Kin Fon Leong’s research while affiliated with Hospital Kuala Lumpur and other places

This case series demonstrate that secukinumab therapy for for paediatric patients with congenital ichthyosis is safe and have variable efficacy, similar to results from clinical trial in adult patients. Good response is seen in patients with the erythrodermic phenotypes, namely congenital ichthyosiform erythroderma and Netherton syndrome, with minor response seen in lamellar ichthyosis phenotypes. Clinical data is overall lacking for paediatric population, and this study adds some insights to the existing research.

Plaque psoriasis is a chronic, systemic inflammatory skin condition that is associated with potentially serious comorbidities and can cause a significant negative impact on the quality of life of affected patients. Around one-third of patients exhibit the initial signs of psoriasis during childhood, typically around the age of 9 years. The interleukin-17A monoclonal antibody secukinumab is one of the targeted biologics that has been approved for the treatment of moderate-to-severe plaque psoriasis in pediatric patients aged 6 years and older. We present a case series of pediatric patients with severe plaque psoriasis who were successfully treated with secukinumab. All four patients showed significant improvement and achieved at least a Psoriasis Area and Severity Index (PASI)-90 with sustained remission. No adverse events were reported.

Autosomal recessive congenital ichthyosis (ARCI) is a group of nonsyndromic rare diseases that affect keratinization. To date, more than 14 causative genes have been identified. ARCI caused by mutations in CYP4F22 is extremely rare. CYP4F22, a protein of the cytochrome-P450 family 4, encodes an epidermal ω-hydroxylase decisive for the formation of acylceramides, which is hypothesized to be important for epidermal barrier function. We report two siblings with ARCI associated with a homozygous missense mutation in CYP4F22, with overlap phenotypic features of lamellar ichthyosis and nonbullous congenital ichthyosiform erythroderma.

Background Pinworm infestation is an important public health problem worldwide, especially among children 5 to 10 years of age in developing countries with temperate climates. The problem is often overlooked because of its mild or asymptomatic clinical manifestations. Objective The purpose of this article was to familiarize pediatricians with the diagnosis and management of pinworm infestation. Methods A search was conducted in August 2023 in PubMed Clinical Queries using the key terms "Enterobius vermicularis," OR "enterobiasis," OR "pinworm." The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. Results Enterobiasis is a cosmopolitan parasitosis caused by Enterobius vermicularis. It affects approximately 30% of children worldwide and up to 60% of children in some developing countries. Predisposing factors include poor socioeconomic conditions, inadequate sanitation, poor personal hygiene, and overcrowding. Children aged 5 to 14 years have shown the highest prevalence of enterobiasis.. Egg transmission is mainly by the fecal-oral route. Approximately 30 to 40% of infested patients do not show any clinical symptoms of the disease. For symptomatic patients, the most common presenting symptom is nocturnal pruritus ani. The diagnosis of E. vermicularis infection is best established by the cellophane tape test. The sensitivity of one single test is around 50%; however, the sensitivity increases to approximately 90% with tests performed on three different mornings. If a worm is visualized in the perianal area or the stool, a pathological examination of the worm will yield a definitive diagnosis. As pinworms and eggs are not usually passed in the stool, examination of the stool is not recommended. The drugs of choice for the treatment of pinworm infestation are mebendazole (100 mg), pyrantel pamoate (11 mg/kg, maximum 1 g), and albendazole (400 mg), all of the above-mentioned drugs are given in a single dose and repeated in two weeks. Mebendazole and albendazole are both adulticidal and ovicidal, whereas pyrantel pamoate is only adulticidal. Given their safety and effectiveness, mebendazole and albendazole are currently the best available drugs for the treatment of pinworm infestation. For pregnant women, pyrantel is preferred to mebendazole and albendazole. Treatment of all household members should be considered, especially if there are multiple or repeated symptomatic infections because reinfection is common even when effective medication is given. Conclusion In spite of effective treatment of pinworm infestation, recurrences are common. Recurrences are likely due to repeated cycles of reinfection (particularly, autoinfection) because of the short life span of adult pinworms. Good personal hygiene, such as frequent handwashing, especially after bowel movements and before meals, clipping of fingernails, avoidance of finger-sucking, nail-biting, and scratching in the anogenital area, are important preventive measures. Treatment of all household members should be considered, especially if there are multiple or repeated symptomatic infections.

Background: Lichen striatus is a benign dermatosis that affects mainly children. This condition mimics many other dermatoses. Objective: The purpose of this article is to familiarize pediatricians with the clinical manifestations of lichen striatus to avoid misdiagnosis, unnecessary investigations, unnecessary referrals, and mismanagement of lichen striatus. Methods: A search was conducted in June 2023 in PubMed Clinical Queries using the key term “Lichen striatus”. The search strategy included all observational studies, clinical trials, and reviews published within the past ten years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of this article. Results: Lichen striatus is a benign self-limited T-cell mediated dermatosis characterized by a linear inflammatory papular eruption seen primarily in children. The onset is usually sudden with minimal or absent symptomatology. The eruption in typical lichen striatus consists of discrete, skin- colored, pink, erythematous, or violaceous, flat-topped, slightly elevated, smooth or scaly papules that coalesce to form a dull red, potentially scaly, interrupted or continuous band over days to weeks. Although any part of the body may be involved, the extremities are the sites of predilection. Typically, the rash is solitary, unilateral, and follows Blaschko lines. In dark-skinned individuals, the skin lesions may be hypopigmented at onset. Nails may be affected alone or, more commonly, along with the skin lesions of lichen striatus. The differential diagnoses of lichen striatus are many and the salient features of other conditions are highlighted in the text. Conclusion: Lichen striatus is a self-limited condition that often resolves within one year without residual scarring but may have transient post-inflammatory hypopigmentation or hyperpigmentation. As such, treatment may not be necessary. For patients who desire treatment for cosmesis or for the symptomatic treatment of pruritus, a low- to mid-potency topical corticosteroid or a topical immunomodulator can be used. A fading cream can be used for post-inflammatory hyperpigmentation.