Kanokvalai Kulthanan

• Doctor of Medicine
• Professor at Mahidol University

Background and Objectives Systemic treatment of pregnant/breastfeeding atopic dermatitis (AD) patients is challenging due to limited safety data. We explored treatment practices with systemic agents, including the guideline‐recommended cyclosporine as the first systemic choice as well as emerging therapies, in this vulnerable population. Patients...

Background Moderate‐to‐severe acne vulgaris (AV) remains a therapeutic challenge, often demonstrating resistance to standard interventions, including topical agents, oral antibiotics, and systemic retinoids. Nonablative monopolar radiofrequency (NMRF) offers a promising alternative by delivering controlled dermal heating without epidermal disruptio...

Background: Limited data exist regarding recurrent chronic spontaneous urticaria (RCSU) following complete disease remission. Objective: This study investigated the clinical characteristics and factors associated with RCSU. Methods: We retrospectively reviewed data from chronic spontaneous urticaria (CSU) patients who actively visited the Urti...

Background Chronic urticaria (CU), in both inducible and spontaneous forms, is associated with a substantial burden in the Asia-Pacific region (APAC). Patient-centred care recognises patients desire to be involved in decisions regarding their health. Although patient-centred approaches have previously not been studied in the context of CU managemen...

Purpose: A booster coronavirus disease 2019 (COVID-19) vaccination was proposed to preserve immunity and prevent new variants of the severe acute respiratory syndrome coronavirus 2 virus. The objectives of this study are to investigate clinical manifestations, associated factors and course of cutaneous reactions after the booster dose of COVID-19...

Background CRUSE® is an app that allows patients with chronic spontaneous urticaria (CSU) to monitor their daily disease activity through the use of visual analogue scales (VASs). We aimed to determine the concurrent validity, reliability, responsiveness and minimal important difference (MID) of CRUSE® VASs. Methods We evaluated the properties of...

Background. Limited knowledge exists about genital psoriasis in Thai individuals. Objectives. This study aimed to assess the clinical features of genital psoriasis and its effects on quality of life and sexual health in Thai patients. Materials and Methods. A cross-sectional, self-administered question-based study was conducted at Siriraj Hospital....

Background The understanding of genital vitiligo among Thai individuals is limited. Objectives This study evaluated the clinical presentation, quality of life, and sexual health consequences of genital vitiligo. Methods This cross-sectional, questionnaire-based study involving vitiligo patients aged 18 years or older with past or present genital...

Background Indirect immunofluorescence (IIF) plays a crucial role in the diagnosis of pemphigus and bullous pemphigoid (BP) by detecting the presence of circulating autoantibodies in the serum of patients. The standard serum transportation method requires delivery to laboratories at 2–8 °C within a day and storage at –20 to –80 °C. However, this pr...

Chronic urticaria is classified as spontaneous (without definite triggers) and inducible (with definite and subtype-specific triggers; eg, cold or pressure). Current management guidelines recommend step-up administration of second-generation H1-antihistamines to four-fold the approved dose, followed by omalizumab and ciclosporin. However, in many p...

Niniejsza aktualizacja i rewizja międzynarodowych wytycznych dotyczących pokrzywki została opracowana zgodnie z metodami zalecanymi przez Cochrane i grupę roboczą Grading of Recommendations Assessment, Development and Evaluation (GRADE). Jest to wspólna inicjatywa Dermatology Section of the European Academy of Allergology and Clinical Immunology (E...

Limited data exist on the factors associated with hospitalization and mortality in Asian inpatients with autoimmune bullous dermatoses (AIBDs). This study aimed to elucidate the risk factors affecting hospitalization and mortality rates in Asian patients with AIBDs. A retrospective analysis of patients with AIBDs treated at Siriraj Hospital during...

Background There is a lack of real-life safety data on treatment options for chronic urticaria in the presence of comedication and comorbidities. Methods We present a single-center UCARE pilot study of 212 outpatients with chronic urticaria. Patients were divided into three groups according to different CU therapies according to international guid...

Background Acne vulgaris (AV) is a prevalent skin condition known for its potential to cause scarring and psychological distress, often leading to diminished self‐esteem. While topical and oral treatments are commonly prescribed, some patients experience treatment failure, adverse effects, or contraindications to conventional therapies. In response...

Background Baricitinib treatment in adults with moderate‐to‐severe atopic dermatitis (AD) has demonstrated rapid improvements in itch as well as AD sign severity and affected body surface area as assessed by the Eczema Area and Severity Index (EASI) total score, whether administered as monotherapy or in combination with topical corticosteroids (TCS...

In vitro investigations of mast cell (MC) degranulation are essential for studying many diseases, particularly allergy and urticaria. Many MC-degranulation inducers are currently available. However, there is no previous systematic comparative analysis of these available inducers in term of their efficacies to induce MC degranulation. Herein, we per...

Objective: This study aimed to assess the effects of AFA and its associated factors, especially those coexisting with hyperandrogenism or PCOS, on QoL using the Dermatology Life Quality Index (DLQI). Materials and Methods: A retrospective cross-sectional study was conducted on AFA patients who had been treated between May 2018 and January 2020. Der...

Introduction The integrated care pathways for atopic dermatitis (AD‐ICPs) aim to bridge the gap between existing AD treatment evidence‐based guidelines and expert opinion based on daily practice by offering a structured multidisciplinary plan for patient management of AD. ICPs have the potential to enhance guideline recommendations by combining int...

Mast cells and eosinophils are considered pivotal contributors to the pathogenesis of chronic spontaneous urticaria (CSU). However, emerging evidence suggests that neutrophils also play a central role. Cutaneous mast cells and macrophages orchestrate the recruitment of neutrophils through the regulation and activation of diverse processes, includin...

Background: Patients with chronic spontaneous urticaria (CSU) have spontaneous wheals, angioedema, or both for >6 weeks. Clinical differences between patients with standalone wheals (W), standalone angioedema (AE), and wheals and angioedema (W+AE) remain incompletely understood. Objective: To compare W, AE, and W+AE CSU patients regarding demogr...

Background: "Blue wheals" and "blue angioedema", the adverse reactions to blue-dye injections with or without anaphylaxis, are poorly defined. Objective: The objective is to review the characteristics (i.e., sex and age at onset, interval between blue dye injection and symptom onset, clinical manifestations, duration of blue wheals or angioedema...

Chronic urticaria is a disease that can significantly impact a patient's quality of life and ability to function. There are effective treatment options, such as non-sedating antihistamines or biologics, but some patients do not respond to these therapies, or the therapies are not available or affordable to all patients. This review aims to summariz...

Objective: This study aimed to investigate the validity and reliability of the Thai version of FDLQI. Materials and Methods: Patients and their accompanying family members attending the Dermatology Outpatient Clinic at Siriraj Hospital were asked to complete the Dermatology Life Quality Index (DLQI), FDLQI, and the global question of their QoL (GQo...

Background: There are gaps in our understanding of the epidemiology of atopic dermatitis (AD) in adults. Objective: To evaluate the prevalence and severity of AD in adults from countries/regions within Asia, Eurasia, Latin America, Middle East, and Russia. Methods: This international, web-based survey was performed in Argentina, Brazil, China,...

Background: Food-dependent exercise-induced allergic reactions can manifest with wheals, angioedema, and anaphylaxis, alone or in combination. Objective: To systematically review the clinical manifestation, culprit foods and exercise, augmenting factors, comorbidities, and treatment options of each phenotype. Methods: Using predefined search t...

Background: Angioedema (AE) is a condition associated with considerable morbidity and mortality that can significantly affect quality of life. AE often occurs in patients with CSU although the true prevalence remains unknown. Therefore, we conducted this systematic review and meta-analysis to summarize the available data. Objective: This study i...

Objective: To evaluate the characteristics of post-adolescent male patients with acne in terms of the onset of the condition, its clinical course and severity, and the behaviors associated with its severity. Materials and Methods: A prospective, cross-sectional study was conducted on adult males with acne who visited Siriraj Hospital, Thailand. All...

Cutaneous manifestations of lupus erythematosus (LE) have a variety of clinical phenotypes and require proper investigation for diagnosis. Knowledge of the direct immunofluorescence (DIF) technique has improved and played an important role in the diagnosis of cutaneous LE. This review explores and summarizes reported DIF findings of each cutaneous...

Background: The Angioedema Control Test (AECT) is a questionnaire that monitors disease control in patients with angioedema, with a recall period of 4 weeks (AECT-4wk) or 3 months (AECT-3mo). Objective: This study investigated the psychometric properties of a Thai version of the AECT. Methods: Of 54 patients, 46, 5, 2, and 1 had recurrent angi...

Background: Rosacea is primarily an inflammatory disease of facial skin associated with impaired skin barrier function. While it is commonly thought of as a Caucasian person's disease, it is likely underdiagnosed in people of color, including Asians, leading to missed and delayed diagnoses and increased morbidity. The purpose of this review is to...

Background and Objective Chronic spontaneous urticaria (CSU) is a distressing disease. We report real-world data from the global Chronic Urticaria Registry (CURE) about associations between various CSU states and sleep impairment, plus important health-related quality of life (HRQoL) outcomes and compared different methods to assess CSU states. Me...

Background: Antinuclear antibody (ANA) is often used as a screening test for autoimmune comorbidities in patients with chronic spontaneous urticaria (CSU). However, the relationship of ANA status and the clinical course of the disease have not been fully described. Objectives: To compare clinical features of CSU patients who are positive and neg...

Background: Dermographism is the most common form of chronic inducible urticaria. However, the natural history and clinical course of patients with dermographism in tropical countries has not fully been described. Objective: To examine clinical features, natural history and clinical course of dermographism in Thai patients according to their exp...

Background: Cutaneous adverse events after receiving a COVID-19 vaccine were identified. The disease activity of urticaria after a COVID-19 vaccine has never been explored in chronic urticaria patients. Objective: To evaluate disease activity of chronic urticaria after receiving a COVID-19 vaccine. Methods: A prospective cross-sectional study...

Mast cell activation plays a key role in various allergic diseases and anaphylaxis. Several methods/techniques can be used for detection of mast cell activation. However, there was no previous systematic evaluation to compare the efficacy of each method/technique. The present study thus systematically compared various markers for mast cell activati...

Background: Androgenetic alopecia (AGA), regarded as the most common cause of hair disorder with increased frequency and severity as patients become older, negatively affects patients’ self-image, activities of daily living, and quality of life. Objective: To assess the quality of life of Thai male AGA patients using the Thai-language Dermatology L...

Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) and drug reactions with eosinophilia and systemic symptoms (DRESS) are the most common severe cutaneous adverse drug reactions (SCARs). Anti-epileptic drugs are one of the most common drugs causing SCARs. Cytokine profiles of SCARs during culprit drug exposure have never been characteriz...

Urticaria is an inflammatory skin disorder that affects up to 20% of the world population at some point during their life. It presents with wheals, angioedema or both due to activation and degranulation of skin mast cells and the release of histamine and other mediators. Most cases of urticaria are acute urticaria, which lasts ≤6 weeks and can be a...

Background Cryotherapy is typically performed by physicians. No cost-utility studies of home-based cryotherapy have been reported. Objectives To study the cost utility of home-based cryotherapy devices and in-hospital liquid nitrogen therapy for cutaneous warts. Materials and methods This randomized, controlled, investigator-blinded trial was car...

Background Chronic inducible urticaria (CIndU) constitutes a group of nine different CIndUs in which pruritic wheals and/or angioedema occur after exposure to specific and definite triggers. Histamine released from activated and degranulating skin mast cells is held to play a key role in the pathogenesis of CIndU, but evidence to support this has,...

Background: Food-dependent exercise-induced wheals, angioedema, and anaphylaxis remain insufficiently characterized. Objective: We systematically reviewed the literature on clinical manifestations, laboratory investigations, culprit foods, triggering exercise, comorbidities, and treatment outcomes. Methods: Using predefined search terms and Pr...

Background: Moisturizers play an important role in restoring the skin barrier. They should be used to treat and prevent eczema, especially in atopic dermatitis (AD). Objective: To evaluate the factors that influence selection of moisturizers in adult patients with AD and without it. Usage behavior between the two groups was also determined. Met...

Background Aquagenic urticaria (AquaU) is a rare variant of chronic inducible urticaria where wheals occur after skin contact with water. Information on clinical manifestations and treatment outcomes is limited, which makes the management of AquaU challenging. Objective To systematically review disease features and relevant triggers of AquaU and p...

Acknowledgement: This work benefited from the support of the GA2LEN UCARE network (www.ga2len-ucare.com), and the results reported here were presented at the First Qatar Allergy Conference and published in Allergy, the European Journal of Allergy and Clinical Immunology.

Intramuscular adrenaline is the first-line treatment for anaphylaxis and an adrenaline autoinjector (AAI) should be carried as a first-aid measure by patients at risk. Cold-induced anaphylaxis (ColdA), which may result in fatality, is common in typical cold urticaria (ColdU), and risk factors for ColdA have recently been identified for the first ti...

Background: Association between chronic spontaneous urticaria (CSU) and autoimmunity has been well documented. Autologous serum skin testing could support the autoimmune etiology of CSU, whereas it is difficult to interpret and could not be performed on antihistamine omitted patients. It was found that immunoglobulin G (IgG) autoantibodies (autoAb...

Purpose Data specific to the epidemiology, clinical features, and management of chronic urticaria (CU) in the geriatric population remain limited and not well understood. We aim to systematically review the prevalence, clinical manifestations, treatment, and clinical course of elderly patients with CU. Patients and methods Original articles that i...

Background Cold urticaria (ColdU), that is, the occurrence of wheals or angioedema in response to cold exposure, is classified into typical and atypical forms. The diagnosis of typical ColdU relies on whealing in response to local cold stimulation testing (CST). It can also manifest with cold‐induced anaphylaxis (ColdA). We aimed to determine risk...

Background: Cold urticaria (ColdU), i.e. the occurrence of wheals or angioedema in response to cold exposure, is classified into typical and atypical forms. The diagnosis of typical ColdU relies on whealing in response to local cold stimulation testing (CST). It can also manifest with cold-induced anaphylaxis (ColdA). We aimed to determine risk fac...

Background: Acne vulgaris (acne) is a common inflammatory skin disorder prevalent among all ethnic groups. This review aimed to investigate the current literature regarding the potential benefit of over-the-counter (OTC) adjuncts (eg, moisturizers, cleansers) for acne patients focusing on Asian phenotypes. Methods: An online procedure was employ...

Background: Pitted keratolysis (PK) is a superficial bacterial infection diagnosed mainly by clinical manifestations. Current data on its dermoscopic and histopathological findings, and the correlation of those findings, are limited. Objectives: To evaluate the clinical manifestations, dermoscopic, and histopathological findings of PK and to det...

This update and revision of the international guideline for urticaria was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI),...

Background Adult female acne (AFA) may be different from adolescent acne, and may be a sign of polycystic ovary syndrome (PCOS). The objective of the study was to investigate the clinical characteristics of AFA, and the factors significantly associated with PCOS in AFA. Methods AFA patients aged 25 years or older were enrolled. History taking and...

This retrospective study was aimed to investigate direct immunofluorescence (DIF) finding between oral and cutaneous lichen planus (LP). Of 147 cases with a definite diagnosis of LP by clinical and histological criteria, 125 cases (85%) demonstrated the positive immunofluorescence findings. The positive yields were significantly lower in oral LP (7...

Atopic dermatitis (AD), a chronic, relapsing dermatitis, is characterized by dry and pruritus skin in patients with a personal or family history of atopy. It affects up to 20% of children and 1-3% of adults in most countries worldwide, and leads to significant treatment costs and morbidity. These guidelines are developed in accordance with evidence...

The increasing incidence of frontal fibrosing alopecia (FFA) suggests that environmental factors may be related to the pathogenesis. Recent studies reported potential association between the use of facial care products and FFA. The aim of this study was to investigate the possible association between the use of facial care products and FFA in Asian...

Background: COVID-19 is a pandemic disease worldwide. Although cutaneous manifestations may present in affected patients, there have been limited studies on the cutaneous findings and hair and nail abnormalities after discharge. Objective: To establish the cutaneous manifestations, hair and scalp disorders, and nail abnormalities in patients who...

Chronic spontaneous urticaria is characterized by a perivascular non-necrotizing cellular infiltrate around small venules of the skin. It consists primarily of CD4(+) lymphocytes, a prominence of the Th-2 subtype but also Th-1 cells, with Th 17 cell derived cytokines elevated in plasma. There are also neutrophils, eosinophils, basophils, and monocy...

Background Intertrigo is an inflammatory skin‐fold condition. Candida infections may occur concurrently or afterwards. Topical corticosteroids may reduce inflammation but exacerbate Candida infections. The treatment is contentious. Objective To evaluate the efficacies and safety of adsorbent lotion containing tapioca starch, spent grain wax, Butyr...

Introduction The COVID‐19 pandemic dramatically disrupts health care around the globe. The impact of the pandemic on chronic urticaria (CU) and its management are largely unknown. Aim To understand how CU patients are affected by the COVID‐19 pandemic; how specialists alter CU patient management; and the course of CU in patients with COVID‐19. Ma...

Cold urticaria (ColdU) is a common form of chronic inducible urticaria characterized by the development of wheals, angioedema or both in response to cold exposure. Recent research and guideline updates have advanced our understanding and management of ColdU. Today, its pathophysiology is thought to involve the cold‐induced formation of autoallergen...

Many topical agents are available for treating the acute phase of acne; however, few agents have been proven beneficial during the maintenance phase. Objective. To evaluate the efficacy and safety of moisturizer containing licochalcone A, 1,2-decanediol, L-carnitine, and salicylic acid during the maintenance phase of mild to moderate acne in Thai p...

Background: Barrier repair therapy is the key management approach for both eczematous and non-lesional skin of atopic dermatitis. The use of appropriate cleansers to enhance skin hydration is an adjunctive treatment that increases topical drug penetration. Anti-inflammatory properties of various medicinal plants in tropical Asia have been reported...

Chronic urticaria (CU) affects about 1% of the world population of all ages, mostly young/middle-aged females, usually lasts for several years (>1 year in 25-75% of patients), and often takes >1 year before effective management is implemented. It presents as chronic spontaneous urticaria (CSU), chronic inducible urticaria (CIndU) or both in the sam...

Background: Vibratory angioedema (VA) is a subtype of chronic inducible urticaria that manifests with erythematous wheals or angioedema after skin exposure to vibration. Since the condition is rare, the available information is limited. Objective: To systematically review the clinical manifestations and treatment options of VA. Methods: Releva...

Background Vitiligo is a common chronic autoimmune disease that is characterized by progressive loss of skin color due to melanocyte destruction. In addition to the physical effects of vitiligo, this condition exerts adverse psychological effects and causes social stigmatization. Earlier studies reported that individuals with vitiligo suffer from p...

Background: Cholinergic urticaria (CholU) is a subset of chronic inducible urticaria characterized by the recurrent pinpoint-sized wheals that are induced by exercising or increasing core body temperature. Currently, the data of CholU in tropical climate is still limited. Objective: To investigate the clinical features and natural course of Chol...

Background Symptomatic dermographism (SD), the most common form of chronic inducible urticaria, presents with transient wheals accompanied by itching in response to scratching. Little is known about available treatment options and their efficacy in SD. Objective To systematically review the efficacy of treatment options for patients with SD. Meth...

Background Chronic urticaria (CU) is a condition characterized by recurrent itchy hives and/or angioedema for ≥6 weeks. Most of the data about CU come from western countries with very little information available about CU in Asia, Africa, and the Middle East. Methods AWARE-AMAC is a 24-month prospective, observational, real-world, non-intervention...

Background: Pruritus is commonly associated with skin disorders. The 5-D itch scale was developed as a specific questionnaire for pruritus. Objective: This study aimed to evaluate the validity, reliability, and sensitivity to change of the Thai 5-D itch scale in Thai patients. Methods: The Thai Dermatology Life Quality Index (DLQI), patient's...

Background Delayed pressure urticaria (DPU) is characterized by recurrent erythematous and often painful swelling after the skin is exposed to sustained pressure. Treatment is challenging. Antihistamines, the first-line and only approved treatment, are often not effective. Objective To systematically review the treatment options for DPU. Method A...

The Angioedema Activity Score (AAS) is recommended by the EAACI/GA ² LEN/EDF/WAO guidelines for urticaria as the standard measure for assessing disease activity in patients with recurrent angioedema (RAE). To date, it has been translated into 80 languages for use in 52 countries, but it has not been formally validated in Asian patient populations....

Background: The Angioedema Quality of Life (AE-QoL) is the first patient reported outcome measure developed for the assessment of quality of life (QoL) impairment in patients with recurrent angioedema (RAE). This study aimed to evaluate the clinimetric properties of the AE-QoL in Thai patients and to establish categories of QoL impairment assessed...

Purpose: This study aimed to systemically review literature relating to factors that could potentially predict a favorable response to cyclosporine A (CsA) treatment for chronic spontaneous urticaria (CSU). Methods: A systematic literature review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendat...

Purpose: To review the clinical features and natural courses of cold urticaria (ColdU) in a tropical country. Methods: A retrospective chart review was performed of patients who visited Siriraj Urticaria Clinic, Siriraj Hospital, Bangkok, Thailand, and were diagnosed with ColdU between 2007 and 2018. Data on provocation and threshold tests, clin...

Background: Several treatment options for cold urticaria (ColdU) have been studied and reported, but systematic reviews and meta-analyses are limited. Objectives: We sought to meta-analyze and review the efficacy and safety of ColdU treatments. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)...

Background Vitamin D has been reported to be associated with many allergic diseases. There are a limited number of the studies of vitamin D supplementation in patients with chronic spontaneous urticaria (CSU). This study aims to study the relationship between vitamin D and CSU in terms of serum vitamin D levels, and the outcomes of vitamin D supple...

Diese evidenz- und konsensbasierte Leitlinie wurde entsprechend den Methoden der Cochrane und der Grading of Recommendations Assessment, Development and Evaluation (GRADE)-Arbeitsgruppen entwickelt. Die Leitlinien-Konferenz fand am 1. Dezember 2016 statt. Sie ist eine gemeinsame Initiative der European Academy of Allergology and Clinical Immunology...

Background: Studies of Pitted keratolysis (PK) treatment are limited. Objectives: To study cost-effectiveness and to compare the safety of 4% chlorhexidine scrub with 4% erythromycin gel, for PK infections. Materials and methods This cohort study was conducted on naval rating cadets with a clinical diagnosis of PK at Chumpol Naval Rating School, Th...