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.
A five-year-old boy presented with a six-week history of scales, flaking and crusting of the scalp. He had mild pruritus but no pain. He did not have a history of atopy and there were no pets at home. Examination of the scalp showed thick, yellowish dry crusts on the vertex and parietal areas and the hair was adhered to the scalp in clumps. There was non-scarring alopecia and mild erythema. There was no cervical or occipital lymphadenopathy. The patient’s nails and skin in other parts of the body were normal.
Antibiotic resistant P. acnes have influenced acne therapy worldwide resulting in increased use of topical and systemic retinoids. Judicious use of oral antibiotic is important for effective therapeutic outcome. To determine the response and side effects of oral antibiotic treatment in acne vulgaris. To determine the type of antibiotic used, therapy duration and the types of concomitant topical therapy. Retrospective analysis of the therapeutic response to oral antibiotics therapy in acne vulgaris in the Dermatology Department, Hospital Kuala Lumpur. New cases of acne vulgaris from 2005 to 2009 were randomly selected. The clinical notes of 250 patients treated with oral antibiotics were reviewed. About 60% of patients achieved good to excellent response to therapy while satisfactory response was seen in 26%. Only 8% patients experienced minor side effects. Doxycycline was the most frequently prescribed antibiotic, followed by tetracycline and erythromycin ethylsuccinate. The prescribing pattern was consistent over the years. The mean duration of treatment is four to five months. Oral antibiotic was augmented with topical therapy in 98.8% of patients. Good to excellent therapeutic response was achieved in the majority of patients and results observed have remained stable over the last five years.