Publications by authors named "Kumutnart Chanprapaph"

47 Publications

Cutaneous, systemic features and laboratory characteristics of late- versus adult-onset systemic lupus erythematosus in 1006 Thai patients.

Lupus 2021 Apr 7;30(5):785-794. Epub 2021 Feb 7.

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Background: Age at disease onset may modulate systemic lupus erythematosus (SLE), but its relation to cutaneous/extracutaneous manifestation remains understudied.

Objective: To compare the cutaneous, systemic features, laboratory characteristics, and disease severity between late- and adult-onset SLE patients.

Methods: Analyses of the cutaneous, systemic involvement, laboratory investigations, SLE disease activity index 2000 (SLEDAI-2K), and disease damage were performed to compare between groups.

Results: Of 1006 SLE patients, 740 and 226 had adult- (15-50 years) and late-onset (>50 years), respectively. Among 782 with cutaneous lupus erythematosus (CLE), acute CLE (ACLE) and chronic CLE (CCLE) were more common in the adult- and late-onset SLE, respectively ( = 0.001). Multivariable logistic regression analysis demonstrated that male patients and skin signs, including papulosquamous subacute CLE, discoid lupus erythematosus, and lupus profundus, were associated with late-onset SLE (all  < 0.05). Late-onset SLE had lower lupus-associated autoantibodies, and systemic involvement (all  < 0.05). ACLE, CCLE, mucosal lupus, alopecia, and non-specific lupus were related to higher disease activity in adult-onset SLE (all  < 0.001). There was no difference in the damage index between the two groups.

Conclusions: Late-onset SLE had a distinct disease expression with male predominance, milder disease activity, and lower systemic involvement. Cutaneous manifestations may hold prognostic values for SLE.
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http://dx.doi.org/10.1177/0961203321991920DOI Listing
April 2021

Dipeptidyl peptidase-4 inhibitor-related bullous pemphigoid: A comparative study of 100 patients with bullous pemphigoid and diabetes mellitus.

J Dermatol 2021 Apr 4;48(4):486-496. Epub 2021 Feb 4.

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Dipeptidyl peptidase-4 inhibitor (DPP4i)-associated bullous pemphigoid (BP) has been emerging but whether it has genotype or phenotype differences from idiopathic BP (IBP) remains to be determined. We aimed to compare clinical characteristics, genetic susceptibility, laboratory features, disease activity, and outcomes between DPP4i-associated BP (DBP) and IBP occurring among patients with diabetes mellitus type 2 (T2DM). Medical records of patients diagnosed with BP and T2DM from January 2009 to December 2019 were retrospectively reviewed, and patients were categorized into DBP or IBP groups. Of 100 patients, 23 had DBP and 77 had IBP. There was no difference in the Bullous Pemphigoid Disease Activity Index score between the two groups; however, the score for urticaria and erythema was less in DBP (p < 0.001), indicating a non-inflammatory phenotype. The HLA-DQB1*03:01 allele was more commonly present in the DBP than IBP cases (odds ratio = 5.33 [95% confidence interval, 1.11-28.59], p = 0.016). The absolute eosinophil count was significantly lower in the DBP group (p = 0.002). Likewise, eosinophilic spongiosis was found less frequently in DBP cases (p = 0.005). Patients in the DBP group had a significantly higher percentage of complete remission on therapy compared to the IBP counterpart (p = 0.026) after DPP4i discontinuation. Moreover, the mean maximum dosage of prednisolone administrated per patient was significantly lower in drug-related cases (p = 0.012). In conclusion, our cohort in Thai patients with T2DM confirms the differences between phenotype and genotype characteristics of DBP and IBP. We emphasize the importance of drug discontinuation in all DPP4i-related cases because doing so may lead to a better disease outcome.
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http://dx.doi.org/10.1111/1346-8138.15778DOI Listing
April 2021

Dermatologic Manifestations, Histologic Features and Disease Progression among Cutaneous Lupus Erythematosus Subtypes: A Prospective Observational Study in Asians.

Dermatol Ther (Heidelb) 2021 Feb 5;11(1):131-147. Epub 2020 Dec 5.

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Introduction: Cutaneous manifestations are central to the primary diagnosis of systemic lupus erythematosus (SLE). However, information on the clinical, histopathologic, and direct immunofluorescence (DIF) features among subtypes of cutaneous lupus erythematosus (CLE), as well as longitudinal prospective observational study to evaluate the natural history and the progression to SLE, is lacking among Asians. Our objectives are to summarize the differences in the clinical, histopathologic, and DIF characteristics and serological profiles between various subtypes of CLE, and to provide its natural history and the association with disease activity in our Asian population.

Methods: A prospective observational study on CLE patients was performed between May 2016 and May 2020. Patients underwent full physical/dermatologic examination, skin biopsy for histology, and DIF. Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) scores and laboratory data were evaluated. Time schedule and characteristics for resolution and/or the disease progression to SLE were recorded in subsequent follow-ups.

Results: Of 101 biopsy-proven CLE patients, 25 had acute CLE (ACLE), 8 had subacute CLE (SCLE), 39 had chronic CLE (CCLE) only, 22 had CCLE with SLE, and 7 had LE-nonspecific cutaneous lesions only. Patients with exclusive CLE showed lower female preponderance, serological abnormalities, and correlation to systemic disease. However, when CLE was accompanied with any LE-nonspecific cutaneous manifestations, they were associated with high antinuclear antibody (ANA) titer, renal, hematologic, joint involvement, and greater SLEDAI score. Of 207 biopsy sections, SCLE/CCLE regardless of systemic involvement showed significantly higher percentage of superficial/deep perivascular and perieccrine infiltration than ACLE. On DIF, deposition of multiple immunoreactants was associated with higher systemic disease. Approximately 10% of CLE-only patients later developed SLE but had mild systemic involvement.

Conclusion: Our findings support that each CLE subtype has a diverse and unique character. Comprehensive understanding of the differences among CLE subtypes is important for achieving the correct diagnosis and providing appropriate disease monitoring and management.
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http://dx.doi.org/10.1007/s13555-020-00471-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859020PMC
February 2021

Clinical Features and Outcomes of Dipeptidyl Peptidase-4 Inhibitor-Associated Bullous Pemphigoid (DPP4i-Associated BP) in Thai Patients.

Case Rep Endocrinol 2020 10;2020:8832643. Epub 2020 Oct 10.

Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand.

The use of dipeptidyl peptidase-4 inhibitors (DPP4i) appears to be associated with a small but significantly elevated risk of bullous pemphigoid (BP). Although the pathogenic mechanism of DPP4i-associated BP remains unclear, this adverse event is reported with multiple gliptins, suggesting a class effect. However, previous studies from various countries showed that vildagliptin had been implicated in most cases. The aim of this study was to illustrate a case series of DPP4i-associated BP in Thai patients. We conducted a retrospective study from consecutive cases of BP in people with type 2 diabetes mellitus (T2DM) from January 2008, the year in which the first DPP4i was introduced in Thailand, until December 2019. During the study period, 10 BP patients with T2DM were identified. A total of 5 DPP4i-associated BP (3 on vildagliptin, 1 on linagliptin, and 1 on sitagliptin) were found. All patients were male with a mean age at BP development of 80.4 years (73-86 years). All patients had a long-standing duration of diabetes (median duration 34 years), and mean A1C was 7.5 ± 1.4%. The median time to BP development after the introduction of DPP4i was 64 months (range 20-128 months). The severity of BP was classified as mild in 2 cases. In all cases, the association between the drug intake and BP onset was classified as "possible" according to the Naranjo causality scale. All of the patients continued taking DPP4i after BP diagnosis, and one patient died of lung cancer 18 months after BP diagnosis. Only 2 patients could achieve complete remission at least 2 months after stopping DPP4i. Our case series demonstrated a potential link between DPP4i and the development of BP, which mainly occurred in very elderly male patients. The latency period from an introduction of DPP-4i could be several years, and the clinical course after DPP4i discontinuation varied. Clinicians prescribing DPP4i should be aware of this association and consider stopping this medication before a refractory disease course ensues.
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http://dx.doi.org/10.1155/2020/8832643DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569454PMC
October 2020

A clinical and histological comparison between acute cutaneous graft-versus-host disease and other maculopapular eruptions following hematopoietic stem cell transplantation: a retrospective cohort.

Int J Dermatol 2021 Jan 29;60(1):60-69. Epub 2020 Sep 29.

Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Background: Prompt management of acute graft-versus-host disease (GVHD) may prevent its morbidity and mortality. Maculopapular (MP) eruption is a presenting sign of acute GVHD, but differentiation from other causes of MP rash is challenging.

Methods: A retrospective study was conducted among patients developing MP eruptions after allogeneic hematopoietic stem cell transplantation. We compared the clinical and histopathological differences between an acute cutaneous GVHD (group 1) and other MP eruptions (group 2). We also determined the clinical prognostic indicators linked to acute GVHD severity, morbidity, and mortality.

Results: Of 95 patients identified, 75 met the classification criteria for acute GVHD, and 25 had other MP eruptions. Palm and/or sole involvement was more frequently found (51.4% vs. 12%, odds ratio [OR] [95% confidence interval] = 7 [2.1, 23.7], P < 0.01 and 41.4% vs. 0%, OR 37.2 [2.2, 635], P < 0.01, respectively) in group 1 than in group 2. Comparing the histological features between the two groups, necrotic keratinocytes in basal and spinous layers (92.9% vs. 22.2%, OR 27 [3.5, 594.7], P < 0.01) and (85.7% vs. 33.3%, OR 9.3 [1.4, 60.8], P = 0.02, respectively), diffuse basal vacuolization (42.9% vs. 0%, OR 14.5 [0.7, 298.2], P = 0.04), lymphocyte satellitosis (71.4% vs. 0%, OR 44.3 [2.1, 936.8], P < 0.01), and subepidermal clefts (42.9% vs. 0%, OR 14.5 [0.7, 298.2], P = 0.04) were significantly more apparent in group 1. Among extracutaneous presentations, diarrhea alone and/or accompanied by hyperbilirubinemia (47.1% vs. 16%, OR 4.3 [1.4, 13.1], P = 0.03 and 27.1% vs. 0%, OR 19.3 [1.1, 332.8], P < 0.01, respectively) and newly developed transaminitis (37.1% vs. 12%, OR 3.3 [1.1, 12.6], P = 0.02) suggested the diagnosis of acute GVHD. Mucosal involvement and/or blister formation correlated with severe acute GVHD (OR 26.6 [5.4, 130.4], P < 0.01). Skin and systemic GVHD severity correlated with time to rash resolution (P = 0.03 and P = 0.04, respectively), length of hospital stays (P < 0.01 and P < 0.01, respectively), and mortality (OR 4.87 [1.4, 17.4], P = 0.02 and OR 4.6 [1.3, 16.5], P = 0.02, respectively).

Conclusions: Our findings may be beneficial tools for establishing the diagnosis of acute GVHD.
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http://dx.doi.org/10.1111/ijd.15186DOI Listing
January 2021

The behavior, attitude, and knowledge towards photoprotection in patients with cutaneous/systemic lupus erythematosus: a comparative study with 526 patients and healthy controls.

Photochem Photobiol Sci 2020 Sep;19(9):1201-1210

Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama IV Rd, Bangkok, 10400, Thailand.

Objective: To evaluate the attitude, knowledge, and behavior towards the sun protection in systemic lupus erythematosus (SLE) patients with and without cutaneous involvement (CLE) compared to non-photosensitive controls and to determine influential factors for photoprotective practices in SLE patients.

Methods: A case-control study was performed. Patients and controls completed a self-reported questionnaire. For SLE patients, the presence of organ involvement, disease activity and laboratory data were acquired from their physical examination and medical records.

Results: A total of 263 SLE patients and 263 healthy controls were recruited. SLE patients had statistically significant better photoprotective practices than controls, i.e. exposure to sunlight <1 hour per day (76.1% vs. 48.3%, OR, 3.40; 95% CI, 2.34-4.93, p < 0.001), less outdoor activities (9.8% vs. 19.1%, OR, 0.44; 95% CI, 0.26-0.71, p = 0.003), wore long-sleeved shirts (57.0% vs. 32.7%, OR, 2.73; 95% CI, 1.92-3.89, p < 0.001) and hats (43.8% vs. 26.6%, OR 2.14; 95% CI, 1.49-3.09, p < 0.001). SLE with CLE subgroup had the highest percentage for regular practice in almost all sun protective means compared to SLE without CLE and controls. SLE with CLE patients had more diligent sunscreen application with higher percentage of consistent use (93.7% vs. 59.3%, OR, 11.66; 95% CI, 2.57-52.89, p = 0.001) and adequate application (58.1% vs. 24.6%, OR, 4.24; 95% CI, 1.93-9.30, p < 0.001) compared to those without CLE. Previous and current CLE were influential factors for adherence to photoprotective methods, while the extracutaneous involvement was not. The majority of SLE patients were well acquainted with the harm of sunlight to their diseases (91.6%). However, 40.1% of them did not perceive that sunlight could escalate their internal flare, which may have led to inferior photoprotective practices in patients with extracutaneous involvement.

Conclusion: SLE patients had good awareness and practiced better photoprotection than controls. The cutaneous sign is a predictor for superior photoprotective behavior. Education regarding the harms of sunlight and the importance of appropriate photoprotection should be emphasized, especially in SLE cases without cutaneous involvement.
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http://dx.doi.org/10.1039/d0pp00073fDOI Listing
September 2020

Cutaneous and Extracutaneous Manifestations of Behçet's Disease Linked to Its Disease Activity and Prognosis.

Clin Cosmet Investig Dermatol 2020 25;13:639-647. Epub 2020 Aug 25.

Division of Allergy Immunology and Rheumatology, Department of Internal Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Background: Behçet's disease is a potentially fatal vasculitis disorder involving vessels in both the arterial and venous systems. Cutaneous manifestation is the most common sign in Behçet's disease, but its relation to disease activity and prognosis is lacking.

Objective: Our study aims to determine the relationship between cutaneous, extracutaneous manifestations with Behçet's disease activity, morbidity, and mortality.

Materials And Methods: Patients diagnosed with Behçet's disease were identified by using the 1990 International Study Group for Behçet's disease criteria and/or the 2014 international criteria for Behçet's disease. Data regarding patients' clinical manifestations, laboratory results, disease activity, and prognosis were retrieved and analyzed. Disease activity was evaluated using the 2006 Behçet's disease current activity form (BDCAF).

Results: Of 119 patients, the mean age at diagnosis was 35.7 ± 10.7 years and 60% were female. Median disease duration was 96 months (IQR 48-168). Minor oral ulcer at the buccal mucosa was associated with lower median BDCAF score ( = 0.003), whereas minor oral ulcer at the tonsil was related to higher BDCAF score ( = 0.024). Male gender was associated with higher cumulative dose of corticosteroids ( = 0.003) and hospitalization (OR = 2.89 (95% CI [1.10, 7.57]), = 0.031). Ocular manifestations were related to higher dose of corticosteroids ( = 0.002) and morbidity (OR = 4.39 (95% CI [1.57, 12.29]), = 0.005).

Conclusion: Our study suggests that different locations of minor oral ulcers help predict disease activity. Male gender and the presence of ocular manifestations resulted in less favorable outcomes for Behçet's disease.
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http://dx.doi.org/10.2147/CCID.S265169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457676PMC
August 2020

Characterization and classification of different female hairline patterns in the Thai population.

J Cosmet Dermatol 2021 Mar 11;20(3):890-896. Epub 2020 Aug 11.

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Background: The hairline is an essential component of the human face. Disfigurement of the hairline may cause physical and psychological problems. Standard guidelines do not exist for female hairline designs, average values of infratemporal portion, hairline classifications, and preferences.

Aims: We aimed to study hairline characteristics in Thai females and further compare the values with previous studies in different populations. Furthermore, we aimed to introduce a comprehensive hairline classification system that allowed an easy and detailed phenotypic characterization of female hairline.

Patients/methods: Healthy Thai females aged over 18 years were included in the study. Collection of demographic data, infratemporal measurements, and standard photography was performed. All collected data were analyzed to determine the standard values of each hairline dimension for comparison to previous studies.

Results: Two hundred and twenty-nine females, with a mean age of 32.4 ± 8.6 years, participated in this study. The mean mid-frontal line was 6.45 ± 0.89 cm, which was not correlated with age. Lateral mounds, widow's peaks, and cowlicks were observed in 42.35%, 24.45%, and 1.74% participants, respectively. Our study revealed five patterns of the frontal hairline and four patterns of the temporal hairline. The mid-frontal line in Asian females trended longer than that in Caucasians, without statistical significance.

Conclusions: Measurements of the infratemporal portions in Thai females revealed no change with age, and the mid-frontal line showed no statistically significant differences between Korean and Turkish participants. The hairline classification system introduced in our study was comprehensive and would be easily applicable in clinical practice. Female hairline dimensions and patterns reported in our study could provide reference values for hairline design in hairline restoration surgery as well as assist in accurate diagnosis of hair disorders.
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http://dx.doi.org/10.1111/jocd.13642DOI Listing
March 2021

Isobutylamido thiazolyl resorcinol for prevention of UVB-induced hyperpigmentation.

J Cosmet Dermatol 2021 Mar 5;20(3):987-992. Epub 2020 Aug 5.

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Background: Isobutylamido thiazolyl resorcinol (ITR, Thiamidol ) has been proposed as a potent tyrosinase inhibitor. A formulation containing ITR has recently shown promising efficacy for the treatment of some hyperpigmentary conditions.

Objectives: This study aimed to evaluate the efficacy and safety of ITR in the prevention of ultraviolet (UV)-induced hyperpigmentation in human skin.

Materials And Methods: We performed a randomized, single-blinded, pilot study in 30 healthy participants. One arm was randomly assigned to receive an ITR-containing product for three weeks. Three hyperpigmented spots were induced by UVB irradiation on both arms after 3 weeks of ITR application. Outcome evaluations included measuring mean lightness index (*L) obtained by colorimeter, hyperpigmentation scores by visual analog scale (VAS), and adverse effects.

Results: Both experimental sides showed no significant difference in terms of skin lightening after ITR application. However, the ITR-treated sides showed a statistically significant lower mean lightness index compared to control after an induction with UVB. In addition, the ITR-treated sides had an earlier improvement and resumed the normal skin color after 3 weeks post-UVB induction. A clinical evaluation by a blinded nontreating physician and subjects was more favorable on the ITR-treated side than the control side (P < .05). No significant side effect was noted.

Conclusions: ITR is an effective agent in the prevention of pigmentary change from UVB irradiation and may serve as a promising agent for preventing other hyperpigmentary conditions.
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http://dx.doi.org/10.1111/jocd.13615DOI Listing
March 2021

Exfoliative Erythroderma: An Unusual Presentation of Paraneoplastic Pemphigus Associated with Castleman's Disease.

Case Rep Dermatol 2020 Jan-Apr;12(1):76-81. Epub 2020 Apr 14.

Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

We report a 23-year-old woman who presented with generalized scaly erythematous rash predominately on the upper trunk and hemorrhagic stomatitis. The histopathologic and immunopathologic findings were consistent with the diagnosis of paraneoplastic pemphigus. Castleman's tumor was diagnosed with computed tomography and exploratory laparotomy. A partial clinical improvement was observed after complete tumor removal and intravenous immunoglobulin administration. However, the patient died as a result of septicemia.
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http://dx.doi.org/10.1159/000507357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184796PMC
April 2020

Cutaneous nontuberculous mycobacterial infection in Thailand: A 7-year retrospective review.

Medicine (Baltimore) 2020 Mar;99(10):e19355

Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

A remarkable increase in the prevalence of cutaneous nontuberculous mycobacterial (NTM) infection has occurred worldwide. However, updated data regarding cutaneous NTM infection in Thailand is limited.This study aim to describe the clinical manifestations, pathogenic organism, and prognostic factors of cutaneous NTM infections among patients living in Thailand.The electronic medical records of all patients with confirmatory diagnosis of cutaneous NTM infection from either positive cultures or polymerase chain reaction were retrospectively reviewed at a university-based hospital.From 2011 to 2017, a total of 88 patients with a confirmed diagnosis of cutaneous NTM infection were included. Mycobacterium abscessus was the most common pathogens followed by M haemophilum and M marinum (61.4%, 10.2%, and 8.1%, respectively). Nodule and plaque were 2 most common lesions (26.4% and 25.5%, respectively) and lower leg is the most common site of involvement (50.9%). The majority of patients presented with single lesion (67%). Seven patients (7.9%) had history of surgical procedure and/or cosmetic injection before the development of lesion and all pathogenic organisms in this group were rapidly growing mycobacteria. Sweet's syndrome and erythema nodosum were the 2 most common reactive dermatoses, presented in 3.4% and 2.3%, respectively. The majority of patients infected with cutaneous M haemophilum infections were immunocompromised and lacked history of preceding trauma (77.8%). Patients with cutaneous NTM that receiving less than 3 medications was associated with higher disease relapse (odds ratio 65.86; P = .02).M abscessus is the most common pathogen of cutaneous NTM infection in Thailand. The prevalence of M haemophilum is increasing and should be particularly cautious in immunocompromised patients. Rapidly growing mycobacteria should be suspected in all cases of procedure-related cutaneous NTM. We recommend at least 3 antibiotics should be considered for cutaneous NTM infection to reduce the rate of relapse.
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http://dx.doi.org/10.1097/MD.0000000000019355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7478711PMC
March 2020

Response to: "Comment on: 'Nonscarring alopecia in systemic lupus erythematosus: A cross-sectional study with trichoscopic, histopathologic, and immunopathologic analyses'".

J Am Acad Dermatol 2020 05 19;82(5):e171. Epub 2020 Jan 19.

Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

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http://dx.doi.org/10.1016/j.jaad.2020.01.022DOI Listing
May 2020

A Comparison of Azathioprine and Mycophenolate Mofetil as Adjuvant Drugs in Patients with Pemphigus: A Retrospective Cohort Study.

Dermatol Ther (Heidelb) 2020 Feb 21;10(1):179-189. Epub 2019 Dec 21.

Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital-Mahidol University, Bangkok, Thailand.

Introduction: Azathioprine (AZA) and mycophenolate mofetil (MMF) are both first-line steroid-sparing agents used for the treatment of pemphigus in combination with a corticosteroid, but few studies to date have directly compared these two combination treatment modalities. The aim of this study was to compare the efficacy and safety of each of these agents as adjuvant therapy with the corticosteroid prednisolone for the treatment of pemphigus, using standardized outcome parameters.

Methods: This was a retrospective study of patients with pemphigus who received corticosteroid therapy in combination with either AZA or MMF at the Autoimmune Blistering Skin Diseases Clinic of Ramathibodi Hospital (Bangkok) between January 2007 and July 2017. The treatment response was evaluated using early [end of the consolidation phase (ECP)] and late endpoints [complete remission (CR) on therapy, CR off therapy and immunological remission]. Cumulative steroid use, relapse rate and adverse events in each treatment group were also compared.

Results: Of the 62 patients with pemphigus included in the study, 37 were treated with prednisolone plus AZA as adjuvant (AZA group) and 25 patients were treated with prednisolone plus MMF as adjuvant (MMF group). The majority of patients in both treatment groups reached the ECP (AZA group 88.2%; MMF group 71.4%; between-group difference not statistically significant at p = 0.156); the median time required to achieve this early endpoint was also comparable (p = 0.362). A high percentage of patients in both the AZA and MMF groups attained CR on therapy (AZA 73%; MMF 72%). The total number of patients who achieved CR on and off therapy were comparable in the two groups (p = 0.933 and p = 0.690, respectively). However, the median time for patients to achieve CR on therapy was significantly shorter for those on MMF than for those on AZA (7.3 vs. 12.5 months; p = 0.019), and the cumulative steroid dose required for patients to achieve CR both on and off therapy was significantly lower in the MMF group than in the AZA group (p = 0.007 and p = 0.043, respectively).

Conclusion: While corticosteroid in combination with either AZA or MMF is an effective therapeutic regimen for the treatment of pemphigus, MMF demonstrates a shorter time to achieve CR on therapy and has a significantly higher steroid-sparing effect.
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http://dx.doi.org/10.1007/s13555-019-00346-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994636PMC
February 2020

Outcome of Repeated Use of Donor Site for Noncultured Epidermal Cellular Grafting in Stable Vitiligo: A Retrospective Study.

Biomed Res Int 2019 11;2019:7623607. Epub 2019 Nov 11.

Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Background: Noncultured epidermal suspension (NCES) is a surgical technique which employs cellular grafting onto depigmented lesions. However, scarring and dyschromia at the donor site often occurs.

Objective: To assess the outcome of reusing the same donor site in subsequent sessions of NCES procedures.

Methods: Electronic records of vitiligo patients who had undergone two sessions of NCES procedures were retrospectively reviewed. Information on the first and second NCES was retrieved for analyses.

Results: A total of 30 patients (female 19 and male 11) were included. The majority of patients had nonsegmental vitiligo (66.7%). The median donor-to-recipient ratios were 1 : 3 (1 : 1-1 : 20) for the first session and 1 : 3 (1 : 1-1 : 13.5) for the second session (=0.661). The mean melanocyte count was 220.7 ± 65.5 cells/mm vs. 242.4 ± 55.3 cells/mm on the first and second sessions, respectively (=0.440). The mean repigmentation rate was 84.2% (±21.1%) and 82.3 (±22.1%) for the first and second NCESs, respectively (=0.645). The frequency of color mismatch and pigment loss were similar between both sessions (=0.706 and =1.000).

Conclusions: Repeated use of donor sites in subsequent NCES sessions gave comparable repigmentation.
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http://dx.doi.org/10.1155/2019/7623607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6885149PMC
April 2020

Degos-Like Lesions In Association With Connective Tissue Diseases: A Report Of Three Cases And Literature Review.

Clin Cosmet Investig Dermatol 2019 7;12:815-822. Epub 2019 Nov 7.

Division of Dermatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Degos disease is characterized by atrophic porcelain-white papules with peripheral erythema. Degos-like lesions have been reported in association with several connective tissue diseases (CTDs), mostly systemic lupus erythematosus (SLE), and rarely in dermatomyositis and systemic sclerosis. Herein, we report three cases of Degos-like lesions in CTDs. Two cases had Degos-like lesions linked to dermatomyositis. Both cases presented with severe inflammatory myopathy without pathognomonic cutaneous signs for dermatomyositis and lacked myositis-specific autoantibodies. Our third case, to our knowledge, is the first case of Degos-like lesions in association with overlapping systemic sclerosis and SLE without major organ involvement. The clinical presentation and histopathology findings of our cases support that Degos-like lesions may not be a specific entity but can be considered as a unique clinical pattern expressed in patients with CTDs.
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http://dx.doi.org/10.2147/CCID.S230081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6848981PMC
November 2019

Adult-onset linear discoid lupus erythematosus on the forehead mimicking en coup de sabre: a case report.

J Med Case Rep 2019 Nov 27;13(1):350. Epub 2019 Nov 27.

Division of Dermatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchatewi, Bangkok, 10400, Thailand.

Background: Linear cutaneous lupus erythematosus (LE) is an unusual form of LE-specific cutaneous condition, occurring in children and young adults. Due to its rarity, the diagnosis of linear cutaneous LE can be difficult and facial lesions can resemble linear morphea or en coup de sabre. Differential diagnosis of similar conditions along the lines of Blaschko must be differentiated from linear LE.

Case Presentation: We report a case of linear discoid LE on the forehead of an adult female Thai patient mimicking en coup de sabre. The dermatoscopy, histopathology and direct immunofluorescence findings were consistent with chronic cutaneous LE.

Conclusions: As this patient demonstrated classic dermatoscopic features of LE, we emphasized that the diagnosis of linear cutaneous LE can be made by dermatoscopy. This is particularly beneficial for young self-conscious patients with facial lesions that are reluctant to perform skin biopsy.
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http://dx.doi.org/10.1186/s13256-019-2249-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6880516PMC
November 2019

Unsuccessful Treatment of Cheilitis Granulomatosa with Oral Methotrexate.

Case Rep Dermatol 2019 Sep-Dec;11(3):249-255. Epub 2019 Sep 27.

Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Cheilitis granulomatosa (CG) is a rare idiopathic condition with painless lip swelling, characterized by non-necrotizing granulomatous inflammation in the absence of other identifiable causes such as Crohn's disease, sarcoidosis, foreign body reaction, or infection. CG may precede the presentation of Crohn's disease after long-term follow-up. Spontaneous remission of CG rarely occurs. To date, given the rarity of CG, there is no gold standard treatment. Recommended treatments are supported by small studies, case reports/series, and expert opinions. Glucocorticoids are the first-line therapy in the acute stages of the disease; however, recurrence commonly occurs. Previously, methotrexate (MTX) showed a beneficial effect on orofacial swelling in a case of CG accompanied by Crohn's disease. We present a patient with CG without Crohn's disease. He was treated with oral MTX in combination with intralesional corticosteroid injection on one side of the lip. The injected side showed improvement, while lip swelling on the noninjected area remained unchanged after 3 months of treatment. Therefore, CG is refractory to treatment with MTX from our experience. Further studies regarding the optimum dosage of MTX is needed.
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http://dx.doi.org/10.1159/000503138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6792424PMC
September 2019

Vesiculobullous diseases in relation to lupus erythematosus.

Clin Cosmet Investig Dermatol 2019 4;12:653-667. Epub 2019 Sep 4.

Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Vesiculobullous lesions in lupus erythematosus (LE) are a rare cutaneous manifestation of cutaneous and/or systemic LE with variable presentation. While the minor forms of LE-associated vesiculobullous disease may cause disfigurement and discomfort, the severe forms can present with hyperacute reaction and life-threatening consequences. Specific LE and aspecific cutaneous LE are defined by the presence or absence of interface change on histopathology that can be applied to vesiculobullous diseases in relation to LE. However, the diagnosis of LE-associated vesiculobullous diseases remains difficult, due to the poorly defined nosology and the similarities in clinical and immunohistopathological features among them. Herein, we thoroughly review the topic of vesiculobullous skin disorders that can be encountered in LE patients and organize them into four groups: LE-specific and aspecific vesiculobullous diseases, LE-related autoimmune bullous diseases, and LE in association to non-autoimmune conditions. We sought to provide an updated overview highlighting the pathogenesis, clinical, histological, and immunopathological features, laboratory findings, and treatments and prognosis among vesiculobullous conditions in LE.
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http://dx.doi.org/10.2147/CCID.S220906DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732903PMC
September 2019

Bilateral Ear Swelling and Erythema after Chemotherapy: A Case Report of Ara-C Ears.

Case Rep Dermatol 2019 May-Aug;11(2):226-232. Epub 2019 Jul 25.

Division of Dermatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Cytarabine is an antimetabolite commonly used to treat hematological malignancies, especially acute myeloid leukemia (AML), acute lymphoblastic leukemia, and non-Hodgkin's lymphoma. Cytarabine-induced cutaneous adverse effects are common, usually manifesting as morbilliform eruptions predominantly on the acral site, intertriginous zone, and to a lesser extent on the elbows, knees, neck, and ears. The presentation on ears is usually called "Ara-C ears," which is considered as a rare subtype of acral erythema. We report a 53-year-old Thai woman with AML who developed cytarabine-induced rashes. The lesions began on symmetrical bilateral ears, posterior auricular areas, and forehead followed by expansion to the trunk and extremities. The clinical presentations and histopathological findings were compatible with toxic erythema of chemotherapy. After giving cetirizine 10 mg orally twice daily and 0.1% triamcinolone acetonide cream twice daily, the lesions gradually improved over 10 days. Notably, two additional courses of high-dose cytarabine were administered without any recurrence.
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http://dx.doi.org/10.1159/000501876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738253PMC
July 2019

Linear and Annular Lupus Panniculitis of the Scalp: Case Report with Emphasis on Trichoscopic Findings and Review of the Literature.

Case Rep Dermatol 2019 May-Aug;11(2):157-165. Epub 2019 Jun 6.

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Linear and annular lupus panniculitis of the scalp (LALPS) is a unique subset of lupus panniculitis, which results in non-scarring alopecia along the Blaschko line of the scalp in an otherwise healthy young patient. Numerous cases have been reported around the world, but data on their trichoscopic findings and correlations with the underlying pathology is sparse. We hereby present a case of 23-year-old male with LALPS and further describe his trichoscopic findings as well as their correlations with histopathological features.
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http://dx.doi.org/10.1159/000500848DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738250PMC
June 2019

Anti-BP180 and anti-BP230 enzyme-linked immunosorbent assays for diagnosis and disease activity tracking of bullous pemphigoid: A prospective cohort study.

Asian Pac J Allergy Immunol 2019 Jun 4. Epub 2019 Jun 4.

Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Background: Autoantibodies against BP180 and BP230 play major roles in bullous pemphigoid (BP). We are the first to describe the values of serum anti-BP180 IgG and anti-BP230 IgG enzyme-linked immunosorbent assays (ELISA) for diagnosis and disease monitoring of BP among Thai patients.

Objectives: We aimed to determine the diagnostic performance of anti-BP180 IgG and anti-BP230 IgG in BP, to correlate disease activity with autoantibody levels through follow-ups, and to relate BP comorbidities with disease activity and autoantibody levels.

Methods: Consecutive patients suspected of having BP were included. Skin biopsy, direct immunofluorescence, and serum anti-BP180 IgG and anti-BP230 IgG tests were performed. BP disease area index (BPDAI) was evaluated at diagnosis and throughout follow-ups.

Results: Of 131 patients, 68 were diagnosed with BP, and 63 were included as controls. Sensitivity and specificity of serum anti-BP180 IgG were 69.1% and 90.5%, respectively, while those of serum anti-BP230 IgG were 55.9% and 85.5%, respectively. Using anti-BP180 and anti-BP230 IgG antibodies resulted in a 7% increase in sensitivity compared with using anti-BP180 IgG antibody alone. Significant correlation with BPDAI was found for both autoantibodies at diagnosis but only for anti-BP180 IgG at follow-ups (p = 0.013). BP patients with positivity to anti-BP180 or anti-BP230 IgG had significantly higher BPDAI than did those without (p = 0.005). BP was associated with neurological diseases (p = 0.025), while patients with diabetes had higher disease activity (p = 0.010).

Conclusions: While both serum autoantibodies are useful for diagnosing BP in patients with suspicious clinical features, only anti-BP180 IgG allowed prediction of disease activity over time.
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http://dx.doi.org/10.12932/AP-231118-0446DOI Listing
June 2019

Nonscarring alopecia in systemic lupus erythematosus: A cross-sectional study with trichoscopic, histopathologic, and immunopathologic analyses.

J Am Acad Dermatol 2019 Dec 28;81(6):1319-1329. Epub 2019 May 28.

Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. Electronic address:

Background: Nonscarring alopecia in systemic lupus erythematosus (SLE) is widely recognized, but reports on its clinical, trichoscopic, histopathologic, and direct immunofluorescence (DIF) features are still limited.

Objective: To summarize the different clinical patterns, trichoscopic, histopathologic, and DIF features of nonscarring alopecia in SLE and to prove its association with disease activity.

Methods: Patients with SLE with and without nonscarring alopecia had full physical/trichoscopic examination and scalp biopsy. Their disease activity scores and laboratory data were evaluated and statistically analyzed.

Results: Thirty-two patients with SLE had different patterns of nonscarring alopecia, including mild diffuse alopecia (43.8% [n = 14]), severe diffuse alopecia (15.6% [n = 5]), patchy alopecia (28.1% [n = 9]), and lupus hair (12.5% [n = 4]). The most common trichoscopic findings were arborizing/interconnecting vessels (83% [n = 26]). Histopathologic examination showed interface changes along the dermoepidermal junction (87.5% [n = 28]) and follicular epithelium (40.6% [n = 13]). On DIF, homogeneous granular deposition was detected along the dermoepidermal junction (78.1% [n = 25]) and follicular epithelium (78.1% [n = 25]). When compared with 10 patients with SLE without alopecia, there was a significantly higher SLE Disease Activity Index 2000 score and prevalence of proteinuria (>1 g/d).

Limitations: This was a small, cross-sectional, single-center study.

Conclusions: Nonscarring alopecia in SLE shows lupus erythematosus-specific changes on histology and DIF. Hair loss in SLE can be considered as an indicator of active disease.
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http://dx.doi.org/10.1016/j.jaad.2019.05.053DOI Listing
December 2019

Successful treatment of normocomplementemic urticarial vasculitis with omalizumab: A report of three cases and literature review.

Asian Pac J Allergy Immunol 2020 Dec;38(4):286-289

Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Urticarial vasculitis (UV) is a rare form of cutaneous leukocytoclastic vasculitis with persistent urticarial lesions. UV may be severe and refractory to standard treatment including antihistamines, anti-inflammatories, antimalarials, corticosteroids and immunosuppressants. Omalizumab, an anti-IgE antibody, is approved for chronic spontaneous urticaria. However, its benefit for UV remains controversial. We report, herein, three patients with normocomplementemic UV and angioedema. All patients were diagnosed with chronic urticaria preceding the presentation of painful urticarial plaques. The diagnosis of UV was confirmed by skin biopsy and/or direct immunofluorescence. All patients had none or minimal response to standard treatments. Initial omalizumab dosing of 150 mg was administered subcutaneously (SC), however, increment to 300 mg monthly was necessary in 2 patients to control the disease. All 3 patients remained in complete remission after minimum follow up period of 9 months. To conclude, omalizumab has shown to be beneficial for severe normocomplementemic UV in our series.
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http://dx.doi.org/10.12932/AP-050918-0402DOI Listing
December 2020

Phototoxic Reaction Induced by Pazopanib.

Case Rep Dermatol 2018 Sep-Dec;10(3):251-256. Epub 2018 Nov 21.

Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Multikinase inhibitors (MKIs) are a novel target therapy that offers promising long-term survival for patients with advanced-stage cancer. However, they cause a wide range of adverse reactions, skin and skin appendage being the most prevalent. Photosensitivity reactions are well-recognized effects from certain MKIs such as sunitinib and vandetanib. However, phototoxic reaction induced by pazopanib has never been reported. We present here the first case of pazopanib-induced phototoxic drug reaction in a patient with renal cell carcinoma.
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http://dx.doi.org/10.1159/000494611DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6276734PMC
November 2018

Thyroid Autoimmunity and Autoimmunity in Chronic Spontaneous Urticaria Linked to Disease Severity, Therapeutic Response, and Time to Remission in Patients with Chronic Spontaneous Urticaria.

Biomed Res Int 2018 1;2018:9856843. Epub 2018 Nov 1.

Division of Dermatology, Department of Internal Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Background: Chronic spontaneous urticaria (CSU) is autoimmune in nature and associated with thyroid autoimmunity (TA), but evidence on autoimmunity in relation to CSU progression and prognosis is limited. We evaluated whether TA and autoimmunity in CSU are correlated with disease severity, therapeutic response, and time to remission and establish an association between CSU characteristics linked to thyroid autoantibody.

Methods: Medical records of patients diagnosed with urticaria attending outpatient dermatology clinic at a university-based hospital from 2013 to 2017 were retrospectively reviewed. Data on the clinical characteristics, laboratory investigations particularly thyroid antibody titers, autologous serum skin test (ASST) and autologous plasma skin test (APST) results and their link to disease severity, treatments, and time to remission of CSU patients were analyzed.

Results: Of 1,096 patients with urticaria, 60.2% had CSU. Three-hundred patients fulfilled the inclusion criteria for CSU with complete thyroid antibody testing. Positive TA was significantly associated with female gender and age > 35 years (p = 0.008). Antithyroid peroxidase (anti-TPO)-positive patients suffered from CSU longer than 12 and 18 months compared to anti-TPO-negative patients (100.0% vs. 82.6%, p = 0.042, and 100.0% vs. 75.9% p = 0.020, respectively). The presence of urticarial attacks > 4 days/week was significantly seen in ASST and APST-positive patients compared to those without (84.6% vs. 61.3%, p = 0.011, and 85.3% vs. 61.8%, p = 0.006, respectively). Positive APST patients were more difficult to treat than those with negative results (61.2% vs. 37.8%, p = 0.017).

Conclusions: Antithyroid peroxidase is a predictor of time to remission, while autologous skin testing is linked to disease severity (ASST and APST) and therapeutic response (APST) in CSU patients.
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http://dx.doi.org/10.1155/2018/9856843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236973PMC
March 2019

Reliability and validity of the Thai Drug Hypersensitivity Quality of Life Questionnaire: a multi-center study.

Int J Qual Health Care 2019 Aug;31(7):527-534

King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama IV Rd, Pathum Wan, Bangkok, Thailand.

Objective: To adapted the Drug Hypersensitivity Quality of Life (DrHy-Q) Questionnaire from Italian into Thai and assessed its validity and reliability.

Design: Prospectively recruited during January 2012-May 2017.

Setting: Multicenter; six Thai tertiary university hospitals.

Study Participants: Total of 306 patients with physician-diagnosed drug hypersensitivity.

Interventions: Internal consistency and test-retest reliability were evaluated among 68 participants using Cronbach's ɑ and intra-class correlation coefficient (ICC). The validity of Thai DrHy-Q was assessed among 306 participants who completed World Health Organization Quality of Life-BREF (WHOQOL-BREF-THAI). Construct and divergent validities were assessed for Thai DrHy-Q. Known-groups validity assessing discriminating ability was conducted in Thai DrHy-Q and WHOQOL-BREF-THAI.

Main Outcome Measures: Validity; reliability; single vs. multiple drug allergy; non-severe cutaneous adverse reactions (SCAR) vs. SCAR.

Results: Thai DrHy-Q showed good reliability (Cronbach's ɑ = 0.94 and ICC = 0.8). Unidimensional factor structure was established by confirmatory factor analysis (CFI&TLI = 0.999, RMSEA = 0.02). Divergent validity was confirmed by weak correlation between Thai DrHy-Q and WHOQOL-BREF-THAI domains (Pearson's r = -0.41 to -0.19). Known-groups validity of Thai DrHy-Q was confirmed with significant difference between patients with and without life-threatening SCAR (P = 0.02) and patients with multiple implicated drug classes vs. those with one class (P < 0.01); while WHOQOL-BREF-THAI could differentiate presence of life-threatening SCAR (P < 0.01) but not multiple-drug allergy.

Conclusions: Thai DrHy-Q was reliable and valid in evaluating quality of life among patients with drug hypersensitivity. Thai DrHy-Q was able to discriminate serious drug allergy phenotypes from non-serious manifestations in clinical practice and capture more specific drug-hypersensitivity aspects than WHOQOL-BREF-THAI.
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http://dx.doi.org/10.1093/intqhc/mzy207DOI Listing
August 2019

Hair and Scalp Changes in Cutaneous and Systemic Lupus Erythematosus.

Am J Clin Dermatol 2018 Oct;19(5):679-694

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.

Cutaneous and systemic lupus erythematosus (SLE) commonly involves the hair and scalp. Alopecia can result from direct activity of disease on the scalp or from the state of physical stress in the form of telogen effluvium. Discoid lupus erythematosus and lupus panniculitis/profundus are known to cause scarring alopecia, while accumulation of recent studies has shown that non-scarring alopecia in SLE may have different subtypes, comprising lupus erythematosus-specific and lupus erythematosus-nonspecific changes on histology. This review aims to summarize the clinical pattern, trichoscopic, histopathological, and direct immunofluorescence features of different types of alopecia in cutaneous and systemic lupus erythematosus, as well as exploring their relationship with SLE disease activity.
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http://dx.doi.org/10.1007/s40257-018-0363-8DOI Listing
October 2018

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis-Like Lupus Erythematosus.

J Clin Rheumatol 2019 Aug;25(5):224-231

From the Division of Dermatology, Department of Internal Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Background/objective: Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN)-like lupus erythematosus is a hyperacute and life-threatening form of cutaneous lupus erythematosus. Because of its rarity, little is known about this entity. We aimed to evaluate the clinical characteristics, laboratory findings, systemic manifestations, treatments, and outcome of SJS/ TEN-like lupus erythematosus.

Methods: We conducted a chart review study from July 2002 to September 2016 of all patients diagnosed with SJS/TEN-like lupus erythematosus who presented with gradual epidermal necrolysis without clear drug or infectious culprit. We evaluate for clinical features, extracutaneous involvement, Systemic Lupus Erythematosus Disease Activity Index, histologic findings, immunofluorescence pattern, serologic abnormalities, treatment, outcome, and recurrence of SJS/TEN-like lupus erythematosus.

Results: Of 9074 patients diagnosed with cutaneous lupus erythematosus and/or systemic lupus erythematosus, 6 patients justified the diagnosis of SJS/TEN-like lupus erythematosus (5 SJS/TEN-like acute cutaneous lupus erythematosus, 1 TEN-like subacute cutaneous lupus erythematosus), accounting for 0.07%. Fifty percent had epidermal necrolysis as the initial presentation of lupus with a median time from onset of 1.5 months (0-48 months). The median duration between initial rash and epidermal detachment was 4.5 days (3-14 days). All had internal organ involvement (hematologic and renal) and high Systemic Lupus Erythematosus Disease Activity Index score (median, 19.5 [16-24]). Most recovered with systemic corticosteroids, antimalarial drugs, and/or immunosuppressants. None had disease recurrence.

Conclusions: This is the largest single series of patients with SJS/TEN-like lupus erythematosus. Skin damage is an indicator of disease activity, and careful search for extracutaneous involvement to prevent further complications is mandatory.
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http://dx.doi.org/10.1097/RHU.0000000000000830DOI Listing
August 2019

Analysis of HLA-B Allelic Variation and IFN-γ ELISpot Responses in Patients with Severe Cutaneous Adverse Reactions Associated with Drugs.

J Allergy Clin Immunol Pract 2019 01 22;7(1):219-227.e4. Epub 2018 May 22.

Division of Dermatology, Department of Medicine, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand.

Background: The prevention and confirmation of drug-induced severe cutaneous adverse reactions (SCARs) are difficult.

Objective: To determine the benefit of HLA-B allele prescreening and the measurement of drug-specific IFN-γ-releasing cells in the prevention and identification of the culprit drug in patients with SCARs.

Methods: A total of 160 patients with SCARs were recruited from 6 university hospitals in Thailand over a 3-year period. HLA-B alleles were genotypically analyzed. The frequencies of drug-specific IFN-γ-releasing cells in patients with SCARs were also measured.

Results: The drugs commonly responsible for SCARs were anticonvulsants, allopurinol, beta-lactams, antituberculosis agents, and sulfonamides. If culprit drugs had been withheld in patients carrying known HLA-B alleles at risk, it would have prevented 21.2% of SCAR cases, mainly allopurinol- and carbamazepine-related SCARs. Culprit drug-specific IFN-γ-releasing cells could be identified in 45.7% (53 of 116) of patients with SCARs caused by 5 major drug groups, particularly in patients diagnosed with drug reactions with eosinophilia and systemic symptoms (DRESS) (50.0%), followed by Stevens-Johnson syndrome/toxic epidermal necrolysis (46.0%), and acute generalized exanthematous pustulosis (31.3%). According to our study, high frequencies of drug-specific IFN-γ-releasing cells were significantly demonstrated in patients who suffered from DRESS phenotype, having anticonvulsants or the drugs belonging to the "probable" category based on the Naranjo algorithm scale, as the culprit drugs.

Conclusions: HLA-B prescreening would succeed in preventing only a minority of SCAR victims. Drug-specific IFN-γ-releasing cells are detectable in almost half of patients. Better strategies are required for better SCAR prevention and culprit drug confirmation.
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http://dx.doi.org/10.1016/j.jaip.2018.05.004DOI Listing
January 2019

Behaviors and Attitudes Toward Cosmetic Treatments Among Men.

J Clin Aesthet Dermatol 2018 Mar 1;11(3):42-48. Epub 2018 Mar 1.

Drs. Girdwichai, Chanprapaph, and Vachiramon are with the Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University in Bangkok, Thailand.

Cosmetic treatments have gained popularity worldwide. However, little is known about the behaviors and attitudes toward cosmetic treatments in men. The authors sought to explore the behaviors and attitudes toward cosmetic treatments in male patients. A cross-sectional study was conducted involving male patients aged 18 to 70 years, who presented for cosmetic consultation at an outpatient dermatology clinic in a university-based hospital. Behaviors and attitudes were assessed using a self-response questionnaire. For comparison, female patients with the same inclusion criteria were also assessed. A total of 302 male patients completed the questionnaire. The internet and close family members were the two most important sources of cosmetic treatment information. Men preferred oral medication compared to women (<0.01). Regarding topical medication, men prefer gel formulations, tube containers, and white-colored packaging. The maximum chosen number of topical medication is three items. The most important factor in medical provider selection was the dermatologists' knowledge and expertise. Behaviors and attitudes toward cosmetic treatment in male patients were different from those seen in female patients. It is essential to alter the approaches regarding cosmetic treatments when treating men.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5868785PMC
March 2018