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Background: Skin care for maintaining skin integrity includes cleansing, skin product use, and photoprotection. Inappropriate skin care can lead to skin problems. Aims: To evaluate the knowledge, attitude, and practices in skin care among Thai adolescents. Patients/Methods: Questionnaire‐based, descriptive, cross‐sectional study. Results: A total of 588 Thai adolescent students (mean age: 15.6 ± 1.8 years, 50.5% female) were included. Of those who responded, 99.5% knew the benefits of cleansing, and 95.9% knew the benefits of skin care products. Skin products, moisturizer, and sunscreen were used by 87.8%, 80.8%, and 71.5% of students, respectively. Female teenagers used moisturizers, cosmetics, and sunscreen significantly more than males (p = 0.001, p = 0.001, and p < 0.001, respectively). High school teenagers applied cosmetics more than junior high school teenagers (p = 0.004). Ninety‐three percent of adolescents knew the effects of sunlight, but only 27.4% regularly applied sunscreen. The sources of knowledge were from person, online social media, print media, and television/radio in 88.5%, 77.5%, 30.7%, and 26.1%, respectively. Data from physicians and parents were trusted by 65.3% and 64.2%, respectively. Most (74.1%) adolescents searched for data from more than 1 source. Adolescent females and high school adolescents demonstrated significantly more accurate knowledge and practice in cleansing and photoprotection (p < 0.001) compared with adolescent males and junior high school adolescents. Knowledge and practices did not significantly correlate with underlying skin diseases or monthly allowance. Conclusion: Gender and education level were found to significantly influence knowledge and practice in skin care among adolescents in Thailand. [ABSTRACT FROM AUTHOR]

Background: Juvenile dermatomyositis is a rare condition, but it is the most common idiopathic inflammatory myopathy in pediatric patients. Aim: To study the clinical manifestations, investigations, treatment, clinical course, and outcomes of juvenile dermatomyositis in Thai children. Method: This retrospective study included juvenile dermatomyositis patients treated at Siriraj Hospital, a 2,300-bed national tertiary referral center in Bangkok, Thailand, from 1994 to 2019. Results: Thirty patients (22 females and 8 males) were included with a female to male ratio of 2.7:1. Median age at diagnosis was 5.1 years (range, 2.6-14.8 years). Median duration of illness before diagnosis was 6.5 months (range, 0.3-84.0 months). Acute and subacute onset occurred in the majority of patients. Presenting symptoms included muscle weakness in 27/30 (90%), skin rash in 26/30 (86.7%), muscle pain in 17/26 (65.4%), and arthralgia in 4/18 (22.2%) of patients. Dermatologic examination revealed Gottron's rash, heliotrope rash, and periungual telangiectasia in 25/30 (83.3%), 21/30 (70.0%), and 15/24 (62.5%) of patients, respectively. Interestingly, scalp dermatitis was found in 8/21 (38.1%) of patients. The most commonly used treatment regimen in this series was a combination of prednisolone and methotrexate. During the median follow-up of 3.1 years (range, 0.0-18.5 years), only one-third of patients were seen to have monocyclic disease. Extraskeletal osteosarcoma at a previous lesion of calcinosis cutis was observed in one patient at 12 years after juvenile dermatomyositis onset. Limitations: This was a retrospective single-center study, and our results may not be generalizable to other healthcare settings. Prospective multicenter studies are needed to confirm the findings of this study. Conclusion: juvenile dermatomyositis usually poses a diagnostic and therapeutic challenge, which can be compounded by the ethnic variations in the clinical presentation, as observed in this study. Asian patients tend to present with acute or subacute onset of disease, and arthralgia and/or arthritis are less common than in Caucasian patients. Scalp dermatitis is not uncommon in pediatric juvenile dermatomyositis patients. An association between juvenile dermatomyositis and malignancy, though rare, can occur. [ABSTRACT FROM AUTHOR]

Background: There is a scarcity of data on the effects of duration of bathing and cutaneous properties. Aims: This study aimed to investigate the changes of capacitance and transepidermal water loss (TEWL) after soaking in water for the different durations. Method: This experimental biophysical study included healthy volunteers whose forearms were randomized to receive 3, 5, 10, 15, or 20 min of soaking of the volar aspect of the forearm. Skin hydration and integrity were assessed capacitance and TEWL measurement before and after soaking. Results: Sixty‐five subjects (130 forearms) were enrolled with an average age of 33 ± 10.8 years. The change in capacitance after soaking for durations of 3, 5, 10, 15, and 20 min was 41.54 ± 14.57, 47.13 ± 11.80, 40.25 ± 14.95, 40.48 ± 14.19, and 39.97 ± 9.47 AU, respectively. The highest capacitance was observed after soaking for 5 min; however, there was no significant correlation between bathing duration and capacitance (p = 0.256). The capacitance measured immediately after soaking was at the uppermost level, but it rapidly decreased within 5 min. The change in TEWL after soaking for durations of 3, 5, 10, 15, and 20 min was 30.27 ± 9.74, 30.57 ± 7.45, 33.78 ± 9.25, 33.44 ± 7.24, and 35.13 ± 9.37 g/m2/h, respectively. There was also no significant correlation between duration of soaking and TEWL (p = 0.191); however, TEWL tended to increase with longer soaking duration. Limitations: This study had a small sample size and measured only capacitance and TEWL. Future studies with more subjects, and that measure other physiologic parameters may further improve our understanding of the effect of bathing on skin. Conclusions: There was no significant correlation between bathing duration and cutaneous properties including capacitance and TEWL. However, a 5‐min soaking provided the highest skin hydration for healthy skin. [ABSTRACT FROM AUTHOR]

Background: Acne is a very common skin disease. Information on it is readily available and accessed by most patients. Nevertheless, they tend to have misunderstandings about the disease. Aims: This study investigated Thai acne patients' perceptions of, and beliefs, about acne; their treatment‐seeking behaviors; and the data sources available to them. Patients/Methods: A cross‐sectional, questionnaire‐based study was conducted among teenage and adult acne patients at the skin clinics of the Department of Dermatology and the Department of Pediatrics, Siriraj Hospital, January‐December 2017. Results: A total of 330 patients with a mean age of 23.89 ± 7.19 years (range: 9‐51 years) were enrolled. Hormonal factors were the most common determinant thought to worsen acne (80.6%), followed by dirt (72.4%), inadequate sleep (65.5%), cosmetics (58.2%), and stress (55.8%), whereas frequent facial washing and exercise were the least common (4.8% each). The most common information source utilized by patients was friends (40.9%), followed by digital media (36.8%). Both males and females felt their acne greatly affected their quality of life. Before visiting the hospital, most patients used vitamin supplements and over‐the‐counter drugs as treatment. Conclusions: Some patients had good conceptions of certain aspects of acne, such as the influence of hormones or food, whereas others had misunderstandings about the effects of poor hygiene on acne. Friends and websites were the most common information resources exploited by patients. Acne substantially impaired the quality of patients' lives. [ABSTRACT FROM AUTHOR]

There was an outbreak of Tinea capitis at the Pak-kred Home for Mentally and Physically Handicapped Babies, Bangkok, Thailand in 1993. One hundred and thirty-eight cases were diagnosed as tinea capitis based on clinical signs and positive laboratory investigations. The results of Wood's light examination, KOH preparation and fungal culture were positive in 89.9, 75.9 and 27.4% respectively. The non-inflammatory form had a higher rate of positive KOH and culture than in the inflammatory form. Microsporum ferrugineum was the major pathogen (66.7%) and most of its infections (80.4%) caused a non-inflammatory type of tinea capitis. Griseofulvin, in a dosage of 10-15 mg/kg/day and selenium sulfide shampoos, yielded an 84.8% cure rate within 14.9 weeks. No recurrence or obvious adverse reactions were observed. [ABSTRACT FROM AUTHOR]

Background: Severe cutaneous adverse drug reactions (SCARs) can cause significant morbidity and mortality. Clinical data regarding such conditions is still limited in the pediatric population., Objective: To investigate the incidence, clinical characteristics, treatment, and outcome of SCARs in Thai pediatric patients., Methods: This retrospective study enrolled 52 patients aged less than 18 years who were diagnosed with acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), or SJS/TEN overlap during January 2005 to August 2021 at Siriraj Hospital., Results: SCARs were slightly more prevalent in females than in males (51.9% vs. 48.1%). Median age at diagnosis was 97 months, and median length of hospital stay was 11 days. DRESS, SJS, TEN, AGEP, and SJS/TEN overlap was found in 44.2%, 36.5%, 9.6%, 5.8%, and 3.8%, respectively. The most common etiologies were antimicrobial agents (40.3%) and anticonvulsants (35.5%). Target lesions, vesicobullous lesions, purpura, positive Nikolsky's sign, and skin tenderness were significant in blistering SCARs. Hematologic (84.6%) and hepatic (65.5%) manifestations were common. Treatment varied according to the clinical features of each condition. Systemic corticosteroids showed some benefit in SJS/TEN. One patient diagnosed with TEN died for an overall SCARs mortality rate of 1.9%., Conclusion: The unique characteristics of SCARs described herein can lead to timely and accurate diagnosis and proper management.

Background: Food allergy (FA) has been reported in one-third of children with moderate-to-severe atopic dermatitis (AD)., Objective: To identify factor associated with food allergy among preschool children with AD, and to compare AD resolution between preschool children with and without FA., Methods: A cross-sectional study using database registry and questionnaire interview was conducted at Siriraj Hospital(Bangkok, Thailand) during 2022, and physician-diagnosed AD children aged ≤ 6 years were enrolled., Results: A total of 110 children (60.9% male, median age: 2.3 years) were included. Of those, 53 and 57 children had AD with and without FA, respectively. Very early-onset AD (≤ 3 months) and moderate-to-severe AD at onset were reported in 43.9% and 26.3% of AD without FA, and in 35.8% and 45.3% of AD with FA, respectively. The most commonly reported FAs were hen's egg, cow's milk, and wheat. Moderate-to-severe AD at onset was found significant associated with FA (aOR: 2.50; p = 0.037). Thirty-one (28.2%) patients experienced completed resolution of AD by 5 years of age. Of those, 19 had AD without FA, and 12 had AD with FA (p = 0.213). The median age at AD resolution was 18 months and 22.5 months in the without and with FA groups, respectively. AD with FA showed a strong trend toward a significantly longer duration to achieving AD resolution after adjusting for onset and severity of AD (aHR: 0.46, p = 0.050)., Conclusion: Preschool AD children with FA were found to have significantly greater AD severity at AD onset and a longer duration to AD resolution compared to AD children without FA.

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.

Objective: To evaluate the validity and reliability of the Thai version of Children Dermatology Life Quality Index (CDLQI)., Material and Method: CDLQI was translated to Thai and approved by Lewis-Jones MS and Finlay AY The patients, 4- to 15-year-old, with skin diseases and with problems unrelated to the skin were included to complete this questionnaire. Some patients with skin diseases were randomly selected to complete the CDLQI again seven days later to test the reliability. The time to complete the questionnaire was recorded., Results: Two hundred six children, which consisted of 113 patients with skin diseases (26 of this group answered the questionnaire twice) and 93 patients without skin diseases, were enrolled in the study. The mean age and sex distribution of the two groups were not statistically different (p 0.84, p 0.60, respectively). The mean CDLQI score of the patients with skin diseases was 7.5 ± 6.1. The validity of the CDLQI Thai version was p < 0.001 by comparing the scores from a variety of skin diseases with controls. Good reliability was demonstrated by assessing repeatability, which showed strong correlation coefficient of test-retest data with Spearman rank correlation coefficient r(s) 0.94 (p < 0.001). The Cronbach's coefficient alphas showed high internal consistency of the individual item (0.87). The average time to complete all questions was 4.5 ± 2.5 minutes. The younger age group spent longer time than the older age group (p < 0.001)., Conclusion: The Thai version of CDLQI has good validity and reliability. It should be used to measure quality of life in the management of skin diseases in Thai pediatric patients.

Background: Atopic dermatitis (AD) is a common chronic inflammatory skin lesion in children. Topical corticosteroid is the mainstay of treatment., Objective: To compare the efficacy of moisturizer containing licochalcone A (LicA) and 1% hydrocortisone for the treatment of mild to moderate childhood AD., Material and Method: This was a multicenter randomized, prospective, split-side, double-blind study in 55 children between the age of three months and 14 years. Patients with AD were treated twice daily, simultaneously with either Lic A or 1% hydrocortisone on opposite sides of the lesion. The SCORAD and transepidermal water loss (TEWL) were performed at the baseline, 2-week, and 4-week visits. Lic A was used on both sides of the body for another four weeks to see the effects and TEWL., Results: In a randomized period, both products were equally effective in the treatment. SCORAD decreased significantly from baseline for both treatments throughout the first four weeks (p < 0.001). There was no statistically significant difference in SCORAD between both treatments (p = 0.321 and p = 0.146 at week 2 and 4, respectively). Lic A had statistically significant decrease in TEWL (p = 0.027 and p = 0.03 at weeks 2 and 4, respectively). One patient had infection on skin lesions of both sides of the body. Forty-three patients continued to the period of using Lic A on both sides of the body. SCORAD and TEWL were comparable to the end of the randomized period and significantly lower from baseline (p < 0.001). Skin lesions flared up in three patients (7.5%)., Conclusion: Lic A had a similar result in terms of SCORAD compared to 1% hydrocortisone for the treatment of mild and moderate AD. TEWL was significantly lower than baseline on the side that used Lic A. Continuing use of Lic A for four weeks can maintain clinical and barrier improvement.

Background: Atopic dermatitis (AD) is an immunological skin disease. It is common in pediatric populations and often requires topical steroid treatment. Moderate to severe AD may not respond to topical steroids. They often require systemic steroids, which may result in growth retardation. Protopic, a non-steroid, tacrolimus based ointment which is a calcinurin inhibitor has been proved to be effective in caucacian with AD., Objective: To evaluate safety and efficacy of 0.03% tacrolimus ointment (Protopic&) in moderate to severe AD in pediatric patients age 2-12 years., Material and Method: This was a one month multicenter open-label clinical trial using tacrolimus ointment twice daily in 61 subjects with moderate to severe AD from September to December 2004. Efficacy assessments were measured by Physician's Global Evaluation of Clinical Response (PhGECR), Eczema area and Severity Index (EASI), Patient's Global Evaluation of Clinical Response (PaGECR), and Quality of Life (QOL). Safety assessment was measured by incidence rate of adverse events., Results: Fifty-eight patients completed the studies. Twenty-two patients were male; thirty-nine patients were female. Twenty-nine patients had moderate AD. Thirty-two patients had severe AD. Three cases had discontinued treatment at the third week due to increase in severity. Over all PhGECR were significantly increased, 94% showed moderate improvement in PhGECR at week 4 or end of treatment (EOT)and 83% had better improvement in PaGECR at EOT Within 7 days, tacrolimus demonstrated rapid onset in reduction of EASI score and itch in patients. Mean QOL were significantly decreased at the end of the present study. Incidence of adverse events included application site burning (21%), itching (17%), pruritus (9%), infections(3%), and erythema and folliculitis (2%). Burning sensation, erythema, pruritus and itching were resolved after the first week., Conclusion: Topical tacrolimus ointment is effective and safe in moderate to severe AD. It significantly improved PhGECR, EASI, PaGECR, and QOL in pediatric patients after the first week of treatment and continued through the end of the study. The major adverse events were burning, itching, and pruritus, which were resolved within the first week of therapy.

Background: Severity of irritant diaper dermatitis (IDD) from diarrhea varies from patient to patient depending on the nature of feces and the number of bowel movements. The purpose of the present study was to compare the effectiveness of dexpanthenol and zinc oxide ointment with ointment base in the treatment of irritant diaper dermatitis from acute diarrhea in children by measuring transepidermal water loss (TEWL)., Material and Method: Forty-six children with diarrhea were prospectively, block randomized, investigator-blinded to receive dexpanthenol and zinc oxide ointment on one side and ointment base on the other side. TEWL was measured before and on days 1, 3, and 7 of treatment together with the assessment of severity score. The efficacy of treatment was defined by complete clearance of the lesion., Results: TEWL in the treated and control side was not different before the application of the topical medication. In the present study, the efficacy of 5% dexpanthenol and zinc oxide ointment on D3 was 39% (18from 46 patients) compared to 32% in the ointment base side. On D7, the efficacy of the treated side was 58.7% and the ointment base side was 56%. The patients who still had skin lesions were those who had prolonged diarrhea. On the treated side, the mean of TEWL was lower than the control side on DI (p = 0.18) and had significant improvement on D3 (p = 0. 002). At the end of the present study, TEWL on the treated side was less than TEWL of the control side but it did not have statistical significance (p = 0.07). There was no rash or sign of abnormality on the treated side at the end of D7., Conclusion: In the treatment of lDD from acute diarrhea, 5% dexpanthenol and zinc oxide ointment significantly decreased TEWL in the treated side more than the ointment base on day 3 but the severity score was not significantly different on days 1, 3 and 7.

Sarcoidosis is a multisystemic disease of unknown etiology. The disease is common in blacks and is very rare in Thailand. It presents as one of the most variable manifestations usually affecting the lungs and intrathoracic lymph nodes. Other organs such as liver, spleen, joints and eyes including skin are also involved The common cutaneous lesions are maculopapular, erythematous plaque, subcutaneous nodule, scar and lupus pernio. No reliable indicator is useful for diagnosis except the histopathologic change which is the only way for approaching this disease. Sarcoidosis is the disease of exclusion. Various infections producing granulomas should be excluded histologically. The ultimate diagnosis requires clinical correlation, laboratory investigations, chest X-ray as well as available tissue culture. Herein, the authors reported eight cases of sarcoidosis by retrospective study primarily diagnosed by histopathological findings at Siriraj Hospital from January, 1997 to December, 2004 with many different clinical presentations. Despite the diverse clinical pictures, interestingly, the presented patients almost had the same histopathologic findings as small, uniform, discrete naked granulomas usually without necrosis. These findings act as a hallmark for diagnosis of this disease.

A prospective, non-randomized, open clinical trial was conducted to determine the efficacy of itraconazole for treatment of Microsporum ferrugineum tinea capitis. Itraconazole capsules were given every day in continuous group and every day for 1 week on and 3-week off in pulse therapy group. Concomitant topical therapy with 2% ketoconazole shampoo was used daily. Clinical evaluation consisted of assessing the degree of hair loss, scaling, erythema, pustule, and crust. In both groups, the treatment was stopped when the clinical signs of inflammation had resolved and the mycological examination had become negative or at week 12. There were 81 patients consisted of 49 boys and 32 girls enrolled and average dose of itraconazole was 4.5 mg/kg/day. During the 16-week study period (with 4-week follow-up visit) the overall clinical severity score decreased every visit (p < 0.001). The improvement of the scores showed no statistical difference between both groups. The cumulative cure rate using combined clinical and mycological cure at week 16 in patients treated with continuous and pulse regimen was 54.3% (19/35) and 37.0% (17/46), respectively. The cumulative percentage of all cure rates including clinical cure, mycological cure and combined clinical and mycological cure of the continuous group was significantly higher than in the pulse therapy group (p < 0.001). The superior efficacy of the continuous therapy group was observed after week 8. The cumulative cure rate increased with the longer treatment duration but decreased with the larger infected area involvement (p = 0.001). All patients who were not cured showed improvement. There was no significant adverse effect. The higher dosage or the longer treatment duration of itraconazole may be required for treatment of tinea capitis from M. ferrugineum to achieve more cure rate.

Atopic dermatitis (AD) is a common skin disease in Thai children. There is no clinical or laboratory gold standard for the diagnosis. It is generally based on the guideline proposed by Hanifin and Rajka. Many studies have shown that some criteria are probably not all that significant in making the diagnosis. This study was designed to evaluate the frequency and diagnostic significance of clinical features of AD in Thai children. The authors studied 108 patients with AD and 103 controls including patients with other skin diseases. The AD group consisted of 60 girls and 48 boys. The mean age was 60.3+/-36.1 months. All previously proposed features were evaluated and the difference infrequency was tested with the chi-square test. History of pruritus, rash on typical distribution, chronically relapsing course, duration more than 6 months, personal or family history of atopy, age of onset before 2 years, recurrent conjunctivitis, itch when sweating, intolerance to rough textile, food and milk intolerance, history of dry skin, seasonal variation, visible dermatitis, dermatitis of a typical distribution, xerosis, ichthyosis vulgaris, foot dermatitis, Dennie-Morgan infraorbital fold, orbital darkening, periorbital dermatitis, pityriasis alba, peri-auricular dermatitis, anterior neck fold, truncal dermatitis, perifollicular accentuation, white dermographism and diffuse scaling of scalp were all significantly more frequent in AD (p < 0.05). A minimum set of diagnostic criteria for AD was derived by using multiple stepwise logistic regression technique. It consisted of history of itchy rash, history of flexural dermatitis, chronicity more than 6 months, and visible xerosis, periorbital dermatitis and perifollicular accentuation.

Two patients with severe atopic dermatitis unresponsive to conventional therapy were enrolled in a clinical trial on thymostimulin (TP-1). TP-1 was administered by subcutaneous injection 1 mg/kg/day for 14 days and then 1 mg/kg/day on alternate days for 2 months. Clinical and immunological status were evaluated at baseline and at regular intervals during the treatment. Clinical severity scores included eight skin conditions (erythema, edema, vesicle, crust, excoriation, scaling, lichenification, pigmentation), two subjective components (itchiness and loss of sleep), and extent of area affected. There was a statistically significant improvement in the overall assessment of the severity scores. There were no definite changes in immunological parameters including CD4, CD8 T-cell subpopulations and serum IgE, but eosinophil count showed a mark decrease in one case. No serious side effects were observed.

Atopic dermatitis is a common skin disease in Thai children. The treatment of atopic dermatitis requires topical corticosteroids, emollients, systemic antihistamine as well as avoidance of the precipitating factors. A double blind multicenter placebo controlled study was conducted to assess the therapeutic efficacy of topical mometasone furoate 0.1 per cent cream in combination with loratadine syrup. Forty-eight patients, 23 boys and 25 girls, mean age 73.67 months, with atopic dermatitis were included in the study. The severity of the disease was measured by using the SCORAD index including the degree of erythema, dryness, edema/papulation, oozing/crusting, lichenification, and excoriation. Total area involved was measured and a target area of dermatitis was selected for specific evaluation. The degree of clinical signs and pruritic symptom was graded. The sensation of pruritus, disturbance of sleep due to pruritus, and feeling of sleepiness in the morning were recorded. Mometasone furoate 0.1 per cent cream was applied to all patients once daily. One group received loratadine syrup and another group received placebo syrup. They were followed-up on day 5, 8 and 15. The severity of atopic dermatitis and pruritus significantly decreased after 14 days of treatment in both groups (p < 0.001). There was no difference in therapeutic response between the loratadine and placebo groups (p = 0.99). All signs examined had decreased by the end of the study. The result demonstrated that 0.1 per cent mometasone therapy is very effective for treating childhood atopic dermatitis. Loratadine did not show beneficial effect when combined with good topical corticosteroid but it was safe and had no serious side effect on the children.