Urticaria pigmentosa in a 9‐month‐old male: case report

@#Urticaria pigmentosa (UP) is the most common form of cutaneous mastocytosis in children. It can be diagnosed clinically, based on the appearance of numerous brownish macules and papules that are symmetrically distributed, mostly on the trunk and the extremities. Skin biopsy is helpful in establishing the diagnosis. Treatment options generally include antihistamines and/or topical corticosteroids. In most cases, pediatric UP tends to disappear spontaneously before puberty. We present the case of a 9-month-old male with a history of multiple brownish patches and plaques, which started when he was four months old. He was diagnosed with UP based on clinical and histopathologic findings, and was prescribed oral antihistamines and emollients for symptomatic treatment.

The great mimicker: A case report of an extensive pyoderma gangrenosum in a 39-year-old Filipino female treated with systemic corticosteroids and antibiotics

Introduction@#Pyoderma gangrenosum (PG) is a rare inflammatory disease with unknown etiology. Ulcerative PG presents with a rapidly enlarging painful ulcer with erythematous and undermined border often misdiagnosed as infection, vascular disorder, malignancy, and other inflammatory disease. Hence, this poses a diagnostic challenge for clinicians leading to a delay in the management and significant morbidity. The treatment of PG is equally challenging due to the rarity of the disease and the scarcity of clinical trials. Currently, there are no clinical practice guidelines for the management of PG. @*Case Report@#Our patient presented with multiple large ulcers with erythematous and undermined borders over the chest, abdomen, and the lower back. Cribriform scars and contractures were noted as well. She underwent several sessions of surgical debridement and was given different broad-spectrum antibiotics with noted worsening of the lesions. Due to extensive involvement of the disease, her quality of life has been significantly affected. A diagnosis of PG was made after the biopsy showed predominantly neutrophilic infiltrate. Prednisone 1mg/kg/day and clobetasol propionate ointment were initiated with significant decrease in pain and size of the ulcers after one month of therapy. Doxycycline was used as an adjunct therapy with excellent response.@*Conclusion@#Pyoderma gangrenosum is a rare, debilitating disease that remains a diagnostic dilemma. The worsening of ulcers despite surgical debridement and antibiotics is a clue that should prompt clinicians to consider PG. This case highlights the important role of dermatology in individuals who present with non-healing chronic ulcers because as seen in this case, not all ulcers are just ulcers.

Idiopathic follicular mucinosis in a 32-year old Filipino man successfully treated with narrow-band UVB: A case report

INTRODUCTION@#Follicular mucinosis is a rare skin condition, which can present as an idiopathic benign condition or as a secondary symptom of a malignant disorder, most commonly mycosis fungoides. Since its first description in 1957, only 90 cases have been reported worldwide. This condition is characterized by erythematous infiltrated plaques with scaling, sometimes with follicular prominence on the head and neck. Definitive diagnosis is made histologically.@*CASE@#A 32-year old male presented with a 3- year history of recurrent scaling with eruption of pruritic erythematous papules and plaques over the face, neck and chest. Different local treatments (topical corticosteroids, antifungal cream and moisturizers) were ineffective. Overall, he was healthy. Histopathological examination of the lesion showed typical histological picture of follicular mucinosis. Alcian blue stain was positive. The patient was successfully treated with narrowband UVB (NB-UVB) therapy with no recurrence of lesions after one- month follow-up.@*CONCLUSION@#Idiopathic follicular mucinosis is a benign condition with localized involvement and excellent prognosis. However, long-term follow-up and monitoring is recommended because of its association with malignancy. Follicular mucinosis is a rare dermatosis, characterized histologically by the presence of mucin deposits within the hair follicle and sebaceous glands.1 There are three clinical types determined. The first and the most common type occurs as an idiopathic benign disorder, typically seen in young patients. The second type affects people 40-70 years of age and has a more chronic course. The third type usually occurs in the elderly and presents with widespread lesions. It can arise as a secondary symptom of a malignant disorder, most commonly mycosis fungoides.

Epidemiology of exfoliative dermatitis at the University of Santo Tomas Hospital (Department of Dermatology) from 2008-2012: A five-year review

@#INTRODUCTION: Exfoliative dermatitis is a potentially life- threatening inflammatory reaction that poses a significant risk for morbidity and mortality. Several underlying etiologies of this dermatologic condition include pre-existing dermatoses, drugs and malignancy. Although it is a common disease entity, local studies on exfoliative dermatitis published in literature are very limited. OBJECTIVE: The primary objective of this study is to determine the epidemiological profile of patients with exfoliative dermatitis diagnosed at University of Santo Tomas Hospital Dermatology department from January 2008 to December 2012. METHODS: Inpatient and outpatient clinical records of patients diagnosed and treated as exfoliative dermatitis were retrieved. The prevalence, clinical presentation, history of previous dermatoses or use of any drugs/topical medications, family history and accompanying systemic symptoms were reviewed and analyzed. RESULTS: A total of 67 patients were included in this retrospective study. The prevalence among patients with exfoliative dermatitis in this study was computed at 1 per 1000 dermatologic patients. The highest number of cases belonged to the group aged seventy-one to seventy-nine (25.4%) with a mean age of 56.62 years. There was a male predilection (65.7%). Clinical presentation of patients included pruritus, generalized scaling and erythema, accompanied by bipedal edema (41.8%), chills (22.4%), fever (T ≥ 38 °C), lymphadenopathies (6%) and joint pains (4.5%). Several etiologic factors of exfoliative dermatitis recorded were: pre-existing dermatosis (67.2%), idiopathic or undetermined causes (19.4%), drug-induced (10.4%) and malignancy (3%). CONCLUSION: Exfoliative dermatitis is a condition more commonly found in the older age group. Pre-existing dermatoses, drugs and malignancy are etiologic factors. The most common pre-existing dermatosis causing exfoliative dermatitis in this study is psoriasis while the most implicated drug is allopurinol.

A double-blind randomized controlled trial on the efficacy and safety of metformin as an adjunct to lymecycline and topical adapalene plus benzoyl peroxide gel in the treatment of moderate to severe acne vulgaris

@#INTRODUCTION: Acne vulgaris has multifactorial causes. Prolonged systemic antibiotics are often necessary because relapse of lesions occurs upon its discontinuation. Currently, antimicrobial resistance is a growing concern. Androgen inhibitors like metformin may decrease need for antibiotics and maintain adequate control of the disease. OBJECTIVE: To determine the efficacy and safety of metformin versus placebo as an adjunct to lymecycline and adapalene+benzoyl peroxide gel in the treatment of moderate to severe acne vulgaris METHODS: Patients with moderate to severe acne vulgaris received either metformin or placebo tablets, together with lymecycline and adapalene+benzoyl peroxide gel. Lymecycline was taken for six weeks. The rest were given for 18 weeks. Evaluation was done biweekly using the mean reduction rates of non-inflammatory, inflammatory and total lesion count, modified global severity score, subjective self-assessment score, Dermatology life quality index (DLQI) score, and cutaneous and systemic adverse events. RESULTS: Forty patients were selected for the trial. Mean reduction rates of the non-inflammatory lesion counts of the two groups were comparable (p>0.05). Mean reduction rates of the inflammatory and total lesion count in the metformin group were higher than the placebo group (p<0.05). The mean modified global severity score of the metformin group was lower than the placebo group (p=0.034). Mean DLQI scores decreased in both groups (p<0.0001). Subjective self-assessment scores improved in both groups with comparable results. Cutaneous adverse events (erythema, pain, scaling, and dryness) were tolerable. Systemic adverse events (diarrhea, flatulence, headache, and epigastric pain) were self-limited CONCLUSION: Metformin is an effective and safe adjunct in the treatment of moderate to severe acne vulgaris.

Guidelines for the management of atopic dermatitis: A literature review and consensus statement of the Philippine Dermatological Society

@#Introduction: Atopic dermatitis (AD) is a complex disease with an interplay of genetic and environmental factors. In the United States, AD affects 10.7% of children andyc 7.2% of adults. Similarly in the Philippines, the prevalence of AD is 12.7% in the under 18 population, and 2% in the over 18 population. While AD affects all ages, the burden of the disease is greater in the pediatric population. The pathogenesis of AD is multifactorial. Variations in genes responsible for epidermal barrier function, keratinocyte terminal differentiation, and the innate and adaptive immune responses have been linked to AD. A null mutation involving the filaggrin gene is the strongest known risk factor for AD. This mutation results in a loss of filaggrin (FLG) protein by at least 50%. Filaggrin breakdown products form part of the natural moisturizing factor (NMF) of the skin, which is essential in skin hydration. A decrease in NMF and an increase in transepidermal water loss (TEWL) are observed in AD patients with FLG mutation. The defective barrier in AD patients decreases skin defenses against irritation and allergen penetration. Exposure to certain environmental chemicals like formaldehyde may worsen this barrier. This may lead to increased skin permeability to aeroallergens that leads to dermatitis in sensitized patients. Barrier defects may also play a role in epicutaneous sensitization and the subsequent development of other atopic conditions, such as bronchial asthma and allergic rhinitis. The Philippine Dermatological Society (PDS) consensus on AD aims to provide a comprehensive guideline and evidence-based recommendations in the management of this condition, with consideration of cultural factors that are often encountered in the Philippine setting. These guidelines are intended to provide practitioners with an overview of the holistic approach in the management of AD, ameliorating the negative effects of the disease and improving overall quality of life.. Methodology: A group of 21 board-certified dermatologists from the Philippine Dermatological Society (PDS) convened to discuss aspects in the clinical management of AD. Database and literature search included the full-text articles of observational studies, randomized controlled clinical trials, and observational studies using the Cochrane library, PubMed, Hardin (for Philippine based studies) as well as data from the PDS health information system. The terms used in combinations from the literature included “atopic dermatitis”, “atopic eczema”, “emollients”, “topical corticosteroids”, “topical calcineurin inhibitors”, “anti-histamines” and “phototherapy”. A total of fifty (50) full text articles were reviewed and found applicable for the scope of the study. Articles were assessed using the modified Jadad scale, with score interpretations as follows: (5- excellent, 3- good, 1– poor). Consensus guidelines for AD from within and outside of the region were also reviewed, from the 2013 Asia-Pacific guidelines, 2014 Taiwanese Dermatological Association consensus, 2016 guidelines in the management of AD in Singapore, 2014 American Academy of Dermatology guidelines, and the 2020 Japanese guidelines for AD. From the literature review, proposed consensus statements were developed, and a Delphi survey was conducted over two separate virtual meetings. Individual dermatologists provided Likert Scoring (1- strongly disagree to 5- strongly agree) based on consensus statements. A consensus was deemed reached at mean scores of > 4.00, a near consensus at > 3.5, and no consensus at <3.5. Summary: AD is a chronic relapsing condition with a significant burden of disease, most commonly affecting the pediatric population. The PDS AD Consensus Guidelines summarizes the standards of therapy and the therapeutic ladder in the management of AD based on published clinical trials and literature review. While these modalities remain the cornerstone of therapy, an individualized approach is the key to the holistic management of an AD patient. Knowledge and awareness of frequently associated conditions, whether in the realm of food allergies, contact allergies, or secondary infections, is paramount. In addition to the standard therapeutic armamentarium, the physician must also consider cultural practices and be knowledgeable of alternative therapeutic options. Referral to a specialist is recommended for recalcitrant cases of AD, or when initiation of systemic immunosuppressive agents, phototherapy, or biologic agents is contemplated.