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).
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.
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:
- Proceedings of the MEDIATE Advisory Board Forum: The Role of Medical Device in Flare and Remission Treatment of Atopic Dermatitis
- Asia-Pacific Seborrheic Dermatitis Leaders’ Summit 2014: Consensus Recommendations for the Diagnosis and Management of Seborrheic Dermatitis in Asian Patients
- 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.
Another book entitled Seborrheic Dermatitis was also signed at the ceremony by Prof Dr Giuseppe Micali, Head of Dermatology Department and Dermatologist Residency Program Director, University of Catania, Italy, who later presented a speech at the dinner symposium.