Basal cell carcinoma arising on two variants of epidermal nevus: A case series

Introduction@#Epidermal nevi are hamartomas of the epidermis and papillary dermis that are usually present during the first years of life. Rarely, malignant transformations develop in association with epidermal nevi. Few cases have been reported worldwide, however the lifetime risk and incidence are unknown. @*Case Report@#This is a case series about basal cell carcinoma arising on epidermal nevus. The first patient is a 42-year-old Filipino female, who presented with a verrucous plaque at birth on the left temple which then developed multiple, discrete to confluent, grayish, papules and nodules on the surface. Histological examination revealed nevus sebaceus and basal cell carcinoma, pigmented type. The second patient is a 53-year-old Filipino male, who presented with a papillomatous plaque on the left temple since the first year of life which then increased in size along with the presence of a solitary bluish-black macule noted by dermoscopic examination. Histologic examination showed verrucous epidermal nevus and basal cell carcinoma, pigmented type.@*Conclusion@#Two rare cases of basal cell carcinoma arising on epidermal nevus are reported. Despite the rarity of malignant transformation on epidermal nevus, any suspicious growth warrants a biopsy. Knowledge of these cases is important for probing suspicious growth over an epidermal nevus that would prompt early treatment before these lesions progress in size making it harder to manage.

A double-blind, randomized controlled trial on the efficacy and safety of intralesional 2% zinc sulfate in the treatment of verruca vulgaris in a tertiary hospital

Background@#Verruca vulgaris ranked 10th in the top 10 diseases in 2019 seen among the Philippine Dermatological Society training institutions. The efficacy of immunotherapy, such as intralesional zinc sulfate (ZS), for warts were reported. Considering the limited studies with promising results on verruca, a study on the efficacy and safety of intralesional zinc in the treatment of verruca was considered.@*Objective@#This study aims to determine the efficacy and safety of intralesional 2% ZS in comparison to intralesional purified protein derivative (PPD) among adult patients with verruca vulgaris.@*Methods@#This is a double-blind, randomized, controlled trial involving 44 patients allocated to group ZS (n=22) and PPD (n=22). Intralesional injections of ZS or PPD to the largest wart were done at weeks 0, 2, 4, 6, 8, 10. Clearance and size reduction of the target and distant wart at 12th week and recurrence at 14th week were assessed. Adverse effects were checked.@*Results@#At the 12th week of treatment, higher proportion in group ZS patients achieved total resolution of the target lesion compared to PPD, but results were not statistically significant (29% vs. 19%). Both groups showed decline in the target lesion size. The median size reduction between the two groups showed no significant differences. Three patients from group ZS showed clearance of distant warts while none in group PPD. There was no recurrence of all previously resolved warts. Adverse reactions were pain, edema, and erythema.@*Conclusion@#Intralesional 2% zinc sulfate (29%) was efficacious and safe compared to Intralesional PPD (19%) but the difference was not statistically significant. There was clearance of distant warts in 5% of group ZS patients. The mild adverse events did not warrant discontinuation of treatment.

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.

Superficial Granulomatous Pyoderma mimicking an infectious process

Introduction@#Superficial granulomatous pyoderma is a rare superficial variant of pyoderma gangrenosum. With clinical and histological features that mimic infectious processes, misdiagnosis is common. This report aims to present a rare, often overlooked disease, highlighting the need for timely histopathologic diagnosis to prevent unnecessary treatment and morbidity.@*Case@#Patient is a 42-year-old female with recurrent painful ulcers on her right leg. Initial histopathology was interpreted as granulomatous dermatitis secondary to cutaneous tuberculosis and was managed with anti-Koch’s regimen for six months. However, the ulcers worsened, which led to right leg amputation. New similar ulcers eventually recurred over the other extremities where repeat biopsy have shown neutrophilic dermatosis with a three-layer granuloma that is distinctive for superficial granulomatous pyoderma. Patient was treated with oral corticosteroids which was effective in controlling the disease.@*Conclusion@#This report documents a rare case of superficial granulomatous pyoderma presenting as non-healing ulcer, previously misdiagnosed and treated with unwarranted surgery and anti-microbials. The awareness of the characteristic clinical and histopathological features is essential for diagnosis so as to provide rapid disease control and avoid potentially aggravating management.

Retrospective analysis of methicillin-resistant staphylococcus aureus skin and soft tissue infection among patients admitted at an academic university hospital from 2011 to 2015: A five-year review

Introduction@#The emergence of methicillin-resistant Staphylococcus aureus (MRSA) is a challenge in the management of skin and soft tissue infections (SSTIs). @*Objective@#To describe the epidemiology of MRSA SSTIs among admitted patients at the University of Santo Tomas Hospital (USTH).@*Methods @#This was a retrospective study of inpatients with MRSA SSTIs from 2011-2015. MRSA infections were classii ed as community-associated (CA-MRSA) and healthcare-associated (HA-MRSA). Demographic characteristics, clinical proi le, comorbidities, complications, risk factors, antibiotic susceptibility and resistance, treatment used, and clinical outcome were determined.@*Results@#Out of the 331 inpatients with Staphylococcus aureus SSTIs, 211 had MRSA with a prevalence of 63.7%, 80.1% of MRSA were CAMRSA while 19.9% were HA-MRSA. The mean age was 41.58 years with male predominance. The majority presented with abscess (62.9%), on the legs (21.8%). The abscess was signii cantly associated with CA-MRSA while infected wounds, previous hospitalization, and surgery were correlated with HA-MRSA. Growing resistance to ciprol oxacin, tetracycline, macrolides, co-trimoxazole, and clindamycin was noted. A low percentage of resistance to vancomycin and linezolid was observed. Almost all cases improved with appropriate antibiotic therapy and 3.3% mortality@*Conclusion@#More than half of the patients with Staphylococcus aureus SSTIs had MRSA. and were mostly CA-MRSA and males. Abscess on the leg was the common presentation and signii cantly associated with CA-MRSA. Infected wounds, previous hospitalization, and surgery were associated with HA-MRSA. There was high resistance of MRSA to ciprol oxacin and tetracycline while low resistance to vancomycin and linezolid. Almost all improved with appropriate treatment.

Epidemiology of severe cutaneous adverse drug reactions in a University Hospital: a Five-year review

Introduction@#Severe cutaneous adverse drug reactions (SCAR) is seen in ≤5% of all hospitalized patients. It includes Stevens-Johnson syndrome/toxic epidermal necrolysis spectrum (SJS/TEN), drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS) and acute generalized exanthematous pustulosis (AGEP).@*Objectives@#The main objective was to determine the epidemiological characteristics of SCAR patients at a tertiary hospital from 2011-2015. Specifi cally, it aimed to determine the prevalence, demographic characteristics and clinical profi le of SCAR patients.@*Methods@#All SCAR patients from 2011-2015 were studied through a single-center, retrospective, descriptive, cross-sectional study.@*Results@#Sixty-eight SCAR cases were diagnosed from 2011-2015 with a prevalence rate of 6.25 per 10,000 people. Majority were 46-55 years old with slight female predominance. The most common SCAR was DIHS/DRESS (50%), followed by SJS/ TEN (30%) and AGEP (20%). Eight percent had previous drug reactions, 69% had co-morbidities and 90% were diagnosed clinically without biopsy. The antibiotics was the most common culprit drug category followed by allopurinol and anticonvulsants. Prompt withdrawal of culprit drug/s, supportive therapy, systemic steroids and antihistamine, topical emollients and saline compress were mainstay of treatment. Mortality rate was 4% for all SCAR categories@*Conclusion@#The epidemiology of SCAR in this study is similar to those reported in other literature. The adults were commonly involved; DIHS/DRESS was the most common SCAR with antibiotics being the most common culprit. Prompt withdrawal and supportive therapy were essential. Systemic steroid, antihistamine; topical emollients and saline compress resulted in improvement of patients. In contrast, there was lower prevalence rate with slight female predominance; and lower mortality rate even with the use of systemic steroids.

Double-blind randomized controlled trial on the efficacy and safety of metformin as an adjunct to Doxycycline and Tretinoin 0.025% cream in the treatment of moderate to severe acne vulgaris

Objectives@#To evaluate the efficacy and safety of metformin as an adjunct to oral doxycycline and tretinoin 0.025% cream in the treatment of moderate to severe acne vulgaris. @*Methods@#This is a double blind randomized controlled trial with 17 patients per group, and a study period of 12 weeks. Both groups (Dt group and DtM group) received doxycycline for the first 6 weeks and tretinoin for 12 weeks, while only the DtM group received metformin 1500mg/day for the entire treatment period. Follow up visits were done every 2 weeks from baseline. Non-inflammatory, inflammatory and total acne lesion count, and the modified global severity, subjective patient assessment, and Dermatology Life Quality Index scores, scores of cutaneous adverse events, and incidence and frequency of systemic adverse events were the outcome measures. @*Results@#The DM group showed significant statistical benefit for the treatment of noninflamma-tory lesions (comedones) in the 4th, 6th, 8th and 12th week. Outcome measures of global severity, subjective patient assessment, and DLQI scores, mean reduction rate of inflammatory and total lesion counts, and mean pain, erythema, dryness and scaling counts between groups were comparable. The incidence and frequency of reported systemic adverse events such as diarrhea, nausea and headache, were higher in the DtM group.@*Conclusion@#The addition of metformin to standard treatment is beneficial in reducing non-inflammatory lesion counts. It offers comparable benefit for inflammatory and total lesion counts. Cutaneous and systemic adverse events in both groups were mild and self-limited, and did not warrant discontinuation of treatment.