundred and fifty-six patients (111 females and 145 males) were included in the study. Their mean age at presentation was 33.7 years. There were no significant statistical mean age differences among the different races (Chinese, Malay and Indian). The mean duration of disease before consultation was 31.2 months; 33.2 months for males and 28.9 months for females (ns). Almost all patients (96.4%) were socially embarrassed and "unhappy" about their androgenetic alopecia. Most (90.5%) sought treatment for "cosmetic" reason. Slightly more males sought treatment for cosmetic reason than female (P = 0.01). 7.5% were worried about an underlying systemic disease as a cause of their alopecia. A positive family history of androgenetic alopecia was recorded in 58.9% (151/256). Male patients tend to have higher proportion of having a father or male sibling with similar problem, whereas female patients tend to have higher proportion of having a mother or females sibling with androgenetic alopecia. The predominant balding patterns for males were a combination of frontal, bi-temporal recession and vertex thinning (43%, 45% and 55%, respectively). Whereas in females, the predominant presentation was vertex thinning (60%) and, infrequently, frontal and bi-temporal thinning (19% and 15%, respectively). Diffuse pattern was also more predominant in females (28%) compared to males (10%). CONCLUSIONS: Most patients presented in their thirties with females presenting earlier than males and almost all patients presented for treatment for cosmetic reasons. Patients are generally unhappy about their appearance as a result of their alopecia. A strong positive family history appears to suggest that the disorder may be acquired through an autosomal dominant trait. Male patients tend to have a father or male sibling with similar condition and female patients tend to have a mother or female sibling with similar condition.

Adaptation, Psychological↗
PubMed2001

Occupational allergic contact dermatitis in Singapore.

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

Chemical Industry↗
PubMed2001

Occupational skin diseases in national servicemen and military personnel in Singapore, 1989-1999.

This is a study of occupational skin disease among military personnel and conscripts in Singapore. All military personnel and conscripts diagnosed with occupational dermatoses in the National Skin Centre, Singapore, between 1989-1999 were studied retrospectively. Conscripts and regulars comprised 7.3% of all occupational skin disease patients seen. All were male, with a mean age of 23 years. Irritant contact dermatitis was more common than allergic contact dermatitis, by 4.4:1. The most common vocations associated with occupational skin diseases are those involving vehicle repairs and maintenance (48%) and food handling (19%). The most common irritants were oil/grease (66%), wet work (23%) and solvents (18%). The most common allergens were food (40%) and chromates (20%). Military personnel and conscripts make up a significant proportion of occupational skin disease patients seen in Singapore.

Adolescent↗
PubMed2001

Positive patch-test reactions to para-phenylenediamine, their clinical relevance and the concept of clinical tolerance.

406 patients were patch tested over an 18-month period (January 1998 to June 1999) at a dermatology referral centre. 33 patients (8.1%) had a positive reaction to para-phenylenediamine (PPD). 20 patients were experiencing PPD hair dye dermatitis (present relevance, 61%), 2 were using PPD hair dyes without developing dermatitis (clinical tolerance, 6%), 4 had previously used PPD hair dyes with dermatitis in the past (past relevance, 12%), 3 had previously used PPD hair dyes without dermatitis (past exposure, 9%) and 4 had no known exposure to PPD (unknown relevance, 12%). Of the 20 patients whose test results were of present relevance, 17 avoided PPD hair dyes, resulting in total clearance of the dermatitis in all except 3, who had concurrent endogenous eczema. 3 continued using PPD hair dyes: 2 had recurrent contact dermatitis and 1 avoided dermatitis with meticulous technique. The 2 patients with clinical tolerance continued using PPD hair dyes with no dermatitis.

Adult↗
PubMed2001

A retrospective review of PUVA therapy at the National Skin Centre of Singapore.

BACKGROUND: Photochemotherapy (PUVA) is beneficial for the treatment of various dermatoses. The introduction of ultraviolet B and narrow-band ultraviolet B phototherapy has had a significant impact on the role of PUVA in dermatology. This study aims to assess the current role of PUVA in treating dermatoses, in a predominantly Asian population, at the National Skin Centre in Singapore. MATERIALS AND METHODS: We reviewed the clinical data of 115 patients who were started on PUVA treatment at the National Skin Centre, Singapore in 1998. We analysed the epidemiology data, the clinical response rate and the adverse effects of PUVA therapy. All of the patients continued to have ongoing maintenance treatment. RESULTS: Most of our patients were Chinese (74.8%) and male (58.3%), ranging from the ages of 4 to 74 years. Vitiligo (60.9%) was the commonest skin disorder treated with PUVA, followed by psoriasis (20.9%), endogenous eczema (11.3%), mycosis fungoides (3.5%), lichen amyloidosis (2.6%) and prurigo nodularis (0.9%). Most of our patients received paint PUVA (50.4%), 33.9% oral PUVA and 15.7% bath PUVA. The best clinical response--those patients achieving a greater that 50% clearance--was observed in patients with endogenous eczema, psoriasis and mycosis fungoides (76.8%, 73.9% and 60%, respectively). Of the vitiliginous patients, 54.3% experienced a poor response to PUVA therapy. The main side effects were mild erythema and pruritus. CONCLUSION: PUVA remains a valuable, well-tolerated therapeutic option for a variety of dermatoses.

Adolescent↗
PubMed2001

The effect of topically applied aspirin on localized circumscribed neurodermatitis.

BACKGROUND: Lichen simplex chronicus is a troublesome intractable itchy dermatosis, which may persist despite intensive topical treatments. Recently it has been demonstrated that topical aspirin solution with dichloromethane has a significant antipruritic effect in an experimentally induced itch. OBJECTIVE: The aim of this double-blind, crossover placebo trial was to evaluate the efficacy of this solution in the treatment of lichen simplex chronicus. METHODS: Twenty-nine patients with lichen simplex chronicus of at least 3 months' duration that did not respond to topical corticosteroids were randomized in a double-blind fashion to receive aspirin/dichloromethane solution in treatment period 1 for 2 weeks followed by placebo in treatment period 2 or placebo followed by aspirin in period 2 with a crossover design after a 2-week washout. The patients rated the pruritus intensity before and during therapy with a visual analog scale; a blinded investigator performed photographic assessment. RESULTS: A significant therapeutic response was achieved in 11 (46%) of the patients who completed the study compared with 3 patients (12%) receiving placebo. Overall, aspirin-treated patients experienced an average decrease in the visual analog scale of 2.18 +/- 2.86 versus 0.69 +/- 2.31 of those receiving placebo. The difference between the 2 treatments for week 2 was significant (P =.03). CONCLUSION: The study suggests that topical aspirin/dichloromethane might be a practical treatment for lichen simplex chronicus.

Administration, Topical↗
PubMed2001

A comparison of the combined effect of cryotherapy and corticosteroid injections versus corticosteroids and cryotherapy alone on keloids: a controlled study.

BACKGROUND: Treatment modalities for keloids, which are commonly found in Asians, include intralesional corticosteroid injections and cryotherapy as well as a combination of these two modalities. Few studies have been performed in a controlled fashion to evaluate the efficacy of these treatments. OBJECTIVE: A controlled study, to evaluate the combined effect of intralesional corticosteroid injection with cryotherapy vs. intralesional corticosteroid or cryotherapy alone. METHODS: Ten patients completed the study: eight patients had at least three keloids and two had two keloids. Patients were treated for at least three sessions 4 weeks apart. The outcome of the lesions was compared between the treatments regarding the thickness of the lesion using a caliper and photographic assessment, and the presence of itch and pain before and after treatment using a visual analogue scale. RESULTS: In terms of thickness, the keloids responded significantly better to combined cryotherapy and triamcinolone vs. triamcinolone alone or cryotherapy alone (P < 0.001). Pain intensity was significantly lowered with all treatment modalities; however, itch was lowered only with the combined treatment and intralesional corticosteroid alone. No significant side effects were noted with any of the treatments and no re-occurrence of keloids was noted with the combined therapy. CONCLUSION: Combined injection of intralesional steroids with cryotherapy appears to be superior to other current modalities.

Adolescent↗
PubMed2001

Parasitic skin infections in the elderly: recognition and drug treatment.

There are many parasitic infections of medical importance, which can produce both systemic disease as well as skin lesions. For the most part, treatment of these infections in the elderly does not differ very much from that of younger patients. However, one must be aware that the geriatric population can present with certain challenges with regard to diagnosis of these diseases because history taking may be more difficult and patients often already have a set of other medical problems, which may overshadow the skin lesions. In addition, the clinical manifestations of these infections may not appear classical and may be altered. Dosages of drugs used to treat these infections, even topical agents, may require adjustments in this population. The recognition of scabies in elderly people living together is important and early treatment with topical scabiecides, including oral ivermectin, will help to control the spread of the infestation. Pediculosis may be a cause of pruritus in the elderly and can be treated with malathione, lindane or permethrin. Less common parasitic infections in the elderly, including cutaneous larva migrans and cutaneous leishmaniasis, present with a characteristic clinical picture and can be effectively treated with oral thiabendazole and intravenous antimonials.

Aged↗
PubMed2001

Antibiotic sensitivity of Propionibacterium acnes isolates from patients with acne vulgaris in a tertiary dermatological referral centre in Singapore.

OBJECTIVES: To study the minimum inhibitory concentrations (MICs) of Propionibacterium acnes (P. acnes) isolates to selected antibiotics from patients with acne vulgaris in Singapore and determine if resistance increases with prolonged use of antibiotics. DESIGN: A single-centre prospective study. SETTING: Tertiary dermatological referral centre in Singapore. PATIENTS: One hundred and fifty patients with acne vulgaris seen at the National Skin Centre. RESULTS: In patients who had never been on antibiotics, there were no resistant isolates of P. acnes. In patients who had been on short-term antibiotics (between 6 to 18 weeks), there were 2 resistant strains among the 34 isolates (6.25%); in patients who had been on antibiotics for longer periods, there were 11 resistant strains among the 51 isolates (21.6%). The differences in the rates of isolation of resistant strains between patients who had not been on antibiotics to those that had been on long-term antibiotics were statistically significant (P = 0.015). There was also a significant difference in isolation of resistant strains from those on short-term antibiotics compared to those who had been on long-term antibiotics (P = 0.036). Resistance to erythromycin was most commonly encountered. Most of the erythromycin-resistant strains also showed cross-resistance to clindamycin. The average MICs to antibiotics such as minocycline, erythromycin and clindamycin in those on long-term antibiotics were significantly higher when compared to patients who had not been on antibiotics. CONCLUSIONS: Antibiotic resistance in P. acnes isolates in Singapore follows similar patterns to studies conducted in Europe. Resistance to erythromycin was most commonly seen, and this is associated with cross-resistance to clindamycin. Among the tetracycline group of drugs, the average MICs to tetracycline was higher than that for doxycycline, which in turn was higher than that for minocycline. Antibiotic resistance can occur with short-term antibiotic courses, and the rate of resistance increases as the duration of antibiotic consumption increases.

Acne Vulgaris↗
PubMed2001

Clinical utility of polymerase chain reaction in the detection of Mycobacterium tuberculosis in different types of cutaneous tuberculosis and tuberculids.

INTRODUCTION: The role of polymerase chain reaction (PCR) in the diagnosis of cutaneous tuberculosis in clinical practice has not been defined as no PCR assay has been tested in a large-scale clinical study. The objective of this study was to test the clinical utility of a PCR assay in the diagnosis of different types of cutaneous tuberculosis and tuberculids. MATERIALS AND METHODS: Analysis of archival biopsy specimens by a nested PCR assay targeting IS6110 of Mycobacterium tuberculosis (M. tb) DNA was performed in a tertiary-care skin hospital in Singapore. PCR results were compared with cultures and concordance with final diagnosis. PATIENTS AND SPECIMENS: One hundred and nineteen skin biopsies from 105 patients comprising 58 cases of confirmed or highly probable cutaneous tuberculosis, ranging from multibacillary infections to paucibacillary forms and 47 cases of possible tuberculids were analysed. Twenty-four subjects with non-tuberculous granulomas and normal skin controls were included. RESULTS: In 14 immunocompromised patients with multibacillary mycobacterial infections (AFB+ on biopsy), PCR was positive in 9 patients. Correlating PCR results with the final diagnosis, the PCR technique was 100% sensitive and specific in this group. In paucibacillary tuberculosis, PCR positivity rates were 55% for tuberculosis verrucosa cutis (38 cases) and 60% for lupus vulgaris (5 cases). When confirmed cases of tuberculosis were considered, the overall sensitivity was 73%. In 26 cases of erythema induratum, PCR was positive in 54% and correlated with a documented response to anti-tuberculous treatment in 80%. CONCLUSIONS: The use of PCR in the routine diagnostic panel for cutaneous tuberculosis should take into consideration the differential sensitivities for different clinical types. In the setting of an immunocompromised patient with AFB+ lesions, PCR has a definite role in rapid diagnosis and in differentiating atypical mycobacterial infection from tuberculosis. Where paucibacillary tuberculosis is suspected, clinical decision should not be based on PCR results alone. In erythema induratum, we found some correlation between PCR results and response to anti-tuberculous therapy.

Base Sequence↗
PubMed2001

Malignant melanoma seen in a tertiary dermatological centre, Singapore.

INTRODUCTION: Primary malignant melanoma is an uncommon skin tumour in Singapore compared with the Western countries. The clinical characteristics of melanoma have been rarely reported in Asians. OBJECTIVES: Our purpose was to study the incidence, clinical characteristics and risk factors of biopsy proven malignant melanoma seen in a tertiary referral skin hospital. METHODS: Case records of patients with histology proven malignant melanoma from January 1989 to December 1998 were retrieved. Patients were interviewed and a complete skin and systemic examination was performed. Data on demographics, histological types, clinical characteristics and risk factors were collated. RESULTS: Between 1989 and 1998, 27 patients were diagnosed with histology proven malignant melanoma. There was a predominance of Chinese with a female to male ratio of 1.3:1. There was a mean lag period of 1.6 years to diagnosing melanoma and there is a general lack of knowledge among the local patients. Most of the lesions (89%) occurred on the extremities. Acral lentiginous melanoma (41%) and nodular melanoma (41%) were the two commonest histologic types. Of the nodular melanomas, 64% were observed in patients below 50 years (64%) while majority of the acral lentiginous melanomas occurred in those above 50 years (91%). In terms of risk factors, we reported a high prevalence of diabetes mellitus with acral lentiginous melanoma. CONCLUSIONS: This study highlighted interesting aspects in terms of clinical characteristics and risk factors in our local patients. It also served as a remainder of the need to raise awareness among the public and medical community of skin cancers or melanomas as they are potentially treatable if detected early.

Adolescent↗
PubMed2001

Long-term colchicine for recalcitrant palmoplantar pustulosis: treatment outcome in 3 patients.

Palmoplantar pustulosis (PPP) is a chronic, relapsing, pustular eruption affecting the palms and soles for which treatment is often difficult and frustrating. Short-term colchicine has been used to treat PPP with variable response. We report on the successful treatment of 3 patients with severe, therapy-resistant, chronic PPP. We observed significant reduction in the frequency of pustular eruptions and the number of pustules with maximum tolerable doses of colchicine treatment for up to 12 months.

Adult↗
PubMed2001

Comparison of allergic contact dermatitis cases in the private and subsidized clinics in the National Skin Centre, Singapore.

INTRODUCTION: This is an epidemiologic study to compare allergic contact dermatitis patients in the private and subsidized clinics. PATIENTS AND METHODS: All patients diagnosed to have allergic contact dermatitis in the National Skin Centre from January 1999 to June 1999 were studied retrospectively. RESULTS: More private patients were evaluated for allergic contact dermatitis than subsidized patients in the study period (138 vs. 99). The female-to-male ratio in the paying clinics was greater than in the subsidized clinics (3:1 vs. 1:1). The mean age was the same for both groups i.e., 40 years. There was a greater proportion of unskilled workers attending the subsidized clinic (24.2% vs. 5.4%). The mean duration of rash before evaluation was longer for paying patients than for subsidized patients (31 vs. 22 months), but this was not statistically significant. A significant proportion of the patients had a history of atopic disease and endogenous dermatitis. The most frequent sites for allergic contact dermatitis were the face, hands and the exposed areas of the limbs. The most common allergens were nickel, cobalt and fragrance in the paying patients; and nickel, chromate and fragrance in the subsidized patients. CONCLUSION: More female patients with allergic contact dermatitis and more atopic patients were seen in the private clinics. The forearms, fingers, feet and ears were more commonly affected in the subsidized patients.

Adolescent↗
PubMed2000

Epidemiology of occupational skin disease in Singapore 1989-1998.

This is an epidemiologic study of occupational skin disease in Singapore. All patients diagnosed with occupational dermatoses in the National Skin Centre, Singapore, over the 10-year period 1989-1998 were studied retrospectively. Irritant contact dermatitis was found to be more common than allergic contact dermatitis. The major sources of occupational dermatitis in Singapore were the metal/engineering, building/construction, electrical/electronics and transport industries. The main irritants were detergents/wet work, solvent and oil/grease. The main allergens were chromate, rubber chemicals and nickel. We concluded that the main sources of occupational skin disease and main allergens in Singapore had remained the same compared to a similar study of occupational skin diseases in 1984-85. Weak irritants are still the predominant causes of occupational irritant contact dermatitis, though the main irritants have changed compared to the previous study, where cutting fluids, cement and solvent were the most common irritants.

Adolescent↗
PubMed2000

Epidemiology of eczematous cheilitis at a tertiary dermatological referral centre in Singapore.

In a retrospective epidemiologic study of 202 patients with eczematous cheilitis attending a patch test clinic, females (182 (90%)) predominated over males (20 (10%)). The mean age of our patients was 30.9 years. There was no significant difference between the mean age of females (31 years) presenting with cheilitis compared to males (29 years). Endogenous cheilitis (53%) was the commonest diagnosis, followed by allergic contact dermatitis (34%) and irritant contact dermatitis (5.4%). A personal history of atopy was recorded in 33%. There was no significant difference in the prevalence of atopy between the sexes or among the diagnoses. The mean duration of cheilitis was 16.4 months. The duration was significantly longer in males (29 months) than in females (15 months) (p=0.004). The mean number of positive patch test reaction in patients with allergic contact cheilitis (2.8) was significantly higher than in those with irritant contact cheilitis (0.2) (p = 0.012) or endogenous cheilitis (0.5) (p = 0.00). The commonest cause of allergic contact cheilitis were lip cosmetics, including lipsticks and lipbalms, followed by toothpastes. The commonest cause of irritant contact cheilitis was lip-licking, lipsticks and medication. In 81/202 (40%) patients, 1 or more causes of contact cheilitis could be ascertained. In females, lip cosmetics were the commonest cause, accounting for 54% (44/81) of cases. Toothpastes accounted for 21% (17/81), followed by topical medication 7% (6/81). For males, toothpastes were the commonest cause of allergic contact cheilitis. Ricinoleic acid and the patient's own lip preparations were the commonest relevant contact allergens.

Adult↗
PubMed2000

The prevalence and clinical characteristics of pruritus among patients with extensive psoriasis.

BACKGROUND: Many patients with psoriasis are known to suffer from itch. However, the data available regarding itch and its characteristics in psoriasis are sparse. OBJECTIVES: To examine the prevalence of pruritus and various related clinical characteristics in 101 patients with extensive psoriasis. METHODS: A structured questionnaire was used. RESULTS: Generalized pruritus was a feature of psoriasis in 84% of the patients. In 77% of these it appeared on a daily basis. It involved all areas of the body, had prolonged duration and appeared mainly in the evening and at night. The pruritus significantly affected quality of life. Important daily factors that were found to exacerbate the itch were ambient heat (81%), skin dryness (80%), sweating (65%) and stress (55%). Important factors that were found to ameliorate itch were sleep (57%) and cold showers (55%). The pruritus was found to be unresponsive to most available antipruritics, including phototherapy. Itch intensity as reflected by a visual analogue scale did not correlate with Psoriasis Area and Severity Index scores; however, a highly significant correlation was obtained between the affective descriptors and itch intensity in the worst itch states (r = 0.6, P < 0.001). CONCLUSIONS: Pruritus is a common feature of psoriasis and affects quality of life.

Activities of Daily Living↗