Introduction: Sun exposure is a risk for skin cancer but is beneficial for multiple other diseases. Recommendations for photoprotection are well defined, guidelines for optimal sun exposure is not clear. We determined sun exposure in healthy adults, considering their skin phototype and amount of skin exposed. Methods: A cross sectional study was performed involving healthy adults working in a tertiary health facility. Fitzpatrick skin phototype quiz was used to determine skin phototype. Sun exposure was quantified as an index (SEI); body surface area exposed times duration of exposure. Results: We recruited 167 volunteers, 110(66%) women and 56(34%) men. Mean age was 29.77±6.58 years, 124(74.7%) were Malay, 27(16.3%) Chinese, 14(8.4%) Indians and 1(0.6%) of other ethnicity. Fitzpatrick skin phototypes were 30(18.1%) type III, 109(65.7%) type IV and 27(16.3%) type V. Exposed body surface area was 13.96±8.33% in males and 14.55±9.58% in females. The duration of sun exposure per week in males was 11.52±6.11hours and 10.71±5.75 hours in females. Mean SEI was 160 ±144. The SEI in females was 158 ±151, 164 ±130 in males, p value =0.81. There were no significant differences in SEI between gender and skin phototypes. Conclusion: SEI was very low in our study population due to limited body surface area exposed and duration of sun exposure. SEI was higher in darker skin and males, however these were not statistically significant.
Doctor shopping increases health economic burden and morbidities. Its prevalence and predisposing factors have to be identified in order to formulate preventive measures. We aimed to determine the prevalence of doctor shopping, its reasons and predisposing factors by conducting a cross sectional study of new patients at the Dermatology Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Doctor shopping was defined as having consultation with ≥3 healthcare providers without a referral for the same illness prior to the patients’ visit to UKMMC. Reasons and contributing factors were classified as disease, healthcare provider, logistic and cost related. Data was collected by a face to face interview. Dermatology Life Quality Index (DLQI) questionnaire determined disease impact on the patients. A total of 58 (55.8%) female and 46 (44.2%) male patients participated. Referral was patient-initiated in 51.9% while 40.4% were doctor shopping. Age, gender, ethnicity, income, occupation and type of health finance provider were not associated with this behaviour. About 95% doctor shopped due to disease factors: searching for a cure (95.2%), lack of improvement (88.1%), worsening disease (50.0%), dissatisfaction with treatment (31.0%), seeking other opinions (26.2%) and exploring treatment options (26.2%). Impaired DLQI (OR 1.17; 95% CI 1.08,1.38), p 0.04, and disease related factors (OR 6.57; 95% CI 1.52, 7.72), p 0.041 were significant independent risk factors. Doctor shopping is very common among our patients. Reasons and predisposing factors are predominantly disease related. Patient education and counselling is important in management of dermatological diseases to prevent doctor shopping.
Introduction: Atopic dermatitis (AD) and its severity has been inconsistently associated with lower vitamin D levels as multiple other factors that influence vitamin D status were not always assessed. Methods: A case control study involving AD patients and controls 18 years old was performed. Exclusion criteria were systemic immunosuppres- sion 4 weeks prior to recruitment, renal or hepatic impairment, parathyroid diseases and vitamin D or calcium supplementation. Healthy controls were matched for age, gender, ethnicity, Fitzpatrick skin type and body mass index (BMI). Sun exposure, a 3-day, 24-hour dietary recall and serum 25-hydroxyvitamin D were measured. Re- sults: 38 AD patients and 38 controls participated. Majority had Fitzpatrick skin type IV. Vitamin D was lower in AD [15.9(9.9-24.0)ng/ml] than controls [17.3(14.4-27.2)ng/ml], p= 0.028. It was sufficient in 16(42.1%) AD and 15(39.5%) controls, insufficient in 7(18.4%) AD and 22(57.9%) controls and deficient in 15(39.5%) AD compared to 1(2.6%) control. Sun exposure was similar in both groups. AD had significantly higher dietary vitamin D intake [1.5(0.6-3.1) vs 0.6 (0.3-1.0)µg]. AD was an independant risk for vitamin D deficiency with OR 17.52; 95%CI:1.4-
212.7 and vitamin D insufficiency OR 0.26;95%CI:0.07-0.95. Vitamin D levels did not correlate with AD severity. Conclusion: AD is a risk for vitamin D deficiency despite higher dietary intake and similar skin type, BMI and sun exposure as controls.
Trichotillomania (TTM) or hair pulling disorder is characterized by repetitive pulling of hair on
the body whereas Polycystic Ovarian Syndrome (PCOS) is a metabolic-endocrine disorder,
manifested by irregular menstrual cycle and clinical hyperandrogenism. Both disorders
commonly occur in young females. TTM and PCOS may be related and share the same
pathophysiology. We reported a case of a teenager with TTM and PCOS, which were triggered
by stress. Neurobiological mechanism may explain the co-occurrences between TTM and
PCOS. Further research in the neurobiology of TTM and PCOS may better explain the cooccurrences between the two disorders.