Wells’ syndrome in an 18-year-old Filipino female: A case report

@#This is a case of an 18-year-old Filipino female with no known comorbidities, who presented with a three-year history of recurrent erythematous papules, vesicles, and nodules over her bilateral side of the chin. She was initially managed as a case of infected acne vulgaris, and was given oral antibiotics such as Cloxacillin, Rifampicin, and Clarithromycin, but with minimal improvement. She was then referred to Dermatology service for further evaluation. A 3-mm skin punch biopsy on an erythematous nodule on the left chin was done, and histopathologic findings were diffuse eosinophilic infiltrates, exhibiting flame figures admixed with few lymphocytes and neutrophils, consistent with Wells’ syndrome, otherwise known as eosinophilic cellulitis. Serology also revealed elevated IgE level at 949.2 IU/mL but normal eosinophil count. Patient was then given oral corticosteroid for eight weeks, resulting in complete resolution of lesions and no residual scarring.

Efficacy of intralesional purified protein derivative for cutaneous warts: A meta-analysis

Introduction@#Intralesional purified protein derivative (PPD) is an affordable therapeutic option that has been studied for cutaneous warts. However, the lack of good evidence precludes its widespread use.@*Objective@#To determine the efficacy and safety of intralesional PPD in the treatment of cutaneous warts.@*Methods@#A systematic search for controlled clinical trials comparing intralesional PPD and placebo or any conventional therapy was conducted using electronic databases. The included studies were assessed for risk of bias, and data such as clearance rate of target and distant lesions, recurrence rate, and adverse events were extracted. Analysis was done through RevMan v5.3.@*Results@#Four controlled clinical trials composed of 205 patients were included. All of the studies compared intralesional PPD to placebo as comparator. Intralesional PPD had a significantly higher clearance rate of target wart (RR=0.43[0.22,0.84], P=0.01) and a significantly higher clearance rate of distant lesions (RR=0.59[0.41,0.85], P=0.005) as compared to placebo. However, there was no significant difference in the recurrence rate (RR=0 [-0.07,0.07], P=0.98). Adverse events reported were only considered minor.@*Conclusion@#Intralesional PPD is an effective and safe treatment option for cutaneous warts. However, more well-structured RCTs with longer follow-up period and those comparing it with conventional treatment are needed to further support its use.

Arsenicosis presenting with cutaneous squamous cell carcinoma: A case report

A 29-year-old male with eleven-year history of hyperkeratotic papules and speckled pigmentation developed cutaneous squamous cell carcinoma. Arsenicosis was confirmed by elevated hair arsenic level, and histopathologic findings of arsenical keratosis and one lesion showing carcinoma-in-situ. Chronic arsenic exposure has been found to activate inflammatory and carcinogenic pathways leading to development of pre-malignant and malignant lesions. A multi-disciplinary approach involving healthcare specialists and environmentalists is crucial in source control and management of long-term complications.

Reduced levels of serum 25-hydroxyvitamin D in alopecia areata: A systematic review and meta-analysis

@#<p><strong>BACKGROUND:</strong> Alopecia areata is postulated to be an autoimmune disease of which vitamin D may play a role being found in the immune system and hair.</p><p><strong>OBJECTIVE:</strong> To determine the association between serum 25-hydroxyvitamin D levels in patients with alopecia areata compared with healthy controls.</p><p><strong>METHODS:</strong> Observational studies on association of vitamin D levels on alopecia areata compared to healthy controls were obtained from all published articles until July 2018 on MEDLINE, Cochrane Library, TRIP, HERDIN, and Google. Review Manager 5.3 was used for the meta-analysis.</p><p><strong>RESULTS:</strong> The search strategy yielded 13 qualified articles for the full-length review and 11 studies, containing 916 patients, were included in the meta-analysis using the pooled random effects model. The pooled mean difference of the serum 25-hydroxyvitamin D levels between alopecia areata patients and healthy controls was -9.55 (95% CI, -10.51 to -8.59) with heterogeneity (I2=85%).</p><p><strong>CONCLUSION:</strong> In conclusion, there were reduced levels of serum 25-hydroxyvitamin D levels in alopecia areata compared to healthy controls and vitamin D deficiency was more prevalent in alopecia areata compared to healthy controls. There was also a trend of lower vitamin D levels in the more severe forms of alopecia.</p>

Azathiopine for the treatment of extensive forms of alopecia areata: A systematic review

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Alopecia areata (AA) is an autoimmune hair disorder, with the clinical variants ophiasis and extensive variants AA totalis and universalis, having poor response to therapy. Oral steroids are used to treat the severe variants, requiring prolonged therapy, which leads to side effects while discontinuation leads to high relapse rate. Azathioprine is a steroid-sparing agent for the severe AA forms.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> To review the current evidence on the therapeutic efficacy and adverse effects of azathioprine for severe forms of alopecia areata</p><p style="text-align: justify;"><strong>METHODS:</strong> Published articles utilizing azathioprine for alopecia areata were obtained until July 2018 from PubMed, MEDLINE, Cochrane Library, TRIP database, HERDIN, and Google Scholar.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Seven articles underwent a full-length review. Clinical variants include patchy, diffuse, steroid-resistant, reticulate, totalis, universalis, ophiasis, and sisaipho. Doses ranged from 2 to 2.5 mg/kg/day or weekly 5 mg/kg pulse therapy. Initial response ranged from 6 to 12 weeks, with almost complete resolution by 32 weeks. Response was sustained for 6 months upon discontinuation, with only 14% relapsing at 2.5 months. Adverse effects were gastrointestinal discomfort, elevated liver function tests, and myelosuppression.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> There is emerging evidence on the efficacy and safety of azathioprine for the treatment of extensive forms of alopecia areata. Randomized-controlled trials are needed to evaluate its efficacy.</p>

Androgenetic alopecia and its association with metabolic syndrome: A systematic review and meta-analysis

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> The study aimed to confirm the association between androgenetic alopecia (AGA) and Metabolic Syndrome (MetS). It also aimed to determine if early-onset AGA among males and AGA among females increases the risk of developing MetS, and if severity of AGA increases the odds of developing MetS.</p><p style="text-align: justify;"><strong>METHODS:</strong> Observational studies from electronic databases were selected by the consensus of three independent review authors. The Newcastle-Ottawa Scale for assessing the quality of non-randomized studies in meta-analysis was used. Statistical analyses were accomplished using Review Manager software.</p><p style="text-align: justify;"><strong>RESULTS:</strong> A total of 11 case-control studies, one prospective cohort study, and five cross-sectional studies were selected. In the meta-analysis of ten case-control studies and three cross-sectional studies (3840 participants), AGA was significantly correlated with MetS (OR 2.59, 95% CI 1.51 to 4.44; p<0.0005). Early-onset AGA among males (</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Although the pathophysiology still remains under investigation, the present study points to an association between AGA and MetS. It can be used as a marker to identify patients who should be screened for MetS and managed accordingly.</p>

Arsenicosis presenting with cutaneous squamous cell carcinoma: A case report

@#A 29-year-old male with eleven-year history of hyperkeratotic papules and speckled pigmentation developed cutaneous squamous cell carcinoma. Arsenicosis was confirmed by elevated hair arsenic level, and histopathologic findings of arsenical keratosis and one lesion showing carcinoma-in-situ. Chronic arsenic exposure has been found to activate inflammatory and carcinogenic pathways leading to development of pre-malignant and malignant lesions. A multi-disciplinary approach involving healthcare specialists and environmentalists is crucial in source control and management of long-term complications.

Systemic lupus erythematosus with coexistent psoriasis vulgaris: A case report

@#<p style="text-align: justify;">We report a 42-year-old female with a 20-year history of systemic lupus erythematosus who subsequently developed psoriasis vulgaris. She has been on chronic, erratic prednisone and hydroxychloroquine intake prior to appearance of psoriatic lesions. Hydroxychloroquine and glucocorticoids are possible triggers of this phenomenon. Both diseases have a shared susceptibility loci and a shared Th17 pathophysiologic pathway.Treatment with methotrexate and selected biologics can target both disease mechanisms.</p>