Objective The objective of this paper is to determine photoprotection awareness, knowledge, practices, and its relationship with disease activity and damage in patients with systemic lupus erythematosus (SLE). Methods A cross-sectional study was performed. Data were acquired from in-person interviews and medical records. Results A total of 199 (89.6%) females and 23 (10.4%) males were recruited. Median age was 39.00 (interquartile range (IQR) 18) years, disease duration 12.12 (IQR 8) years, Fitzpatrick skin phototype III 119 (53.6%) and IV 81 (36.5%). Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2 K) was 2.95 (IQR 4) while Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC-ACR DI) was 1.20 (IQR 2). The majority 205 (92.3%) were aware of sun exposure effects on SLE. Photoprotection methods were shade seeking 209 (94.1%), sun avoidance 212 (95.5%), long pants 168 (75.7%), long sleeves 155 (69.8%), sunscreen 116 (52.3%), sunglasses 114 (51.4%) and head cover 103 (46.4%). Significantly higher photoprotection practice scores (PPS) were observed in females, Malays, and individuals with higher education level and internet accessibility. PPS were not significantly correlated with SLICC-ACR DI and SLEDAI-2 K. Independent predictors for good photoprotection practice (GPP) were ethnicity (OR = 3.66, 95% CI 1.78-7.53), awareness (OR = 3.77, 95% CI 1.09-13.08) and cutaneous involvement (OR = 2.43, 95% CI 1.11-5.28). Photoprotection methods and GPP were not predictors for disease activity or damage. Conclusion Photoprotection awareness and knowledge was good. Shade seeking and sun avoidance were the common photoprotection methods practised. The use of sunscreen requires improvement. Photoprotection awareness and cutaneous manifestation were predictors for GPP. Neither photoprotection methods nor GPP were associated with disease activity or damage.

While electrocardiogram (ECG) changes are common during viral dengue infection, atrial fibrillation (AF) is a very rare manifestation. It has previously been highlighted that cardiac complications during dengue infection are invariably transient and will spontaneously resolve following recovery from the illness. We present the case of a young patient with IgM- and IgG-positive dengue hemorrhagic fever complicated by AF. ECG revealed a structurally normal heart. The patient remained in AF despite resolution of the illness. Reversion to normal sinus rhythm was achieved after loading of oral amiodarone.

Background. Pruritus is common in patients with diabetes mellitus (DM), and may lead to complex dermatological conditions if left untreated. Pruritus can be caused by increased transepidermal water loss (TEWL) and reduced skin hydration. Aims. To compare TEWL and skin hydration in patients with DM and controls, and to investigate associations between TEWL and skin hydration with glycated haemoglobin (HbA1c), fasting blood sugar (FBS), treatment, peripheral neuropathy (PN) and age in patients with diabetes. Methods. This was a prospective, case-control study carried out at a tertiary medical centre in Kuala Lumpur, Malaysia. TEWL and skin hydration measurements were taken at six different body sites in both groups. Results. In total, 146 patients (73 cases, 73 controls) were included (24 men and 49 women in each group). No significant difference in TEWL or skin hydration was seen between patients with DM and controls, but there were significant reductions in skin hydration in patients with DM who had FBS > 7 mmol/L (P < 0.01) or PN (P < 0.01). There was a reduction in TEWL over the anterior shin in patients with HbA1c levels > 6.5% (P < 0.02) and an increase in TEWL on the flank in patients on insulin injections at doses of > 1 U/kg/day (P < 0.01). In participants > 45 years old, there was a significant reduction in TEWL (P = 0.04) and hydration (P < 0.04) in the DM and control groups, respectively. Conclusion. There was no difference in TEWL and skin hydration in patients with DM compared with controls. In the DM group, reduction in skin hydration was associated with uncontrolled FBS and PN but not with HbA1c or DM treatment, whereas TEWL was lower in patients with FBS > 8 mmol/L and increased in patients with higher insulin requirement.

Background: Multiple factors affect growth in children with atopic dermatitis (AD).We investigated food restriction practice, nutrition, and growth in children with AD.Food restriction is defined as restriction ≥3 types of food due to AD or food allergy. Methods:A cross-sectional study was performed in 150 children aged 12-36 months.Exclusion criteria: recurrent infections, moderate to severe asthma, recent systemic steroid, other diseases affecting growth/nutrition. Growth parameters, SCORing Atopic Dermatitis (SCORAD), hemoglobin, hematocrit, sodium, potassium, albumin, protein, calcium, phosphate, B12, iron, and folate values were determined. Parents completed a 3-day food diary. Results:The prevalence of food restriction was 60.7%. Commonly restricted foods were shellfish 62.7%, nuts 53.3%, egg 50%, dairy 29.3%, and cow's milk 28.7%. Foodrestricted children have significantly lower calorie, protein, fat, riboflavin, vitamin B12, calcium, phosphorus and iron intakes and lower serum iron, protein and albumin values. Z scores of weight-for-age (−1.38 ± 1.02 vs −0.59 ± 0.96, P = .00), height-forage (−1.34 ± 1.36 vs −0.51 ± 1.22, P = .00), head circumference-for-age (−1.37 ± 0.90 vs −0.90 ± 0.81, P = .00), mid-upper arm circumference (MUAC)-for-age (−0.71 ± 0.90 vs −0.22 ± 0.88, P = .00), and BMI-for-age (−0.79 ± 1.15 vs −0.42 ± 0.99, P = .04) were significantly lower in food-restricted compared to non-food-restricted children.More food-restricted children were stunted, underweight with lower head circumference and MUAC. Severe disease was an independent risk factor for food restriction with OR 5.352; 95% CI, 2.26-12.68. Conclusion:Food restriction is common in children with AD. It is associated with lower Z scores for weight, height, head circumference, MUAC, and BMI. Severe disease is an independent risk factor for food restriction. K E Y W O R D S atopic dermatitis, diet habits, eczema, nutritional status 1 | INTRODUC TI ON Growth and development are important reflections of a child's overall health. Atopic dermatitis (AD) has been shown to negatively affect growth in children. 1-4 Height and weight percentiles, z scores, and growth velocity of children with AD are lower than normal controls. 1-3 The degree of growth impairment correlates with severity of AD; children with milder AD are less affected compared to those 70 | Pediatric Dermatology LOW et aL.with severe disease. 2,4 The role of AD as a major predisposing factor in affecting children's growth is still unclear as there are various factors that contribute to growth. Dietary restriction, increased metabolism, sleep disturbances, and cutaneous nutrient loss have all been implicated in growth impairment.Dietary restriction in children with AD ranges from 16% to as high as 75%. [5][6][7] In most, food restriction is imposed by parents or caregivers as part of AD treatment without proper medical advice or supervision. 7 Subsequently, food restriction can be a major factor contributing to malnutrition and worsening of AD. Nutritional intervention has result...

The pathophysiology of atopic dermatitis (AD) is multifaceted. The role of skin pH in skin barrier repair is increasingly applied in therapeutic strategies. The pH of normal skin ranges from 4.5 to 6.0. 1-5 Acidic pH is involved in the protective functions of the skin by providing a favourable environment for normal microbiota, inhibiting growth of pathogenic microorganisms including Staphylococcus 1,6,7 and maintaining the barrier structure of the stratum corneum. 8 Corneocyte desquamation is regulated by the protease enzymes and its inhibitors. Optimal activity of the main skin specific proteases, stratum corneum chymotryptic enzyme (SCCE) and stratum corneum tryptic enzyme (SCTE) occurs at neutral to slightly alkaline pH while cysteine proteases are optimal at acidic pH. Lower pH limits the activity of lymphoepithelial Kazal-type 5 serine protease inhibitor (LEKTI). Hydrolytic enzymes β-glucocerebrosidase and sphingomyelinase involved in the production of ceramides, and free fatty acids in the lipid lamellae matrix require pH of 4.5 and 5.6 for optimal activity. 8,9 Skin surface