Subsidiary of Italian’s No.1 bio-pharmaceutical
company, A.Menarini Singapore Pte Ltd, ushered the New Year in launching three
guidebooks for medical doctors in Malaysia at an informative skin forum on 17
January 2016. The ‘Primary Care Skin Forum 2016’, Malaysia’s first CPD (Continuing
Professional Development) symposium of the year saw doctors equipped with the
latest medical updates in treating the three most common chronic skin disorders,
namely, Atopic Dermatitis (AD), Seborrheic Dermatitis (SD) and Acne Vulgaris.
The forum was jointly organised under the patron of Persatuan Dermatologi Malaysia (PDM),
the Malaysian Paediatric Association (MPA) and three other medical associations
in the private medical sectors, namely Malaysian Medical Association (MMA)
Selangor, Private Medical Practitioners Association of Selangor and Kuala Lumpur (PMPASKL)
and Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM).
(From left to right) Dr Leong Kin Fon, Dr Lee Yin Yin, Dato’ Dr Noor Zalmy Azizan and Prof Dr Giuseppe Micali (Head of Dermatology Department and Dermatologist Residency Program Director, University of Catania, Italy) signing three consensus handbooks and another book entitled Seborrheic Dermatitis. The three consensus handbooks are namely: 1.Proceedings of the MEDIATE Advisory Board Forum: The Role of Medical Device in Flare and Remission Treatment of Atopic Dermatitis 2.Asia-Pacific Seborrheic Dermatitis Leaders’ Summit 2014: Consensus Recommendations for the Diagnosis and Management of Seborrheic Dermatitis in Asian Patients 3.Proceedings from the 4th Asia Pacific Leaders’ Summit 2015 – Meeting the Challenges of Acne Treatment: An Evaluation of the Role of Dermocosmetics in Management of Acne Vulgaris in Malaysia.
In his opening speech, Dr Henry Foong Boon Bee,
President of PDM said, “Skin conditions form
a large proportion of the consultations in a primary care clinic. This is very
timely for general practitioners to come together to be updated with the latest
advances in skin diseases so as to help patients get the best possible care.”
Updates in Atopic Dermatitis
Dr Leong Kin Fon, Consultant Paediatric Dermatologist Hospital Kuala Lumpur began the
first session by addressing the common misconceptions and myths surrounding AD,
which is commonly known as ‘eczema’ among Malaysians. He highlighted that AD presents
itself in four basic components namely, skin dryness, itchiness, inflammation
and infection.
Dr Henry Foong (
President of Persatuan Dermatologi Malaysia)
delivering the
opening address to doctors and members of the media at the Primary
Care Skin Forum
2016.
Dr Henry Foong (
President of Persatuan Dermatologi Malaysia)
delivering the
opening address to doctors and members of the media at the Primary
Care Skin Forum
2016.
Dr Henry Foong (
President of Persatuan Dermatologi Malaysia)
delivering the
opening address to doctors and members of the media at the Primary
Care Skin Forum
2016.
Dr Henry Foong (President of Persatuan Dermatologi Malaysia) delivering the opening address to doctors and members of the media at the Primary Care Skin Forum 2016.
Due to the multifaceted aspects of AD, managing
the disease requires a combined rotational approach that will consist of moisturisers,
cleansers, anti-itch package, steroids, antibiotics and mild antiseptics. All
these, in addition to subjugating environmental triggers.
Dr Leong then spoke about a
new class of treatment – a topical medical device to
treat paediatric AD. He added that this newer class of topically applied,
semi-solid formulation, approved by the United States for Food and Drugs
Administration (USFDA) for the treatment of various skin diseases, including
AD. Unlike OTC cosmetic products, medical device has a more specific indication
and with some evidences to support its usage.
Citing
from a handbook titled ‘The Role of Medical Device in Flare and Remission
Treatment of Atopic Dermatitis’, faculty members formed by six consultants represented
by dermatologists, paediatric dermatologists, and allergists and immunologists,
reached a consensus that medical devices can play a role as an important emollient
and can also be used as a monotherapy treatment in mild AD cases or to prevent
AD flare during remission period to keep AD under control.
One
medical device that is well-supported with research papers is Atopiclair – a hypoallergenic
and non-steroidal cream that is able to assist in physiological skin barrier
repair and break the dry-itch-inflammation-infection cycle. The consensus
handbook highlighted the unique anti-itch and anti-inflammatory properties of
Atopiclair that may have a role in shortening the use of topical
corticosteroids or topical calcineurin inhibitors, thus reducing the need for
steroid rescue.
Dr
Leong went on to discuss about the cost-effectiveness of using medical devices
in paediatric AD. In a comparison study against regular emollients, Atopiclair
was found to dominate over regular moisturisers to be a more cost-effective option
to keep AD under control. The latest study in 2015 showed that Atopiclair could
save up to a whopping USD786 (RM3,436) per year because of lesser medical expenditure,
reduced drug use and increase in productivity time as compared to patients
using conventional moisturisers.
Updates in Seborrheic Dermatitis
The second session zeroed in on SD, a
common inflammatory skin disease characterised by scaly lesions usually on the
scalp, hairline and face. According to Dato’ Dr Noor Zalmy Azizan, Consultant Dermatologist Hospital Kuala
Lumpur, SD is often underdiagnosed and undertreated. Mild SD may present itself
among Malaysian adults in the form of uncontrolled dandruff.
In infants, SD takes the form of cradle caps
(yellowish scaling on scalp) and inflammation of the groin folds that often
manifest in the first few weeks of life. Dr Azizan explained that infantile SD does
not necessarily cause extreme itchiness. Hence, the baby often appears
undisturbed by the rash, and the condition is usually resolved when the baby is
12 months of age.
In adults however, SD may take the form of red
or yellow and whitish scaly patches on scalps, behind the ears, on the eyebrows.
Patients with SD may resemble having bad ‘dandruff’ on their face. SD may also
take the form of inflammation of eyelids, noses and lips, upper body, armpits and
groin areas. Adults with SD often live their lives feeling embarrassed at work
and in their social life as there are often labelled by associates as being dirty,
unhygienic, drunk (with presence of red face) and being unattractive to the
opposite sex.
In terms of treatment, current treatments
for SD have their limitations. At this juncture, Sebclair’s arrival to the
Malaysian market is very much welcomed. Dato’ Dr Noor Zalmy Azizan explained
that Sebclair™, a non-steroidal, non-azole derivative and non-calcineurin
inhibitor topical device cream, has been effective in treating both mild to moderate
adult SD and infants with cradle cap.
In the 2014 Asia-Pacific SD Leaders’
Summit, one of the consensus recommendations for the management of SD in Asian
patients was the use of Sebclair™ as a first line treatment. This novel agent
helps enhance the natural barrier of the skin and restore its natural
physiology, which is altered in SD. Sebclair™ has been shown to be effective
and well-tolerated for treatment of mild to moderate SD of the face, scalp and
body. Sebclair™ has been shown to provide comparable results with topical
steroid (desonide cream 0.05%) but with better relapse prevention rate.
Sebclair™ has been proven to provide both anti-inflammatory and anti-fungal
actions which are needed to manage and control SD.
Updates in Acne Vulgaris
“Acne vulgaris is a medical disease and
medical treatment by healthcare providers is required,” said Dr Lee Yin Yin, Consultant Dermatologist Sunway Medical
Centre, the final plenary speaker.
Acne vulgaris is a chronic inflammatory
disorder of the hair
follicles and oil glands, which is very common among adolescents and young
adults. Treatment gaps were shared during this forum. Dr Lee shared that
current treatments may give rise to skin irritation to acne patients such as
dry skin, sensitive skin, burning, stinging, redness, inflammation, sensitivity
to sunlight, shaft lips among others. Prescription of topical and oral antibiotics
over the years also has led to a global antibiotic resistance in P. acnes, the main culprit in acne
vulgaris.
Citing from the outcome of the
Proceedings from the 4th Asia Pacific Acne Leaders’ Summit 2015 –
Malaysian Advisory Board Meeting, Dr Lee explained that resistance is a
significant problem facing acne patients and steps to prevent it are necessary.
The update this year was the
introduction of dermocosmetics as the new adjunctive acne therapy in Malaysia.
This is based on the latest consensus reached by dermatologists in the 4th
Asia Pacific Acne Leaders’ Summit 2015. An example will be Papulex, a
well-studied dermocosmetic used by dermatologists worldwide with active
ingredients nicotinamide, zinc PCA and patented anti-bacterial adhesive technology
(ABA) that has been shown to reduce inflammation, sebum production and P. acnes proliferation (rapid
multiplication).
Studies have shown that 4%
nicotinamide gel is of comparable efficacy to 1% clindamycin gel, a common
topical antibiotic used in acne treatment in Malaysia. ABA helps inhibit P. acnes proliferation, biofilm
formation and adhesion to acne skin. The consensus recommended the use of ABA
in acne management. The antimicrobial adhesion properties of ABA looked
promising and further studies are necessary to establish its mechanism of
action.
The forum ended with a book-signing ceremony of the
three consensus handbooks:
1. Proceedings of the MEDIATE Advisory Board Forum: The
Role of Medical Device in Flare and Remission Treatment of Atopic Dermatitis
2. Asia-Pacific Seborrheic Dermatitis Leaders’ Summit
2014: Consensus Recommendations for the Diagnosis and Management of Seborrheic
Dermatitis in Asian Patients
3. Proceedings from the 4th Asia Pacific Leaders’ Summit
2015 – Meeting the Challenges of Acne Treatment: An Evaluation of the Role of
Dermocosmetics in Management of Acne Vulgaris in Malaysia.
Prof Dr Giuseppe Micali, Head of Dermatology Department and Dermatologist Residency Program Director, University of Catania, Italy
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