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Biomedical subjects

C L Goh

Publications and source records attributed to C L Goh.

At least 91 records · Page 5Linked to original sources
PubMed1997

A retrospective study of the clinical presentation and outcome of herpes zoster in a tertiary dermatology outpatient referral clinic.

BACKGROUND: This is a retrospective study of the epidemiology and morbidity of herpes zoster and the risk factors for herpes zoster morbidity in Singapore. RESULTS: The mean age of 164 patients with herpes zoster seen at our dermatology clinic between January 1994 and December 1995 was 48.8 years, with a sex ratio of 1:1. The common presenting symptoms were pain (90%), feelings of helplessness and depression (20%), and flu-like symptoms (12%). The commonest prodromes were pain (41%), itching (27%), and paresthesia (12%). Prodromal pain was more frequently experienced by patients aged more than 50 years (42%) than by patients aged less than 30 years (25%). The thoracic (45%) and cervical (23%) dermatomes were the most commonly affected in all age groups. There was no statistically significant difference in the frequency of dermatomal distribution among the different age groups and between the sexes. Pain was experienced by almost all (95%) patients during the course of their disease. It tended to be more severe in older patients. Burning (26%), stabbing (15%), and shooting (15%) pain were the most common types experienced. Post-herpetic neuralgia was significantly more common in older patients. The prevalence of post-herpetic neuralgia decreased over time in all age groups. A higher proportion of older patients (more than 50 years of age) (20%) suffered from post-herpetic neuralgia compared with younger patients (less than 30 years of age) (7%) (not significant). Patients in all age groups considered acute pain (46%) and persistent pain (25%) to be their most unbearable symptoms during the course of herpes zoster. The most significant problems caused by herpes zoster pain were insomnia (25%), misery (feeling helpless and depressed) (20%), limitation of movement (9%), and inability to continue work (8%). Insomnia was significantly more commonly experienced by patients more than 50 years of age (36%) than those less than 30 years of age (P = 0.026). Few patients (9%) consulted their general practitioner (GP) during the prodrome or on the day of appearance of skin eruptions. Most patients (45%) consulted their GP within the first 3 days of the onset of skin eruptions; 33% sought treatment more than 3 days after the appearance of zoster symptoms. Only 30% of patients were willing to pay more than S$200 for antiviral therapy. Most (43%) were only prepared to pay for antiviral treatment if it cost less than S$200. The most important features the patients wished to derive from antiviral therapy were a shortening of the duration of skin lesions (55%) and a reduction in the severity of pain (acute and chronic) (30%). CONCLUSIONS: Our study indicated that older patients (aged more than 50 years) were at a higher risk of developing post-herpetic neuralgia. They were also more likely to suffer morbidity, e.g. insomnia. There is a need to educate patients at risk to identify the prodrome and skin eruptions of herpes zoster so that early antiviral therapy can be considered.

Adult↗
PubMed1997

Skin colonization of Staphylococcus aureus in atopic dermatitis patients seen at the National Skin Centre, Singapore.

OBJECTIVE: This prospective study sought to determine the bacterial colonization rates on eczematous and non-eczematous skin and nasal mucosa of patients with atopic dermatitis attending a tertiary dermatologic referral clinic in Singapore. The colonization rates were evaluated according to age, sex, race, and severity of dermatitis compared with controls. The results may help to determine whether antibiotics should be considered in the treatment of atopic dermatitis. PATIENTS: Patients, of any age, presenting with atopic dermatitis at the subsidized clinic of the National Skin Centre, Singapore, between 23 August 1996 and 14 September 1996, were included in the study. RESULTS: Thirty-three patients with atopic dermatitis were seen at the outpatient clinic during the study period. Staphylococcus aureus was isolated in 69.7% of the eczematous lesions and in 42.4% of non-eczematous skin of patients with atopic dermatitis. S. aureus was isolated in 53% of patients with mild dermatitis, and in 100% with moderate and severe dermatitis. The nasal carriage rate of S. aureus was higher in atopic dermatitis patients (51.5%) than in non-atopics (35%) (not significant). S. aureus was isolated in 42% of non-eczematous skin in atopics compared with only 5% in the control group (p = 0.003). In patients with atopic dermatitis, all S. aureus isolated was sensitive to cloxacillin, cephalexin, clindamycin, and co-trimoxazole; 92% was sensitive to erythromycin, but only 13% was sensitive to penicillin and ampicillin. In the control group, all S. aureus isolated was sensitive to cloxacillin, cephalexin, erythromycin, clindamycin, and co-trimoxazole, but only 13% was sensitive to penicillin and ampicillin, and 87% to tetracycline. CONCLUSIONS: This study confirmed that the skin of patients with atopic dermatitis was more frequently colonized with S. aureus than that of non-atopics. The more severe the dermatitis, the higher the rate of colonization. S. aureus is also more of than present in non-eczematous skin of atopics than of non-atopics. There is also a higher percentage of S. aureus nasal carriage in patients with atopic dermatitis than in non-atopics. Hence antibiotics may have a role in the treatment of atopic dermatitis. Because 87% of S. aureus is resistant to penicillin and ampicillin, antibiotics such as cloxacillin and cephalexin should be used to eradicate S. aureus in the skin of atopic dermatitis individuals.

Adolescent↗
PubMed1997

Allergic contact dermatitis from grasses.

This study attempts to demonstrate the existence of allergic contact dermatitis from grass, and to develop a patch test series to screen patients with grass intolerance. 6 common grass species from lawns and military training areas were collected. Solvent extracts of polar, non-polar and volatile fractions were prepared and used for patch testing in 20 control subjects and 46 patients with a history of grass intolerance. The 20 controls had negative responses to patch testing. 5 out of 46 patients had positive patch tests to Axonopus compressus (carpet grass), Ischaemum muticum (seashore centipede grass), Imperata cylindrica (lalang), Panicum maximum (Guinea grass) and Pennisetum purpureum (elephant grass). Reactions to the non-polar fraction for all 5 species were noted. This study demonstrates the existence of allergic contact dermatitis from various common species of grass. In our series, this is seen in 11% of those with a history of grass intolerance.

Adolescent↗
PubMed1997

Proposal for a revised international standard series of patch tests.

Worldwide, there are 3 major standard series of patch tests, the European, North American and Japanese, together presenting 32 allergens, the differences between them being the result of regional variation in allergen distribution as well as differences in dermatological opinion. We propose a "minimal" international standard series of 20 allergens, together with an "extended" international standard series of 14 allergens.

Dermatitis, Contact↗
PubMed1997

STD/AIDS knowledge and risk behaviour among masseuses and bar hostesses in Singapore.

Sex workers are not confined to brothels, they also include a variety of individuals who practise part-time in establishments conductive to sexual liaisons. We undertook to study the extent of sex work among masseuses and nightclub hostesses and the level of AIDS and STD knowledge in these 2 groups. The studies were conducted in 1993 and 1996. Altogether 1244 masseuses and 746 hostesses attended educational sessions at the STD clinic, during which they were also surveyed for knowledge on AIDS and STDs, and practices which may put them at risk of infection; they were also offered tests for HIV and syphilis. Knowledge on AIDS transmission was good, knowledge of other aspects of AIDS and STDs was not. Sexual activities resulting from the conduct of their work was practised by only a minority of masseuses (13.5%) and hostesses (7.9%). Among those who engaged in sexual activities at work, masseuses practised safe sex more commonly than hostesses (83.5% vs 27.6%). The prevalence of HIV (0.175% in hostesses, 0% in masseuses) and syphilis (0.87% in hostesses and 1.7% in masseuses) was very low in both groups.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Sporotrichosis: a case report and successful treatment with itraconazole.

We report the case of a 51-year-old man who presented with a six-month history of a slowly growing plaque on the right ring finger and nodules over the right arm. Cultures grew Sporothrix schenckii. He was treated with itraconazole, 100 mg daily, with complete resolution of the lesions after five months of therapy. The differential diagnoses and the various modalities of treatment are emphasized.

Antifungal Agents↗
PubMed1997

Occupational skin disease in workers from the electronics industry in Singapore.

Of 149 workers from the electronics industry with occupational dermatoses seen at the Joint Occupational Dermatoses Clinic at the National Skin Centre, Singapore, 51.0% (76) were diagnosed to have irritant contact dermatitis, 40.9% (61) had allergic contact dermatitis, and 8.1% (12) had noncontact dermatitis. More than half of the patients were younger than 30 years of age. Common irritants were soldering flux, oils and coolants, solvents, and acids/alkalis. The most common allergens were nickel and resins, followed by rubber chemicals and the constituents of flux. Of the noncontact dermatitis, 8 were caused by occupationally relevant exacerbation of endogenous eczema, whereas there was one case each of miliaria, frictional dermatitis, and fatal toxic epidermal necrolysis caused by trichloroethylene allergy.

Adult↗
PubMed1997

A knowledge, attitudes, beliefs and practices (KABP) survey on HIV infection and AIDS among doctors and dental surgeons in Singapore.

An anonymous postal questionnaire survey studying the knowledge, attitudes, beliefs and practices on human immunodeficiency virus (HIV) infection was conducted among all registered medical and dental practitioners in Singapore in 1996. In all, 1523 replies were received, yielding a response rate of 29.3%. The level of knowledge regarding transmission and prevention was generally good, although there were a number who believed that HIV could be transmitted by the respiratory and oral routes. However, knowledge regarding diagnosis and medical management was unsatisfactory. Although a large majority felt they had the ethical obligation to treat HIV patients, only half of them indicated their willingness to do so if they were given the choice. The majority (62.3%) supported the idea of routine preoperative HIV testing for patients, but fewer (40%) supported mandatory HIV testing for health care workers. Dentists seemed more sensitive to issues involving transmission in the workplace, and 95% of them practised universal precautions. Continuing medical education on HIV infection is required to improve and maintain the level of knowledge and competency of doctors and dentists in Singapore.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Change in cement manufacturing process, a cause for decline in chromate allergy?

Hexavalent chromate in cement is the commonest cause of allergic contact dermatitis, especially among construction workers. Over the past decades, there has been a general decline in the prevalence of chromate allergy among construction workers. We suspect that a change in the constituents of cement, resulting in the lowering of hexavalent chromate, contributed to the decline. Slag (free from hexavalent chromate) from the iron-quenched, blast furnace process has been used as a substitute for clinker (which contains high hexavalent chromate) in manufacturing cement. As a result, the slag has diluted the hexavalent chromate content of cement. Our analytical study showed that slag is free from hexavalent chromate and that the hexavalent chromate of clinker ranged from 6-17 micrograms/g. Substituting slag for clinker resulted in dilution of hexavalent chromate in the cement. The hexavalent chromate content of cement declines proportionately with increasing proportion of slag, e.g., a cement containing 5% slag has a total hexavalent chromate concentration of 17.5 micrograms/g, whereas increasing the proportion of slag to 60% reduced the hexavalent chromate content to 7.1 micrograms/gm in the same cement.

Carcinogens, Environmental↗
PubMed1996

Sweet's syndrome in a skin clinic in Singapore: an epidemiology study.

Thirty-nine patients with Sweet's syndrome seen at the National Skin Centre in Singapore between 1982 and 1994 were reviewed. Diagnosis was based on the presence of acute tender, erythematous plaques and nodules, and histologically on a dense dermal infiltrate composed predominantly of neutrophils. The female to male ratio was 1.6:1. Only 4 patients had an underlying malignancy: 3 had haematologic malignancies and 1 had nasopharyngeal carcinoma, all of which were present before the onset of Sweet's syndrome. The arms and legs were the sites most frequently involved. Other findings were fever, oral ulceration, arthralgia and weight loss. Laboratory examinations were not found to be very helpful. Most of the patients responded to oral prednisolone although relapses were noted in 11 patients.

Adolescent↗
PubMed1996

Treatment response of port-wine stains with the flashlamp-pulsed dye laser in the National Skin Centre: a report of 36 patients.

This is a report of a prospective study on the treatment response of 36 patients with port-wine stains with the 585 nm flashlamp-pulsed dye laser and who have completed at least 1 year of follow-up. All patients received treatment at 8-weekly intervals under topical lidocaine-prilocaine anaesthesia. Most of the patients received at least 4 treatments in total. At the end of each treatment and on completion of treatment, patients were assessed for response based on a subjective scoring system where excellent is more than 75% improvement (lightening of redness), good is 50% to 75% improvement, fair is 25% to 75% improvement and poor is less than 25% improvement and the same is no observable improvement. The author and patients administered the scores after each treatment separately. The mean age was 26.1 years (range 2 years to 53 years). The mean initial energy density dose was 6.432 J/cm2. Most patients experienced significant improvement after the initial treatment and further improvements were observed with each subsequent treatment. The author generally recorded better improvement scores than the patients. Ninety percent of the patients were satisfied with the outcome of treatment. Only 11% of the patients scored the improvement after treatment as excellent, while the author scored 36% of the lesions treated as excellent improvement. More than two-thirds of the patients observed good to excellent improvements after the first treatment and by the fourth treatment, all patients recorded either good or excellent improvement. There were no statistically significant differences in treatment response in the various types (papular or macular) of lesions and skin colour type of patients. Light coloured port-wine stains tended to respond better to treatment than darker lesions (not statistically significant), but overall, all coloured lesions responded well to treatment. Patients' expectations of improvement were generally higher than those of the author.

Adolescent↗
PubMed1996

Lyme disease is not prevalent in patients presenting with annular erythema in Singapore.

The aim of this study was to ascertain the prevalence of Lyme disease as a cause of annular erythematous eruptions in patients attending the National Skin Centre. Serum samples of 72 patients presenting with annular erythema were tested for syphilis, and antibodies against Berrelia burgdorferi by haemagglutination, indirect immunofluorescence and enzyme-linked immunosorbent tests. All the serum tested were negative for syphilis serology and antibody against B. burgdorferi. It would appear that the Lyme disease is not a cause of annular erythema in Singapore.

Borrelia burgdorferi Group↗
PubMed1996

A comparison of topical tannic acid versus iontophoresis in the medical treatment of palmar hyperhidrosis.

This is a report comparing the efficacy of tannic acid lotion (an astringent) and iontophoresis in the medical treatment of idiopathic hyperhidrosis. Ten patients with long-standing symptomatic idiopathic palmar hyperhidrosis were recruited into the study. One palm was treated with daily tannic acid (20%) lotion and the opposite palm with iontophoresis. Visual scoring using a visual analog scale by patients and assessors showed the mean score to be significantly lower on the iontophoresis treated palm than the tannic acid treated palm. There was significant reduction in the severity of hyperhidrosis on the iontophoresis treated palm after treatment. There was also a significant reduction in transepidermal water vapour loss on the iontophoresis treated palms. The study indicated that iontophoresis is an effective medical treatment for idiopathic hyperhidrosis. The disadvantage of iontophoresis is its short-lived effect. Patients need to undergo the treatment weekly to achieve euhidrosis.

Administration, Topical↗
PubMed1996

Molecular detection of human immunodeficiency virus-1 infection among commercial sex workers using the polymerase chain reaction in Singapore.

We studied the sensitivity of polymerase chain reaction (PCR) for detecting early human immunodeficiency virus-1 (HIV-1) in sex workers. Blood samples of sex workers who attended our Sexually Transmitted Diseases clinic were tested for HIV infection by testing for the presence of HIV antibody and HIV-1 proviral DNA using PCR (with the Amplicor HIV-1 amplification kit, Roche) at 00 (when they first register to work as sex workers), 01 and 03 months after starting work. The objective was to detect HIV-1 using PCR in sex workers during the "window" period when their HIV antibody tests were still negative. Sixty-nine blood samples were PCR-tested at 00 month of which 8 were simultaneously positive for HIV antibody and PCR tests. Seventy-seven blood samples were tested at 03 month. We found that PCR test using the Amplicor HIV-1 amplification kit (Roche) to be sensitive in detecting HIV infection in sex workers but the test appeared not sensitive enough to detect HIV-1 infection during the "window" period. We were unable to detect any sex workers with PCR detectable HIV-1 before they seroconverted to become HIV antibody positive. The reason for the failure was attributed to the low infection rate among sex workers and possible lack of sensitivity of the Amplicor PCR/HIV-1 amplification kit to detect early HIV-1 infection. We are currently studying other PCR procedures to improve the sensitivity of the PCR test for HIV-1.

DNA, Viral↗
PubMed1996

Topical squaric acid dibutylester therapy for alopecia areata: a double-sided patient-controlled study.

In this prospective, double-sided patient-controlled therapeutical trial involving 20 patients with alopecia areata, we investigated the efficacy of topical acid dibutylester (SADBE) in the treatment of alopecia areata. Sensitisation was achieved with 2% SADBE in acetone followed by weekly application of topical SADBE to designated alopecia sites for 20 weeks. Untreated alopecia sites on the same patient acted as controls. Nineteen of the twenty patients completed 20 weeks of treatment. On the SADBE treated sites, excellent response (> 75% hair regrowth) was observed in 68% (13/19) of patients at the end of 20 weeks of treatment. On the untreated control sites, the corresponding figure was 11% (2/19). The difference in response between SADBE treated and untreated sites was statistically significant (P < 0.001). Mean onset of hair regrowth was 6 weeks after starting treatment. Patients with duration of alopecia 12 months or longer fared poorer compared with patients with a shorter duration of the disease. The extent of involvement did not appear to influence treatment outcome. Side effects were mainly local and were mainly local and were well tolerated. At 6 months follow-up, 33% (2/6) of responders with alopecia totalis relapsed compared to 11% (19) of those with patchy alopecia areata. We conclude that topical immunotherapy with SADBE is effective in inducing hair regrowth in alopecia areata.

Administration, Topical↗
PubMed1995

Skin cancers at Tertiary Referral Skin Hospital in Singapore.

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

Adult↗