Leena Chularojanamontri - Academia.edu (original) (raw)

Papers by Leena Chularojanamontri

BioMed Research International

Background. Antinuclear antibody (ANA) is often used as a screening test for autoimmune comorbidi... more 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 negative for ANA. Methods. This was a retrospective cohort study that enrolled CSU patients attending the Urticaria Clinic at Siriraj Hospital from 2013 to 2019. Demographics, clinical characteristics, laboratory investigations, and treatments were collected until July 2021. All patients were investigated for ANA. Clinical feature data was compared between CSU patients with positive ANA and negative ANA groups using the 2-sample t -test and the Mann–Whitney U test for quantitative variables. The chi-squared test or Fisher’s exact test was conducted to explore the association of qualitative variables. Disease relapse and remission were analysed v...

Psoriasis forum, Mar 1, 2014

Clinical and Experimental Dermatology, Dec 1, 2020

An overlap disease between IgG4-related disease (IgG4-RD) and antineutrophil cytoplasmic antibodi... more An overlap disease between IgG4-related disease (IgG4-RD) and antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) was proposed in 2017. 1 IgG4-RD with localized AAV has rarely been reported. A 48-year-old man presented with an 8-month history of multiple ulcers on his face and scalp (Fig. 1a-c). When he had presented previously to a different hospital, PCR for Mycobacterium tuberculosis complex and a pus culture were negative. A skin biopsy taken at the time showed a necrotizing granulomatous inflammation without vasculitis. Following this, the patient had received several courses of oral antibiotics without any improvement. We performed computed tomography scans of the orbit and paranasal sinuses, which showed right orbital cellulitis with dacryocystitis and dacryoadenitis and right ethmoidal sinusitis. Histological examination of a skin biopsy from the patient's eyelid and cheek revealed dense infiltration by lymphocytes and plasma cells, with arteritis (Fig. 1d-g). Immunostaining showed IgG4+ plasma cells at 200-250 cells/high power field (HPF), with an IgG4+/IgG+ ratio of 30% (Fig. 1h,i). Laboratory investigations showed mild anaemia without hypereosinophilia and an IgG4 level of 573 mg/dL (11-330 mg/dL). Tests for ANCAs and serology testing for HIV were negative.

Asian Pacific Journal of Allergy and Immunology, 2021

Atopic dermatitis (AD), a chronic, relapsing dermatitis, is characterized by dry and pruritus ski... more 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-based publications and expert opinions. Following simple algorithms, the guidelines aim to assist adult and pediatric physicians in the better care of patients with AD. As with other diseases, there have been several diagnosis criteria proposed over time. Nonetheless, the classical Hanifin and Rajka criterion with no pathognomonic laboratory biomarkers is still the most widely used worldwide for the diagnosis of AD. The management of AD must be considered case by case to provide suitable care for each patient. Basic therapy is focused on avoiding specific/unspecific provoking factors and hydrating skin. Topical anti-inflammatory treatments such as glucocorticoids and calcineurin inhibitors are suggested for disease flare, and proactive therapy is best for long-term control. Other therapies, including antimicrobial agents, systemic antihistamines, systemic anti-inflammatory agents, immunotherapy, phototherapy, and psychotherapy, are reviewed in these guidelines. Crisaborole, a new topical phosphodiesterase 4 inhibitor, can be used twice daily in AD patients over three months old. Dupilumab, a biological drug for patients with moderate-to-severe AD, may be considered in patients with no improvement from other systemic treatments.

International Journal of Dermatology, Jul 29, 2014

Objectives There is a paucity of data regarding clinical differences between early-onset psoriasi... more Objectives There is a paucity of data regarding clinical differences between early-onset psoriasis (EOP) and late-onset psoriasis (LOP) in Asian populations. This study aimed to investigate clinical differences between EOP (onset at the age of <40 years) and LOP (onset at the age of ≥40 years) in Thai patients. Methods From 2002 until 2008, staff and residents in the Department of Dermatology, Siriraj Hospital, were asked to complete a questionnaire detailing the age of onset, family history of psoriasis, comorbid diseases, clinical features, nail and joint involvement, and severity of psoriasis in all psoriasis patients. Data were analyzed using descriptive statistics and chi-squared tests. Results A total of 1017 patients were enrolled. Of these, 663 (65.2%) patients had EOP and 354 (34.8%) had LOP. The mean AE standard deviation age of onset was 24.8 AE 8.7 years in the EOP group and 51.6 AE 9.6 years in the LOP group. The two most common comorbid diseases were hypertension and diabetes mellitus in both groups. Patients with EOP had a significantly higher likelihood of both a family history of disease and guttate psoriasis. Palmoplantar psoriasis was more commonly found in LOP patients. Nail and joint involvement and disease severity were not associated significantly with age of onset. Conclusions The present study supports the hypothesis that there are clinical differences between EOP and LOP in Asian populations.

CRC Press eBooks, Dec 16, 2022

Journal of Dermatological Treatment, Jul 30, 2020

Abstract Background Methotrexate (MTX) is a mainstay drug in the treatment of psoriatic and rheum... more Abstract Background Methotrexate (MTX) is a mainstay drug in the treatment of psoriatic and rheumatologic conditions. Subcutaneous MTX has become a feasible treatment alternative with the development of prefilled syringes or autoinjectors containing MTX solution that can be self-administered by the patient at home. However, MTX prefilled auto-injector pens are still not available in some countries. Objective This study aimed to investigate the stability and sterility of 25 mg/mL MTX solution in a disposable plastic syringe over a 12-week period under light protection at temperatures of 4 °C, 25 °C, and 37 °C. Methods This study was conducted during November 2019 to February 2020 at the Faculty of Medicine Siriraj Hospital, Mahidol University. Stability was evaluated using ultra-high-performance liquid chromatography technique, and sterility was assessed by cultures for bacterial and fungal contamination. Results Our results revealed that patient-ready syringes containing 25 mg/mL MTX solution can be prepared in advance and kept for up to 12 weeks under light protection, and they can be kept at temperatures ranging from 4 to 37 °C. Conclusion This system for delivering MTX to patients that are refractory to or intolerant of oral MTX via a self-administered pre-filled syringe is both efficient and easy to implement in care settings where commercially alternatives are not yet available.

Asian Pacific Journal of Allergy and Immunology, 2022

Background: Pruritus is commonly associated with skin disorders. The 5-D itch scale was developed... more 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 global assessment of disease severity (PatGA-VAS), Chronic Urticaria Quality of Life Questionnaire (CU-Q 2 oL), and seven-day urticaria activity score (UAS7) were evaluated as correlation with Thai 5-D itch scale. Seventy-five stable patients (42 chronic urticaria patients and 33 eczema patients), who had no change in disease severity after 4-weeks were assessed for test-retest reliability. Results: Of 130 pruritus patients who were treated at Department of Dermatology, Siriraj Hospital, 65 patients were diagnosed with chronic urticaria. The others were diagnosed with eczema. The validity of Thai 5-D itch scale correlated strongly with Thai DLQI total score (r = 0.76, p < 0.0001) and PatGA-VAS (r = 0.79, p < 0.0001). The strong reliability of Thai 5-D itch scale was demonstrated as intraclass correlation coefficient of 0.90. The changes in Thai 5-D itch scale was correlated with the changes in PatGA-VAS and UAS7 which indicated that the Thai 5-D itch scale had good sensitivity to change (r = 0.66) and (r = 0.67), respectively. Conclusion: The Thai 5-D itch scale is a questionnaire with good validity, reliability and sensitivity to change to evaluate pruritus in Thai patients. This will support the use of 5-D itch scale in practice, in other languages.

Archives of Dermatological Research, Oct 29, 2022

Asian Pacific Journal of Allergy and Immunology, 2022

Background: Cutaneous adverse events after receiving a COVID-19 vaccine were identified. The dise... more 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. Objectives: To evaluate disease activity of chronic urticaria after receiving a COVID-19 vaccine. Methods: A prospective cross-sectional study was conducted in chronic urticaria patients aged 18 or above who visited Siriraj Hospital between July and September 2021, and received the first and second dose of COVID-19 vaccine. The status prior to vaccination, including disease activity, disease control and disease severity was assessed by a urticaria activity score over seven days, urticaria control test, and modified medication score. The disease activity after vaccination was recorded. Results: A total of 130 patients with a mean age of 45.9 ± 14.7 were enrolled in this study. Adenoviral and inactivated vaccines were administered to 85 (65.4%) and 45 patients (34.6%), respectively. Exacerbation was reported in 20 cases (15.4%) after the first dose and 17 cases (13.1%) after the second dose. Nine patients (45%) reported exacerbation after both the first and second dose. The majority of patients only had wheal, while three patients reported wheal with angioedema. No anaphylaxis was reported. Factor predicting exacerbation was concurrent thyroid disease (aRR 2.78, p < 0.01). Conclusion: Approximately 15% of chronic urticaria patients reported exacerbation after receiving a COVID-19 vaccination. No serious events were observed. Chronic urticaria patients should be vaccinated against COVID-19 after a discussion of the risk of disease flare-up.

Siriraj Medical Journal

Objective: This study aimed to investigate the validity and reliability of the Thai version of FD... more 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 (GQoL). The severity of the disease was assessed by physicians, the patients and the family members of the patients. Results: One hundred family members accompanying 92 patients with dermatological diseases (63% with inflammatory skin diseases and 37% with non-inflammatory skin diseases) were included. The mean age of the family members was 43.5±12.1 years and 70% were women. They had been mostly employed (74%) and graduated from universities (65%). Validity was demonstrated by a positive correlation between FDLQI and GQoL scores (rs=0.695, P<0.001), and between FDLQI and severity of the patient's disease (rs=0.578, P<0.001) as evalu...

Experimental Dermatology

Pustular psoriasis is characterised by eruptions of neutrophilic sterile pustules. The European R... more Pustular psoriasis is characterised by eruptions of neutrophilic sterile pustules. The European Rare and Severe Psoriasis Expert Network consensus defines pustular psoriasis into three subtypes; generalised pustular psoriasis (GPP), palmoplantar pustulosis and acrodermatitis continua of Hallopeau (ACH). Mixed forms are categorised according to their predominant features. However, the Japanese Dermatological Association includes ACH under the diagnosis of GPP. This article aims to review the similarities and differences between ACH and GPP. Based on our review, interleukin (IL)‐36RN mutations, the most frequent genetic findings in pustular psoriasis are found most commonly in GPP, followed by ACH. Genotypes of IL‐36RN mutations among GPP patients and ACH patients are different between European and Asian ethnicities. IL‐36 signalling pathway is the main mechanism. Metabolic diseases are common comorbidities and joint involvement can occur in 20.5%–36.4% of both conditions. Associated ...

The Journal of Dermatology

The Journal of Dermatology, 2022

Psoriasis in people living with HIV (PLHIV) has been reported as having particular clinical chara... more Psoriasis in people living with HIV (PLHIV) has been reported as having particular clinical characteristics. However, most of the source data was derived from descriptive studies in Europe and the USA. This study was conducted to compare the characteristics of psoriasis in PLHIV to general psoriasis patients. We retrospectively reviewed the records of 73 cases of psoriasis in PLHIV and of 232 general psoriasis patients who visited a psoriasis clinic in Bangkok, Thailand. Psoriasis in PLHIV predominated in males (78.1%), with an older age of onset, significantly lower rates of nail involvement and psoriatic arthritis, but higher rates of co-infectious diseases than for general psoriasis patients. A low nadir CD4 T-cell count (<100 cells/μl) and CD4 T-cell count at psoriasis diagnosis were associated with a high body surface area (BSA) involvement. The mean BSA involvement in PLHIV was 24. Although 64.4% (47/73) of the PLHIV had moderate-to-high psoriasis severity, 29.8% of those (14/47) only received topical treatment. Acitretin was the most common drug used. Other therapies were rarely used, and no biologics were administered. In conclusion, psoriasis in PLHIV has several clinical features that differ from general psoriasis. PLHIV tend to receive substandard care for psoriasis, even in upper-middle-income countries.

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are over-the-counter drugs which are w... more Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are over-the-counter drugs which are widely used. In Thailand, cutaneous reactions to nonsteroidal anti-inflammatory drugs were frequently angioedema and urticaria. However, there are many limitations of the diagnostic investigations, so the diagnosis is still based on history and clinical manifestation. In 2007, there was a study in Italy, which reported that an autologous plasma skin test (APST) could detect autoreactive state in patients with multiple intolerances to NSAIDs. Objective: We aimed to investigate whether APST is positive in single and multiple NSAID reactors in the Thai population or not. Methods: The patients with recent history of urticaria and/or angioedema following the administration of NSAIDs were prospectively recruited. Individuals were classified into two groups (single or multiple NSAID reactors) based on history, clinical manifestation and/or laboratory investigation and then APST was done after ...

The Journal of Allergy and Clinical Immunology: In Practice, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Clinical and Experimental Dermatology, 2018

A 62-year-old Thai woman presented with acute onset of fever, headache, mild myalgia, and an itch... more A 62-year-old Thai woman presented with acute onset of fever, headache, mild myalgia, and an itchy rash that initially developed on her abdomen and then spread to her face, arms and thighs. She had returned from the shrub areas in Chiang-Mai, Thailand 9 days previously, with the fever developing the day after her return, and the rash developing 5 days later. Her underlying diseases included ischaemic stroke and supraventricular tachycardia. On physical examination, the patient was found to have a temperature of 38.6°C, respiration rate of 24 breaths/min and pulse oximetry of 90% in room air. She also had conjunctival hyperaemia and generalized maculopapular rashes on her face, trunk and extremities (Fig. 1a). No eschar lesion was seen, and the rest of the examination was unremarkable. Laboratory investigations, including full blood count, renal and liver function tests, were normal. Chest radiography revealed interstitial infiltrations in both lower lungs (Fig. 1b). Despite the absence of eschar lesion, rickettsial infection was strongly suspected, as Thailand, especially Chiang-Mai, is known to be an endemic area for scrub typhus. 1 Consequently, azithromycin for empirical treatment of scrub typhus and Mycoplasma pneumonia was initiated while serological diagnosis was awaited. The following day (day 7 of the illness), tests for M. pneumoniae antibodies came back negative. Indirect fluorescence antibody (IFA) test (using polyclonal rabbit anti-human IgM/FITC antibodies; Dako, Glostrup, Denmark) for IgM antibodies showed positive results

International Journal of Molecular Sciences, 2019

Psoriasis has been thought to be driven primarily by innate and adaptive immune systems that can ... more Psoriasis has been thought to be driven primarily by innate and adaptive immune systems that can be modified by genetic and environmental factors. Complex interplay between inflammatory cytokines and T-cells, especially Th1 and Th17 cells, leads to abnormal cell proliferation and psoriatic skin lesions. Nevertheless, such mechanisms do not entirely represent the pathogenesis of psoriasis. Moreover, earlier and better biomarkers in diagnostics, prognostics, and monitoring therapeutic outcomes of psoriasis are still needed. During the last two decades, proteomics (a systematic analysis of proteins for their identities, quantities, and functions) has been widely employed to psoriatic research. This review summarizes and discusses all of the previous studies that applied various modalities of proteomics technologies to psoriatic skin disease. The data obtained from such studies have led to (i) novel mechanisms and new hypotheses of the disease pathogenesis; (ii) biomarker discovery for ...

Siriraj Medical Journal

Objective: To evaluate the characteristics of post-adolescent male patients with acne in terms of... more 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 male acne patients aged 21 years and older were enrolled. Diagnoses and physical examinations were performed by dermatologists. Results: Seventy-two patients (mean age, 26.9 [± 4.3] years) were included. Persistent acne, relapse acne, and late-onset acne (onset at age ≥ 21 years) were reported in 62.5%, 33.3%, and 4.2% cases, respectively. Persistent acne tended to subside at 26 years of age, whereas late-onset acne tended to start at 28 years of age. The acne severity was mild in most cases. Pimple-picking, followed by frequent face washing, were common habits among male acne patients. Shaving influenced the severity in some adult male w...

Experimental Dermatology

This study evaluated the impacts on psoriasis flares of 3 vaccine platforms: inactivated, viral v... more This study evaluated the impacts on psoriasis flares of 3 vaccine platforms: inactivated, viral vector and mRNA. Respectively, 198 and 96 psoriasis patients with and without COVID‐19 vaccination during the study period. Group comparison revealed no increased risk of psoriasis flaring after COVID‐19 vaccination. The vaccinated group received 425 doses of vaccine (140 inactivated, 230 viral vector and 55 mRNA). Patients' self‐reported symptoms included all three platforms causing psoriasis flare, but the highest was among patients administered with mRNA vaccines. Most flares were mild to moderate, and most patients (89.8%) managed their flare‐up lesions without rescue therapy. In conclusion, our study showed that the rate of psoriasis flare was not significantly different between vaccinated and unvaccinated groups. Factors that might explain psoriasis flare include vaccine‐related psychological stress and side effects from vaccination. Different platforms of corona vaccines seemed...

BioMed Research International

Background. Antinuclear antibody (ANA) is often used as a screening test for autoimmune comorbidi... more 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 negative for ANA. Methods. This was a retrospective cohort study that enrolled CSU patients attending the Urticaria Clinic at Siriraj Hospital from 2013 to 2019. Demographics, clinical characteristics, laboratory investigations, and treatments were collected until July 2021. All patients were investigated for ANA. Clinical feature data was compared between CSU patients with positive ANA and negative ANA groups using the 2-sample t -test and the Mann–Whitney U test for quantitative variables. The chi-squared test or Fisher’s exact test was conducted to explore the association of qualitative variables. Disease relapse and remission were analysed v...

Psoriasis forum, Mar 1, 2014

Clinical and Experimental Dermatology, Dec 1, 2020

An overlap disease between IgG4-related disease (IgG4-RD) and antineutrophil cytoplasmic antibodi... more An overlap disease between IgG4-related disease (IgG4-RD) and antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) was proposed in 2017. 1 IgG4-RD with localized AAV has rarely been reported. A 48-year-old man presented with an 8-month history of multiple ulcers on his face and scalp (Fig. 1a-c). When he had presented previously to a different hospital, PCR for Mycobacterium tuberculosis complex and a pus culture were negative. A skin biopsy taken at the time showed a necrotizing granulomatous inflammation without vasculitis. Following this, the patient had received several courses of oral antibiotics without any improvement. We performed computed tomography scans of the orbit and paranasal sinuses, which showed right orbital cellulitis with dacryocystitis and dacryoadenitis and right ethmoidal sinusitis. Histological examination of a skin biopsy from the patient's eyelid and cheek revealed dense infiltration by lymphocytes and plasma cells, with arteritis (Fig. 1d-g). Immunostaining showed IgG4+ plasma cells at 200-250 cells/high power field (HPF), with an IgG4+/IgG+ ratio of 30% (Fig. 1h,i). Laboratory investigations showed mild anaemia without hypereosinophilia and an IgG4 level of 573 mg/dL (11-330 mg/dL). Tests for ANCAs and serology testing for HIV were negative.

Asian Pacific Journal of Allergy and Immunology, 2021

Atopic dermatitis (AD), a chronic, relapsing dermatitis, is characterized by dry and pruritus ski... more 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-based publications and expert opinions. Following simple algorithms, the guidelines aim to assist adult and pediatric physicians in the better care of patients with AD. As with other diseases, there have been several diagnosis criteria proposed over time. Nonetheless, the classical Hanifin and Rajka criterion with no pathognomonic laboratory biomarkers is still the most widely used worldwide for the diagnosis of AD. The management of AD must be considered case by case to provide suitable care for each patient. Basic therapy is focused on avoiding specific/unspecific provoking factors and hydrating skin. Topical anti-inflammatory treatments such as glucocorticoids and calcineurin inhibitors are suggested for disease flare, and proactive therapy is best for long-term control. Other therapies, including antimicrobial agents, systemic antihistamines, systemic anti-inflammatory agents, immunotherapy, phototherapy, and psychotherapy, are reviewed in these guidelines. Crisaborole, a new topical phosphodiesterase 4 inhibitor, can be used twice daily in AD patients over three months old. Dupilumab, a biological drug for patients with moderate-to-severe AD, may be considered in patients with no improvement from other systemic treatments.

International Journal of Dermatology, Jul 29, 2014

Objectives There is a paucity of data regarding clinical differences between early-onset psoriasi... more Objectives There is a paucity of data regarding clinical differences between early-onset psoriasis (EOP) and late-onset psoriasis (LOP) in Asian populations. This study aimed to investigate clinical differences between EOP (onset at the age of <40 years) and LOP (onset at the age of ≥40 years) in Thai patients. Methods From 2002 until 2008, staff and residents in the Department of Dermatology, Siriraj Hospital, were asked to complete a questionnaire detailing the age of onset, family history of psoriasis, comorbid diseases, clinical features, nail and joint involvement, and severity of psoriasis in all psoriasis patients. Data were analyzed using descriptive statistics and chi-squared tests. Results A total of 1017 patients were enrolled. Of these, 663 (65.2%) patients had EOP and 354 (34.8%) had LOP. The mean AE standard deviation age of onset was 24.8 AE 8.7 years in the EOP group and 51.6 AE 9.6 years in the LOP group. The two most common comorbid diseases were hypertension and diabetes mellitus in both groups. Patients with EOP had a significantly higher likelihood of both a family history of disease and guttate psoriasis. Palmoplantar psoriasis was more commonly found in LOP patients. Nail and joint involvement and disease severity were not associated significantly with age of onset. Conclusions The present study supports the hypothesis that there are clinical differences between EOP and LOP in Asian populations.

CRC Press eBooks, Dec 16, 2022

Journal of Dermatological Treatment, Jul 30, 2020

Abstract Background Methotrexate (MTX) is a mainstay drug in the treatment of psoriatic and rheum... more Abstract Background Methotrexate (MTX) is a mainstay drug in the treatment of psoriatic and rheumatologic conditions. Subcutaneous MTX has become a feasible treatment alternative with the development of prefilled syringes or autoinjectors containing MTX solution that can be self-administered by the patient at home. However, MTX prefilled auto-injector pens are still not available in some countries. Objective This study aimed to investigate the stability and sterility of 25 mg/mL MTX solution in a disposable plastic syringe over a 12-week period under light protection at temperatures of 4 °C, 25 °C, and 37 °C. Methods This study was conducted during November 2019 to February 2020 at the Faculty of Medicine Siriraj Hospital, Mahidol University. Stability was evaluated using ultra-high-performance liquid chromatography technique, and sterility was assessed by cultures for bacterial and fungal contamination. Results Our results revealed that patient-ready syringes containing 25 mg/mL MTX solution can be prepared in advance and kept for up to 12 weeks under light protection, and they can be kept at temperatures ranging from 4 to 37 °C. Conclusion This system for delivering MTX to patients that are refractory to or intolerant of oral MTX via a self-administered pre-filled syringe is both efficient and easy to implement in care settings where commercially alternatives are not yet available.

Asian Pacific Journal of Allergy and Immunology, 2022

Background: Pruritus is commonly associated with skin disorders. The 5-D itch scale was developed... more 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 global assessment of disease severity (PatGA-VAS), Chronic Urticaria Quality of Life Questionnaire (CU-Q 2 oL), and seven-day urticaria activity score (UAS7) were evaluated as correlation with Thai 5-D itch scale. Seventy-five stable patients (42 chronic urticaria patients and 33 eczema patients), who had no change in disease severity after 4-weeks were assessed for test-retest reliability. Results: Of 130 pruritus patients who were treated at Department of Dermatology, Siriraj Hospital, 65 patients were diagnosed with chronic urticaria. The others were diagnosed with eczema. The validity of Thai 5-D itch scale correlated strongly with Thai DLQI total score (r = 0.76, p < 0.0001) and PatGA-VAS (r = 0.79, p < 0.0001). The strong reliability of Thai 5-D itch scale was demonstrated as intraclass correlation coefficient of 0.90. The changes in Thai 5-D itch scale was correlated with the changes in PatGA-VAS and UAS7 which indicated that the Thai 5-D itch scale had good sensitivity to change (r = 0.66) and (r = 0.67), respectively. Conclusion: The Thai 5-D itch scale is a questionnaire with good validity, reliability and sensitivity to change to evaluate pruritus in Thai patients. This will support the use of 5-D itch scale in practice, in other languages.

Archives of Dermatological Research, Oct 29, 2022

Asian Pacific Journal of Allergy and Immunology, 2022

Background: Cutaneous adverse events after receiving a COVID-19 vaccine were identified. The dise... more 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. Objectives: To evaluate disease activity of chronic urticaria after receiving a COVID-19 vaccine. Methods: A prospective cross-sectional study was conducted in chronic urticaria patients aged 18 or above who visited Siriraj Hospital between July and September 2021, and received the first and second dose of COVID-19 vaccine. The status prior to vaccination, including disease activity, disease control and disease severity was assessed by a urticaria activity score over seven days, urticaria control test, and modified medication score. The disease activity after vaccination was recorded. Results: A total of 130 patients with a mean age of 45.9 ± 14.7 were enrolled in this study. Adenoviral and inactivated vaccines were administered to 85 (65.4%) and 45 patients (34.6%), respectively. Exacerbation was reported in 20 cases (15.4%) after the first dose and 17 cases (13.1%) after the second dose. Nine patients (45%) reported exacerbation after both the first and second dose. The majority of patients only had wheal, while three patients reported wheal with angioedema. No anaphylaxis was reported. Factor predicting exacerbation was concurrent thyroid disease (aRR 2.78, p < 0.01). Conclusion: Approximately 15% of chronic urticaria patients reported exacerbation after receiving a COVID-19 vaccination. No serious events were observed. Chronic urticaria patients should be vaccinated against COVID-19 after a discussion of the risk of disease flare-up.

Siriraj Medical Journal

Objective: This study aimed to investigate the validity and reliability of the Thai version of FD... more 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 (GQoL). The severity of the disease was assessed by physicians, the patients and the family members of the patients. Results: One hundred family members accompanying 92 patients with dermatological diseases (63% with inflammatory skin diseases and 37% with non-inflammatory skin diseases) were included. The mean age of the family members was 43.5±12.1 years and 70% were women. They had been mostly employed (74%) and graduated from universities (65%). Validity was demonstrated by a positive correlation between FDLQI and GQoL scores (rs=0.695, P<0.001), and between FDLQI and severity of the patient's disease (rs=0.578, P<0.001) as evalu...

Experimental Dermatology

Pustular psoriasis is characterised by eruptions of neutrophilic sterile pustules. The European R... more Pustular psoriasis is characterised by eruptions of neutrophilic sterile pustules. The European Rare and Severe Psoriasis Expert Network consensus defines pustular psoriasis into three subtypes; generalised pustular psoriasis (GPP), palmoplantar pustulosis and acrodermatitis continua of Hallopeau (ACH). Mixed forms are categorised according to their predominant features. However, the Japanese Dermatological Association includes ACH under the diagnosis of GPP. This article aims to review the similarities and differences between ACH and GPP. Based on our review, interleukin (IL)‐36RN mutations, the most frequent genetic findings in pustular psoriasis are found most commonly in GPP, followed by ACH. Genotypes of IL‐36RN mutations among GPP patients and ACH patients are different between European and Asian ethnicities. IL‐36 signalling pathway is the main mechanism. Metabolic diseases are common comorbidities and joint involvement can occur in 20.5%–36.4% of both conditions. Associated ...

The Journal of Dermatology

The Journal of Dermatology, 2022

Psoriasis in people living with HIV (PLHIV) has been reported as having particular clinical chara... more Psoriasis in people living with HIV (PLHIV) has been reported as having particular clinical characteristics. However, most of the source data was derived from descriptive studies in Europe and the USA. This study was conducted to compare the characteristics of psoriasis in PLHIV to general psoriasis patients. We retrospectively reviewed the records of 73 cases of psoriasis in PLHIV and of 232 general psoriasis patients who visited a psoriasis clinic in Bangkok, Thailand. Psoriasis in PLHIV predominated in males (78.1%), with an older age of onset, significantly lower rates of nail involvement and psoriatic arthritis, but higher rates of co-infectious diseases than for general psoriasis patients. A low nadir CD4 T-cell count (<100 cells/μl) and CD4 T-cell count at psoriasis diagnosis were associated with a high body surface area (BSA) involvement. The mean BSA involvement in PLHIV was 24. Although 64.4% (47/73) of the PLHIV had moderate-to-high psoriasis severity, 29.8% of those (14/47) only received topical treatment. Acitretin was the most common drug used. Other therapies were rarely used, and no biologics were administered. In conclusion, psoriasis in PLHIV has several clinical features that differ from general psoriasis. PLHIV tend to receive substandard care for psoriasis, even in upper-middle-income countries.

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are over-the-counter drugs which are w... more Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are over-the-counter drugs which are widely used. In Thailand, cutaneous reactions to nonsteroidal anti-inflammatory drugs were frequently angioedema and urticaria. However, there are many limitations of the diagnostic investigations, so the diagnosis is still based on history and clinical manifestation. In 2007, there was a study in Italy, which reported that an autologous plasma skin test (APST) could detect autoreactive state in patients with multiple intolerances to NSAIDs. Objective: We aimed to investigate whether APST is positive in single and multiple NSAID reactors in the Thai population or not. Methods: The patients with recent history of urticaria and/or angioedema following the administration of NSAIDs were prospectively recruited. Individuals were classified into two groups (single or multiple NSAID reactors) based on history, clinical manifestation and/or laboratory investigation and then APST was done after ...

The Journal of Allergy and Clinical Immunology: In Practice, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Clinical and Experimental Dermatology, 2018

A 62-year-old Thai woman presented with acute onset of fever, headache, mild myalgia, and an itch... more A 62-year-old Thai woman presented with acute onset of fever, headache, mild myalgia, and an itchy rash that initially developed on her abdomen and then spread to her face, arms and thighs. She had returned from the shrub areas in Chiang-Mai, Thailand 9 days previously, with the fever developing the day after her return, and the rash developing 5 days later. Her underlying diseases included ischaemic stroke and supraventricular tachycardia. On physical examination, the patient was found to have a temperature of 38.6°C, respiration rate of 24 breaths/min and pulse oximetry of 90% in room air. She also had conjunctival hyperaemia and generalized maculopapular rashes on her face, trunk and extremities (Fig. 1a). No eschar lesion was seen, and the rest of the examination was unremarkable. Laboratory investigations, including full blood count, renal and liver function tests, were normal. Chest radiography revealed interstitial infiltrations in both lower lungs (Fig. 1b). Despite the absence of eschar lesion, rickettsial infection was strongly suspected, as Thailand, especially Chiang-Mai, is known to be an endemic area for scrub typhus. 1 Consequently, azithromycin for empirical treatment of scrub typhus and Mycoplasma pneumonia was initiated while serological diagnosis was awaited. The following day (day 7 of the illness), tests for M. pneumoniae antibodies came back negative. Indirect fluorescence antibody (IFA) test (using polyclonal rabbit anti-human IgM/FITC antibodies; Dako, Glostrup, Denmark) for IgM antibodies showed positive results

International Journal of Molecular Sciences, 2019

Psoriasis has been thought to be driven primarily by innate and adaptive immune systems that can ... more Psoriasis has been thought to be driven primarily by innate and adaptive immune systems that can be modified by genetic and environmental factors. Complex interplay between inflammatory cytokines and T-cells, especially Th1 and Th17 cells, leads to abnormal cell proliferation and psoriatic skin lesions. Nevertheless, such mechanisms do not entirely represent the pathogenesis of psoriasis. Moreover, earlier and better biomarkers in diagnostics, prognostics, and monitoring therapeutic outcomes of psoriasis are still needed. During the last two decades, proteomics (a systematic analysis of proteins for their identities, quantities, and functions) has been widely employed to psoriatic research. This review summarizes and discusses all of the previous studies that applied various modalities of proteomics technologies to psoriatic skin disease. The data obtained from such studies have led to (i) novel mechanisms and new hypotheses of the disease pathogenesis; (ii) biomarker discovery for ...

Siriraj Medical Journal

Objective: To evaluate the characteristics of post-adolescent male patients with acne in terms of... more 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 male acne patients aged 21 years and older were enrolled. Diagnoses and physical examinations were performed by dermatologists. Results: Seventy-two patients (mean age, 26.9 [± 4.3] years) were included. Persistent acne, relapse acne, and late-onset acne (onset at age ≥ 21 years) were reported in 62.5%, 33.3%, and 4.2% cases, respectively. Persistent acne tended to subside at 26 years of age, whereas late-onset acne tended to start at 28 years of age. The acne severity was mild in most cases. Pimple-picking, followed by frequent face washing, were common habits among male acne patients. Shaving influenced the severity in some adult male w...

Experimental Dermatology

This study evaluated the impacts on psoriasis flares of 3 vaccine platforms: inactivated, viral v... more This study evaluated the impacts on psoriasis flares of 3 vaccine platforms: inactivated, viral vector and mRNA. Respectively, 198 and 96 psoriasis patients with and without COVID‐19 vaccination during the study period. Group comparison revealed no increased risk of psoriasis flaring after COVID‐19 vaccination. The vaccinated group received 425 doses of vaccine (140 inactivated, 230 viral vector and 55 mRNA). Patients' self‐reported symptoms included all three platforms causing psoriasis flare, but the highest was among patients administered with mRNA vaccines. Most flares were mild to moderate, and most patients (89.8%) managed their flare‐up lesions without rescue therapy. In conclusion, our study showed that the rate of psoriasis flare was not significantly different between vaccinated and unvaccinated groups. Factors that might explain psoriasis flare include vaccine‐related psychological stress and side effects from vaccination. Different platforms of corona vaccines seemed...