Dermatopathology of 400 Skin Biopsies from Sarawak
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Letters to the Editor Arabia showed that eczema was more common than diagnosis and management of skin diseases. Review of infections.[4] Despite the high prevalence of infections skin biopsies allows determination of disease pattern in our series, there were relatively few cases of leprosy and clinicopathologic correlation. and STIs. It will be interesting to know whether this trend is seen in other parts of the country also. In Sarawak General Hospital, a tertiary center, 400 skin biopsies were retrospectively reviewed from June Even though a further disease wise break-up was 2006 to June 2008. These biopsies were taken from the not attempted in our study, it was noted during data skin clinic, Sarawak General Hospital; visiting skin collection that the majority of the infections were tinea clinic, Sibu and Miri General Hospital (both secondary versicolor, dermatophytosis, common pyodermas such centers) and the leprosy health survey team; all run as impetigo, ecthyma and folliculitis and viral warts. by same doctors and paramedical personnel. Of these The fact that common infections account for such a 400 biopsies, 75% (n = 300) were taken in Sarawak large volume of the OP attendance, points to the poorly General Hospital. These biopsies were separately developed referral system in our healthcare. Ideally reviewed by a dermatologist and a pathologist before a most of the common infections should be managed final diagnosis was made. at the peripheral level. To achieve this, the peripheral institutions should be strengthened in terms of The correlation between the pathologist and the manpower and the level of knowledge and skills. More dermatologist was high at 92% agreement. A positive focused and effective training of medical students at the clinicopathological correlation was noted in 86.8% undergraduate level and continuing medical education (n = 347). Other study found a clinicopathologic [1] for practitioners, are important in this regard. correlation of up to 75% by the treating dermatologists. The high correlation seen here might be due to the active NN.. AAsokan,sokan, PPriyariya PPrathap,rathap, KK.. AAjithkumar,jithkumar, participation of the treating dermatologist in reviewing the dermatohistopathological slides and the open BBetsyetsy AAmbooken,mbooken, VV.. GG.. BBinesh,inesh, discussion between the dermatologist and pathologist. SSandhyaandhya GeorgeGeorge1 Department of Dermatology and Venereology, Trichur Medical Table 1 shows the pattern of skin diseases diagnosed College, Kerala, 1Calicut Medical College, Kerala, India by skin biopsies in Sarawak. From this data, it is AAddressddress fforor ccorrespondence:orrespondence: Dr. Asokan N, “Prashanthi”, interesting to note that 14.7% (n = 59) of the skin Kanattukara (P.O.), Thrissur, Kerala - 680011, India. biopsies were drug-related dermatoses, constituting E-mail: [email protected] the second commonest skin lesions biopsied. This DDOI:OI: 10.4103/0378-6323.55406 - PPMID:MID: *** high proportion of cases might be attributed to the RREFERENCESEFERENCES Table 1: Pattern of skin diseases diagnosed by skin biopsies 1. Onayemi O, Isezuo SA, Njoku CH. Prevalence of different skin in Sarawak conditions in an outpatients’ setting in north-western Nigeria. Skin disease Number of Percentage Int J Dermatol 2005;44:7-11. cases 2. Alakloby OM. Pattern of skin diseases in Eastern Saudi Arabia. Saudi Med J 2005;26:1607-10. Benign tumors 71 17.7 3. Symvoulakis EK, Krasagakis K, Komninos ID, Kastrinakis I, Drug-related dermatoses 59 14.7 Lyronis I, Philalithis A et al. Primary care and pattern of skin Infectious diseases 56 14.0 diseases in a Mediterranean island. BMC Fam Pract. 2006;7:6. 4. Shelleh HH, Al-Hatiti HS. Pattern of skin diseases in a hospital Eczema 37 9.2 in southwestern Saudi Arabia. Saudi Med J 2004;25:507-10. Papulosquamous disorders 31 7.7 Malignancies 27 6.7 Connective tissue diseases 24 6.0 Vasculitis 16 4.0 DDermatopathologyermatopathology ofof 400400 skinskin Non infectious granulomatous disorders 11 2.8 bbiopsiesiopsies fromfrom SSarawakarawak Vascular disorders 9 2.3 Urticaria 9 2.3 Non-infectious bullous disorders 6 1.5 Sir, Lymphatic disorders 3 0.8 Skin biopsy is an essential investigation for Folliculitis 2 0.5 dermatologists. Histopathological findings in skin Non-speciÞ c changes 39 9.8 biopsies frequently assist dermatologist in the Total 400 100 518 Indian J Dermatol Venereol Leprol | September-October 2009 | Vol 75 | Issue 5 Letters to the Editor high usage of topical traditional herbal medications Dermatol 2005;52:823-30. in Sarawak. These agents were the culprit in 71.2% 2. Sehgal S, Balachandran C, Shenoi SD. Clinical study of cutaneous drug reactions in 80 patients. Indian J Dermatol (n = 42) of cases. Eczematous changes were seen Venereol Leprol 2003;69:6-7. in 55.9% (n = 33) of drug-related dermatoses. 3. Gerson D, Sriganeshan V, Alexis JB. Cutaneous drug eruptions: A 5-year experience. J Am Acad Dermatol. 2008;59:995-9. Psoriasiform changes were seen in 18.6%, (n = 11), 4. Koh D, Wang H, Lee J, Chia KS, Lee HP, Goh CL. Basal cell vasculitic in 13.6% (n = 8), lichenoid in 5.1% (n = 3), carcinoma, squamous cell carcinoma and melanoma of the erythema multiforme in 5.1% (n = 3) and fixed skin: analysis of the Singapore Cancer Registry Data 1968-1997. Br J Dermatol. 2003;148:1161-6. drug eruption in 1.7% (n = 1). Other studies found morbilliform rash constituting majority of cases clinicopathologically. [2,3] This is in marked contrast with the current study where eczematous changes AAwarenesswareness ofof STDsSTDs aandnd HHIV/IV/ were the commonest drug-related dermatoses because maculopapular morbilliform rashes due to drugs are AAIDSIDS aamongmong tthehe aadolescentdolescent girlsgirls not biopsied in Sarawak. ooff cclasseslasses IIX–XIIX–XII iinn AAmritsar,mritsar, Another interesting finding was the high proportion PPunjab:unjab: AnAn iinterventionalnterventional studystudy of cutaneous lymphoma. Cutaneous lymphoma was seen as the third most common malignancy constituting 11.1% (n = 3) of the 27 cases of cutaneous Sir, malignancies. It ranked behind basal cell carcinoma Adolescents are defined by the World Health with 51.9% (n = 14) and squamous cell carcinoma with Organization (WHO) as persons between 10 and 19 33.3% (n = 9). Malignant melanoma was seen in only years of age (WHO 1998). Many adolescents around 3.7% (n = 1) of cases. The malignant melanoma was of the world are sexually active and because many sexual acral lentiginous type. In neighboring Singapore, Koh contacts among them are unprotected, they are at risk et al. noted that basal cell carcinoma make up 55.6% of contracting sexually transmitted diseases (STDs). of the 4765 skin cancer cases seen from 1968 to 1997 Another reason for their vulnerability to STDs is the followed by squamous cell carcinoma with 29.5% lack of sex education, including education on STD [1] and malignant melanoma with 5.9%.[4] Although the prevention. Most parents do not discuss topics related frequencies of basal cell carcinoma and squamous cell to sexual issues and hence many teens turn to peers and carcinoma were almost similar, this study showed that to the media and get inaccurate information. The risk cutaneous lymphoma was more common in Sarawak of becoming infected with human immunodeficiency compared to malignant melanoma. However, due virus (HIV) during unprotected sex is two to four times to the small number of cases, this finding cannot be greater for a woman (even higher in adolescent women) [2] conclusively confirmed. than for a man. Thus, this study was planned with the objective to study the knowledge about STDs, including In conclusion, a high clinicopathologic correlation HIV/Acquired Immunodeficiency Syndrome (AIDS) was noted in Sarawak and the pattern of drug-related among school going adolescent girls (classes IX–XII) in dermatoses and cutaneous malignancies seen here a rural area and to assess the impact of health education differ from other studies. on their knowledge. FFelixelix BBoonoon BBinin YYapap The study was carried out from 2005 to 2007 Department of Dermatology, Sarawak General Hospital, Jalan among 852 adolescent girls (of a rural area) from Hospital, 93586 Kuching, Sarawak, Malaysia classes IX–XII in all the seven Government Senior Secondary Schools situated in Verka Block, Amritsar, AAddressddress fforor correspondence:correspondence: Dr. Felix Boon Bin Yap, Department of Dermatology, Sarawak General Hospital, Jalan Hospital, 93586 Punjab. Ethical clearance was taken from the ethical Kuching, Sarawak, Malaysia. E-mail: [email protected] committee. The students were asked to fill a pretested DDOI:OI: 10.4103/0378-6323.55407 - PPMID:MID: ***** self-administered questionnaire after informed consent. Then, they were educated regarding various RREFERENCESEFERENCES STDs, transmission, symptoms, complications and prevention in their vernacular language, in groups 1. Sellheyer K, Bergfeld WF. A retrospective biopsy study of the clinical diagnostic accuracy of common skin diseases by of about 50 students for 20–30 min. In the end, their different specialties compared with dermatology. J Am Acad queries were clarified. After a gap of 3 months, they Indian J Dermatol Venereol Leprol | September-October 2009 | Vol 75 | Issue 5 519.