Papers by Wareeporn Disphanurat
Archives of Plastic Surgery, Sep 15, 2020
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has received increasing inter... more Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has received increasing interest among plastic surgeons as a long-term complication of breast augmentation. Although the prognosis is usually good, mortality is a possible outcome. Most of the cases reported in the past two decades have been from the United States, Europe, and Australia, whereas cases of BIA-ALCL in Asia remain rare. Herein, we describe the first known case of BIA-ALCL in Thailand, in which a 32-year-old woman developed BIA-ALCL 3 years after breast augmentation using textured implants. The patient underwent bilateral removal of the implants and ipsilateral total capsulectomy. This case report-the first of its kind from Thailand-should increase awareness of BIA-ALCL among plastic surgeons in Asia. The true incidence of BIA-ALCL in Asia may be underreported.
Research Square (Research Square), May 30, 2023
Allopurinol is causing substantial morbidity and mortality particularly in Asian population by pr... more Allopurinol is causing substantial morbidity and mortality particularly in Asian population by producing cutaneous adverse drug reactions (cADRs). The goal of this study was to identify genetic biomarkers of single nucleotide polymorphisms (SNPs) for allopurinol induced cADRs among Thai patients. We conducted a case-control association study after enrolling 57 Thai patients with allopurinol induced cADRs and 101 allopurinol tolerant controls. Genetic biomarkers and associated SNPs located on chromosome 6p21 were examined by TaqMan® SNP genotyping assays in both case and controls. Out of 15 SNPs in nine genes, four combined SNPs (rs3099844 of HCP5; rs9263726 of PSORS1C1; rs9263733 of POLR2LP and rs9263745 of CCHCR1) were signi cantly associated with allopurinol induced cADRs compared to tolerant controls (OR 3.2; 95% CI 24.2-266.8; P = 1.9x10 − 24). Overall sensitivity, speci city, positive predictive value and negative predictive value of these combinations were 84%, 94%, 9% and 100%, respectively. The SNPs were not in absolute linkage disequilibrium with HLA-B*58:01, however, the variant alleles of these SNPs combination were detected in 89.5% (51/57) of the cases. The ndings suggest that these SNPs could be used as an alternative novel biomarker in predicting cADRs in patients taking allopurinol especially in those with absence of HLA-B*58:01 allele but still experiencing cADRs.
Journal of The European Academy of Dermatology and Venereology, Feb 10, 2012
... On the pathogenesis of idio-pathic guttate hypomelanosis. J Am Acad Dermatol 1987; 16: 35–44.... more ... On the pathogenesis of idio-pathic guttate hypomelanosis. J Am Acad Dermatol 1987; 16: 35–44. 4 Hexsel DM. ... J Am Acad Dermatol 1990; 23: 681–684. 6 Kumarasinghe SP. 3–5 second cryotherapy is effective in idiopathic guttate hypomelanosis. ...
Journal of The American Academy of Dermatology, Aug 1, 2018
Background: Non-invasive fat removal is preferred because of decreased downtime and lower perceiv... more Background: Non-invasive fat removal is preferred because of decreased downtime and lower perceived risk. It is important to seek new non-invasive fat removal treatments that are both safe and efficacious. Objective: To assess the extent to which carboxytherapy, the insufflation of carbon dioxide gas into subcutaneous fat, results in reduction of fat volume. Methods: Randomized, sham-controlled, split-body study. Adults (BMI 22-29) were randomized to receive five weekly infusions of 1000 cc CO 2 to one side of the abdomen, and five sham treatments to the contralateral side. Primary outcome measures were ultrasound measurement of fat layer thickness, as well as total circumference before and after treatment. Results: Sixteen participants completed the study. Ultrasound measurement indicated less fat volume on the sides treated with carboxytherapy one week after the last treatment, (p=0.011), but was not maintained at 28 weeks. Total circumference decreased nominally but not significantly at Week 5 compared to baseline (p=0.0697). Participant body weights did not change over the entire course of the study (p=1.00) Limitations: Limitations included modest sample size and some sources of error in circumference and fat layer measurements. Conclusion: Carboxytherapy provides a transient decrease in subcutaneous fat that may not persist. Treatment is well-tolerated.
Allopurinol is causing substantial morbidity and mortality particularly in Asian population by pr... more Allopurinol is causing substantial morbidity and mortality particularly in Asian population by producing cutaneous adverse drug reactions (cADRs). The goal of this study was to identify genetic biomarkers of single nucleotide polymorphisms (SNPs) for allopurinol induced cADRs among Thai patients. We conducted a case-control association study after enrolling 57 Thai patients with allopurinol induced cADRs and 101 allopurinol tolerant controls. Genetic biomarkers and associated SNPs located on chromosome 6p21 were examined by TaqMan® SNP genotyping assays in both case and controls. Out of 15 SNPs in nine genes, four combined SNPs (rs3099844 of HCP5; rs9263726 of PSORS1C1; rs9263733 of POLR2LP and rs9263745 of CCHCR1) were significantly associated with allopurinol induced cADRs compared to tolerant controls (OR 3.2; 95% CI 24.2-266.8; P = 1.9x10− 24). Overall sensitivity, specificity, positive predictive value and negative predictive value of these combinations were 84%, 94%, 9% and 10...
Lasers in Surgery and Medicine
British Journal of Dermatology, 2016
The skin tests and in vitro assays currently available exhibit low sensitivity in verifying the d... more The skin tests and in vitro assays currently available exhibit low sensitivity in verifying the diagnosis of allopurinol hypersensitivity in suspected cases. What does this study add? This is the first study to introduce the in vitro test, demonstrating high diagnostic value in confirming the diagnosis of allopurinol-induced severe cutaneous adverse reactions.
Archives of Dermatological Research
Lasers in Surgery and Medicine, 2019
Objectives: Striae distensae are linear atrophic dermal scars. Despite several currently availabl... more Objectives: Striae distensae are linear atrophic dermal scars. Despite several currently available therapeutic modalities, no consistently effective therapies have been established. This study aimed to evaluate and compare the efficacy of topical recombinant human epidermal growth factor (rhEGF) and ablative fractional carbon dioxide (CO 2) laser (AFXL) versus ablative fractional CO 2 laser and topical Aloe vera gel in treating striae alba. Methods: A total of 24 participants with striae alba were enrolled. Patients' striae were divided into the left and right sides. Participants were treated with fractional CO 2 laser on both sides for three sessions at 4-week intervals. Immediately after the laser treatment, each side of the striae was randomly assigned to either rhEGF or Aloe vera gel treatment. Patients were required to apply the medication twice daily up to 1 month after the last laser treatment session. Texture, average melanin, and melanin variation were assessed at pretreatment, 1 month after the first, second, and third treatments, and 6 months after the last treatment. Participants were asked to complete a selfadministered questionnaire. Nine participants underwent skin biopsies of the nontreated and treated striae, which were obtained from each treated side. Results: Both sides of the treatment area showed significant improvement in texture starting from 1-month follow-up, which sustained up to 6 months after the final treatment, albeit without statistically significant difference between the rhEGF-and Aloe vera-treated sides (P < 0.001, 0.003, and 0.002 for the AFXL-rhEGF-treated side and P ¼ 0.024, 0.001, and 0.001 for the AFXL-Aloetreated side at 1 month after the first treatment, 1 month after the last treatment, and 6 months after the last treatment, respectively). Participants expressed satisfaction with the AFXL-rhEGF-treated side, which showed significantly greater marked improvement (at 50%) than the AFXL-Aloe-treated side at 6 months after the final treatment (P ¼ 0.034). Post-inflammatory hyperpigmentation (PIH) occurred in 95.8% of participants, which decreased after 6 months compared with baseline. Both treatments improved melanin variation at 6 months after the final treatment, although without significant difference from pretreatment between both groups. Skin biopsy revealed a statistically significant increase in epidermal thickness and decrease in elastic fragmentation in both groups. Conclusion: AFXL-rhEGF and AFXL-Aloe significantly improved the striae surface texture. PIH was the most common side effect, which improved at 6 months.
Journal of the European Academy of Dermatology and Venereology, 2018
Background: The lymphocyte transformation test (LTT) is a standard laboratory method to identify ... more Background: The lymphocyte transformation test (LTT) is a standard laboratory method to identify culprit drugs in patients with a history of drug-induced non-immediate hypersensitivity and is mainly performed during the recovery phase. The measurement of drug-specific interferon-γ (IFN-γ)-releasing cells has been introduced to confirm culprit drugs, even during the acute phase of drug allergy. Objectives: This study aimed to evaluate the capability of the enzyme-linked immunospot assay (ELISpot) to detect drug-specific IFN-γ-releasing cells during the acute phase and the capability of LTT to identify culprit drugs during the recovery phase in patients presenting with severe cutaneous adverse reactions (SCARs). Methods: Peripheral blood mononuclear cells (PBMCs) from 23 SCAR patients were collected during the acute and recovery phases and assayed for drug-specific IFN-γ-releasing cells and lymphocyte proliferation, respectively. Results: Drug-specific IFN-γ releasing cells were detectable in 73.9% of SCAR subjects (55.6% and 85.7% in patients who were and were not taking systemic steroids, respectively), whereas LTT results were positive in 52.2% of SCAR subjects. The frequencies of drug-specific IFN-γ-releasing cells were significantly higher in patients with positive LTT than in those with negative LTT (260.1 ± 110.0 and 46.6
Journal of Allergy and Clinical Immunology, 2022
Allergy, Asthma & Immunology Research, 2021
Propose: The purpose of this study was to investigate panels of enzyme-linked immunospot assays (... more Propose: The purpose of this study was to investigate panels of enzyme-linked immunospot assays (ELISpot) to detect drug-specific mediator releasing cells for confirming culprit drugs in severe cutaneous adverse reactions (SCARs). Methods: Frequencies of drug-induced interleukin-22 (IL-22)-, interferon-gamma (IFN-γ)-, and granzyme-B (GrB)-releasing cells were measured by incubating peripheral blood mononuclear cells (PBMCs) from SCAR patients with the culprit drugs. Potential immunoadjuvants were supplemented to enhance drug-induced mediator responses. Results: Twenty-seven patients, including 9 acute generalized exanthematous pustulosis (AGEP), 10 drug reactions with eosinophilia and systemic symptoms, and 8 Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) were recruited. The average frequencies of drug-induced IL-22-, IFN-γ-, and GrB-releasing cells were 35.5±16.3, 33.0±7.1, and 164.8±43.1 cells/million PBMCs, respectively. The sensitivity of combined IFN-γ/IL-22/GrB ELISpot was higher than that of IFN-γ ELISpot alone for culprit drug detection in all SCAR subjects (77.8% vs 51.9%, P < 0.01). The measurement of drug-induced IL-22-and IFN-γ
Dermatology Research and Practice, 2019
Background. There are limited randomized controlled trials of oral vitamin D supplementation in p... more Background. There are limited randomized controlled trials of oral vitamin D supplementation in psoriasis, especially in Asia, and the results are inconclusive. Objective. To investigate the clinical effect of oral vitamin D supplementation on psoriasis. Methods. Patients with psoriasis were randomized to receive vitamin D2 60,000 IU or similar-looking placebo pills once every 2 weeks for 6 months. The primary outcome was improvement of the Psoriasis Area and Severity Index (PASI) score at 3 and 6 months after treatment. Serum levels of 25(OH)D, calcium, phosphate, parathyroid hormone, and C-reactive protein and adverse events were monitored. The chi-square test, Fisher’s exact test, Student’s t-test, and Spearman’s correlation analysis were used in statistical analysis. Results. Of 50 subjects screened, 45 were eligible and randomized to the oral vitamin D2 group (n=23) or placebo group (n=22). At enrollment, the mean PASI score was 4.45, and 26.7% of patients had vitamin D deficie...
Journal of Allergy and Clinical Immunology, 2019
In vitro detection of drug-induced granzyme B, interferon-gamma, and interleukin-22 releasing cel... more In vitro detection of drug-induced granzyme B, interferon-gamma, and interleukin-22 releasing cells in different phenotypes of severe cutaneous adverse reactions
International journal for quality in health care : journal of the International Society for Quality in Health Care, Jan 20, 2018
To adapted the Drug Hypersensitivity Quality of Life (DrHy-Q) Questionnaire from Italian into Tha... more To adapted the Drug Hypersensitivity Quality of Life (DrHy-Q) Questionnaire from Italian into Thai and assessed its validity and reliability. Prospectively recruited during January 2012-May 2017. Multicenter; six Thai tertiary university hospitals. Total of 306 patients with physician-diagnosed drug hypersensitivity. Internal consistency and test-retest reliability were evaluated among 68 participants using Cronbach's ɑ and intra-class correlation coefficient (ICC). The validity of Thai DrHy-Q was assessed among 306 participants who completed World Health Organization Quality of Life-BREF (WHOQOL-BREF-THAI). Construct and divergent validities were assessed for Thai DrHy-Q. Known-groups validity assessing discriminating ability was conducted in Thai DrHy-Q and WHOQOL-BREF-THAI. Validity; reliability; single vs. multiple drug allergy; non-severe cutaneous adverse reactions (SCAR) vs. SCAR. Thai DrHy-Q showed good reliability (Cronbach's ɑ = 0.94 and ICC = 0.8). Unidimensional ...
The journal of allergy and clinical immunology. In practice, Jan 22, 2018
The prevention and confirmation of drug-induced severe cutaneous adverse reactions (SCARs) are di... more The prevention and confirmation of drug-induced severe cutaneous adverse reactions (SCARs) are difficult. To determine the benefit of HLA-B allele prescreening and the measurement of drug-specific IFN-γ-releasing cells in the prevention and identification of the culprit drug in patients with SCARs. A total of 160 patients with SCARs were recruited from 6 university hospitals in Thailand over a 3-year period. HLA-B alleles were genotypically analyzed. The frequencies of drug-specific IFN-γ-releasing cells in patients with SCARs were also measured. The drugs commonly responsible for SCARs were anticonvulsants, allopurinol, beta-lactams, antituberculosis agents, and sulfonamides. If culprit drugs had been withheld in patients carrying known HLA-B alleles at risk, it would have prevented 21.2% of SCAR cases, mainly allopurinol- and carbamazepine-related SCARs. Culprit drug-specific IFN-γ-releasing cells could be identified in 45.7% (53 of 116) of patients with SCARs caused by 5 major dr...
Journal of Allergy and Clinical Immunology, 2017
RATIONALE: Among other triggers, medications and underlying infections may cause worsening of chr... more RATIONALE: Among other triggers, medications and underlying infections may cause worsening of chronic urticaria (CU). We hypothesize that a significant proportion of patients labeled with multiple drug allergies have an underlying, undiagnosed chronic or recurrent urticaria ultimately leading to overdiagnosis of drug hypersensitivity. METHODS: A retrospective chart review was performed on drug allergic pediatric and adult outpatients evaluated by the division of Allergy & Immunology. Multiple drug allergies were defined as reaction to 2 or more chemically unrelated drugs. Demographics, drug allergy class, atopic conditions, and presence or absence of screening questions for urticaria were recorded. RESULTS: Seventy charts from patients in the division of Allergy from 8/ 2013-7/2016 were reviewed. Forty-one patients met our definition of multiple drug allergies. 24.4% (10/41) of patients with multiple drug allergies had a concomitant diagnosis of CU. Of those patients, 90% were female and 90% had atopic disease. Antibiotics were the most common culprits (80%), with sulfonamides and beta-lactams comprising 87.5% and 62.5%, respectively. Notably, 65.9% (27/41) of the patients included in our study were not asked screening questions for chronic or recurrent urticaria. CONCLUSIONS: Prevalence of reported drug allergy in CU patients is dramatically higher in comparison to that of the general population. With increasing importance on accuracy of drug allergies reported in medical records, it is prudent that patients with multiple drug allergies be screened for chronic or recurrent urticaria. Further studies are needed to evaluate if patients with CU have increased prevalence of drug hypersensitivity, or if underlying, untreated urticaria accounts for misdiagnosed drug allergy.
Journal of Allergy and Clinical Immunology, 2016
Journal of the European Academy of Dermatology and Venereology, 2012
... On the pathogenesis of idio-pathic guttate hypomelanosis. J Am Acad Dermatol 1987; 16: 35–44.... more ... On the pathogenesis of idio-pathic guttate hypomelanosis. J Am Acad Dermatol 1987; 16: 35–44. 4 Hexsel DM. ... J Am Acad Dermatol 1990; 23: 681–684. 6 Kumarasinghe SP. 3–5 second cryotherapy is effective in idiopathic guttate hypomelanosis. ...
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Papers by Wareeporn Disphanurat