We aimed to study the prevalence of refractive conditions in Singapore teenagers. Grade 9 and 10 students (n = 946) aged 15–19 years from two secondary schools in Singapore were recruited. The refractive errors of the students’ eyes were measured using non‐cycloplegic autorefraction. Sociodemographic data and information on risk factors for myopia (such as reading and writing) were also obtained using an interviewer‐administered questionnaire. The prevalence of refractive conditions was found to be: myopia [spherical equivalent (SE) at least −0.50 D] – 73.9%, hyperopia (SE at least +0.50 D) – 1.5%, astigmatism (cylinder at least −0.50 D) – 58.7% and anisometropia (SE difference at least 1.00 D) – 11.2%. After adjusting for age and gender, currently doing more than 20.5 h of reading and writing a week was found to be positively associated with myopia [odds ratio 1.12 (95% CI 1.04–1.20, p = 0.003)], as was reading and writing at a close distance and a better educational stream. The prevalence of myopia (73.9%) in Singapore teenagers is high. Current reading and writing habits, reading at close distances and a better educational stream are possible risk factors for myopia.

High-dose pulsed corticosteroid therapy combined with methotrexate for severe alopecia areata of childhood EditorAlopecia areata (AA) in childhood can run a chronic course and worsen over time. 1 Spontaneous hair regrowth is rarely appreciated in chronic severe AA. [2][3][4] Our centre described the ineffective use of high-dose pulsed corticosteroid therapy (HDPCT) in the long term. 1 Methotrexate (MTX) as a maintenance therapy following HDPCT showed some success in adults. 5 Although the evidence for using either drug individually was weak, 6 the combination of using both was not well studied.From 2010 to 2015, 14 paediatric cases of alopecia totalis (AAT) and universalis (AAU) who failed topical therapy underwent treatment consisting of 3 days of intravenous methylprednisolone at 10 mg/kg/day for three consecutive months followed by MTX at 0.2 mg/kg/day. Evaluation of photographs and clinical documentation before starting treatment, at 3 months then 6 monthly were performed by two dermatologists. Hair regrowth was defined as A0 = no change, A1 = 1-24%, A2 = 25-49%, A3 = 50-74%, A4 = 75-99%, A5 = 100%. 7 A further simplified global score was classified as 0 = no change, 1 ≤ 50%, 2 ≥ 50% to 99%, 3 = 100%. Good and poor responders to treatment were defined by hair regrowth of ≥50% (score of 2 or 3) and <50% (score 0 or 1), respectively.The mean age of AA onset was 5.6 years. The median age of starting HDPCT:MTX was 14 years. There were 6 good responders (Table 1). 4 showed good responses by 6 months of treatment. Two good responders who stopped MTX had sustained *6/F AU 11 13 2 3 1.5No., Number; AU, alopecia universalis; AT, alopecia totalis; HDPCT, high-dose pulsed corticosteroids (intravenous methylprednisolone); MTX, methotrexate; *, best responder (see Fig. 1).

A 13-year-old boy underwent allogeneic hematopoietic stem cell transplantation (HSCT) for underlying acute lymphoblastic leukemia and achieved neutrophil engraftment 28 days after HSCT. He developed ichthyosis 6 weeks after HSCT and then keratotic follicular papules, palmoplantar keratoderma, and a seborrheic dermatitis-like eruption 18 weeks after HSCT. From skin biopsies he was diagnosed with eczematoid graft-versus host disease (GVHD), which showed spongiosis with scattered necrotic keratinocytes. He responded to oral and topical steroids and an increase in cyclosporine dose. Although uncommon, eczematoid GVHD must be considered in children who have undergone HSCT and then develop an atypical eczematous eruption, especially in the absence of a history of atopy.