Systematic review and meta-analysis on synthetic antifungal versus keratolytic agents for topical treatment of Pityriasis Versicolor

Background@#Pityriasis versicolor is a common fungal infection of the superficial skin layer caused by Malassezia furfur, a normal commensal in the skin. Keratolytic agents are popular, cheap, and readily available over-the-counter treatments for pityriasis versicolor. Conventional antifungal agents are more expensive, requiring prescription, and may induce resistant strains. However, evidence of their comparative safety and efficacy is still lacking. @*Objectives@#To assess the efficacy and safety of synthetic antifungals compared to keratolytic agents in the topical treatment of pityriasis versicolor through a systematic review.@*Methods@#We searched the following databases: MEDLINE (from 1966) through PubMed, CENTRAL (Issue 9 of 12, September 2021), EMBASE (from 1974), LILACS (from 1987); Herdin (from 1970), www.clinicaltrials.gov, www. isrctn.com, www.trialregister.nl. We contacted researchers in the field, hand searched relevant conference abstracts, and the Journal of the Philippine Dermatological Society 1992-2019. We included all randomized controlled trials involving patients with diagnosed active pityriasis versicolor where topical antifungal was compared with a topical keratolytic for treatment. Two review authors independently applied eligibility criteria, assessed risk of bias using the Cochrane collaboration tool, and extracted data from included studies. We used RevMan 5.3 to pool dichotomous outcomes using risk ratios (RR) and continuous outcomes using the mean difference (MD), using random-effects meta-analysis. We tested for statistical heterogeneity using both the Chi² test and the I² test. We presented results using forest plots with 95% confidence intervals. We planned to create a funnel plot to determine publication bias but were unable to due to few studies. A Summary of Findings table was created using GRADE profile software for the primary outcomes. @*Results@#We included 8 RCTs with a total of 617 participants that compared azole preparations (ketoconazole, bifonazole and econazole) versus keratolytic agents (selenium sulfide, adapalene, salicylic-benzoic acid). Pooled data showed that azoles did not significantly differ from keratolytic agents for clinical cure (RR 0.99, 0.88, 1.12; 4 RCTs, N=274, I2=55%; very low-quality evidence), and adverse events (0.59 [0.17, 2.06]; very low-quality evidence) based on 6 RCTs (N=536). There were two patients given a keratolytic agent (selenium sulfide shampoo) who had acute dermatitis and discontinued treatment. @*Conclusion@#It is uncertain whether topical azoles are as effective as keratolytic agents in clinical clearance and occurrence of adverse events in patients with pityriasis versicolor. A wider search of grey literature and local studies are warranted. Larger RCTs with low risk of bias are recommended.

Perspectives of a “Good Death” among patients who have recovered from severe COVID-19, immediate family members of patients who have died from COVID-19, and health care providers who took care of patients who have died from COVID-19 in a tertiary hospital

@#<p style="text-align: justify;"><strong>Background.</strong> The premise of a "good death" is vital in delivering proper care of terminally-ill patients but the COVID-19 pandemic has brought about new challenges and necessary protocols. There is a need to explore this gap in knowledge and understand perspectives of various stakeholders in COVID-19-related deaths.<br /><br /><strong>Objectives.</strong> To describe the perception, barriers, and facilitators of a "good death" from COVID-19 survivors, relatives, and healthcare providers in the setting of a COVID-19 tertiary hospital.<br /><br /><strong>Methods.</strong> The study was done in a COVID-19 tertiary hospital in Metro Manila from September to December 2021. Three groups of target respondents were invited to participate in the study: 8 survivors of severe/critical COVID-19, 9 close relatives of COVID-19 patients who had died, and 9 healthcare providers who directly cared for COVID-19 patients who had died. Semi-structured in-depth interviews were conducted by video calls which explored themes on good death. Thematic analysis was also done.<br /><br /><strong>Results.</strong> A total of 26 respondents were included in the study: 8 COVID-19 survivors, 9 relatives, and 9 healthcare providers. The definition of "Good Death" among the participants focused on "being at peace" and having "everything in order". The experience with COVID-19 were influenced by the fear of the infection and isolation restrictions during hospitalization. Recurring themes across all groups were the fear of COVID-19 and death, importance of family in the healthcare process, difficulty in communication, and cremation viewed as necessary but not preferred.<br /><br /><strong>Conclusion.</strong> A "good death" is perceived as a peaceful, prepared experience. The main barriers of a "good death' were the strict restrictions on physically comforting and communicating with patients. Video/voice calls and compassionate health care providers facilitated a better hospitalization experience. Careful study and focus on these factors can improve interventions for terminally ill patients to achieve a "good death" in the Filipino socio-cultural context.</p>

Ocular findings among Filipino patients with Leprosy in a tertiary hospital: A cross-sectional survey

Background@#Leprosy, a chronic granulomatous disease affecting mainly the skin and peripheral nerves, has widely recognized ocular complications. It is a significant cause of visual impairment in countries where it is still prevalent, including the Philippines. @*Methods@#This was a cross-sectional study that determined the clinical profile and distribution of ocular pathology among Filipino patients with leprosy seen at a tertiary institution in the Philippines. @*Results@#A total of 67 patients consented to be included in the study and were evaluated by an ophthalmologist. Thirty-seven out of the 67 patients diagnosed with leprosy had reported ocular findings. The average age was 41.2 ± 13.1 years and the majority of patients were men (78%). Thirty-six patients were multibacillary cases, 10 (27%) had a lepra reaction, and 24 (65%) were undergoing multi-drug therapy. Three patients had varying degrees of visual acuity impairment (one was visually impaired with visual acuity [VA] 6/24-6/60, one with VA 3/60-5/60, and one with VA <3/60). Steroid-induced cataracts occurred in four patients (6%) with concurrent or previous systemic corticosteroid treatment for lepra reactions. Univariate logistic regression and Fisher’s exact test of patient-, disease-, and treatment-related variables on ocular morbidity revealed non-significant values for all variables except for age with an odds ratio of 1.1 (95% CI, 1.04, 1.16) (p = 0.001). @*Conclusions@#No ocular morbidities directly caused by leprosy were seen, and treatment-related ocular findings (steroid-induced cataracts) were the only morbidities documented. There is an age-related risk for developing ocular morbidity in patients with leprosy.

The clinical profile, wound dressings, and clinical outcomes of in-patients with pressure ulcers at a tertiary hospital in the Philippines: A seven-year retrospective study

Objectives@#Currently, there are no local studies examining wound dressing usage among pressure ulcers in Filipino patients. The study aims to provide preliminary Philippine data among in-patients with pressure ulcers: their demographic characteristics, wound characteristics, wound dressing usage, and associated outcomes per wound dressing. @*Methods@#A retrospective chart review of patients admitted at the Philippine General Hospital from 2011 to 2017 with a diagnosis of pressure ulcer was conducted. @*Results@#Eighty-five records were retrieved; 56% were female and 44% male, with a mean age of 47.67 ± 23.03 years. The mean number of ulcers per patient was 1.65 ± 1.37, mostly in Stages 2 and 3, and 90.6% were in the sacral area. Seventy-three (85.9%) had utilized at least one form of the wound dressing, mostly plain gauze (83.5%), usually with silver sulfadiazine or Dakin’s solution. Only a smaller subset used silver-impregnated dressings (10.55%) and hydrocolloid dressings (5.9%). Comparing advanced versus basic dressings for improved wound outcomes, the crude odds ratio was 3.81 (1.62 - 8.99; p-value 0.003), which on stratification accounting for bed turning, became 8.92 (1.66 - 47.97; p-value 0.009) for those bed turned and 3.05 (1.01-9.20; p-value 0.075) for those not bed turned. @*Conclusion@#Filipino in-patients with pressure ulcers were similar to those in the literature in terms of the mean number of ulcers and site of involvement. Basic gauze dressings, combined with topical agents, constitute the majority of wound dressing practice. Use of an advanced wound dressing showed a trend favoring improved outcomes, enhanced by pressure redistribution through bed repositioning.

Dermoscopic patterns in relation to the Clinicopathologic manifestations of Leprosy

Objectives@#Leprosy is a chronic granulomatous infection caused by the obligate intracellular organism Mycobacterium leprae. Current diagnostic tests for confirmation and treatment monitoring such as slit skin smear and biopsy are invasive and require time for processing, reading, and interpretation. Dermoscopy is a technique that allows the visualization of structures not readily seen by the naked eye. It can be performed at the point of care, providing a non-invasive link between clinical and histopathologic examination. This study aimed to determine the dermoscopic findings and associated clinicopathologic findings of the different forms of leprosy. @*Methods@#A cross-sectional study was conducted. All new and follow-up patients aged 19 years old and above clinically diagnosed with leprosy were invited to participate in the study during the three-month investigation period. Clinical and dermoscopic photographs of representative skin lesions were taken, and a review of slit skin smear and histopathology results was done. Data analysis was performed using Stata SE version 13. The association between dermoscopic findings and the following parameters: anatomic location, Ridley-Jopling classification, WHO classification, treatment duration, and average bacteriologic index were analyzed using Fisher’s exact test. The level of significance was set at 5%. @*Results@#A total of 57 lesions were included. Linear vessels (p=0.031), structureless areas (p=0.008), and globules (p=0.002) were found to be significantly associated with the anatomic location. Decreased hair was found to be significantly associated with treatment duration (p=0.038). No significant associations were found between dermoscopic findings and Ridley-Jopling classification, WHO classification, and ABI. Eight biopsies taken at the time of dermoscopy were reviewed, with all sites showing structureless or globular areas corresponding to the presence of granulomas on histopathology (100%). No other notable associations were observed. @*Conclusion@#Dermoscopy is a potentially useful tool to aid in the diagnosis and treatment monitoring of leprosy. Limitations of this study include the small sample size, the preponderance of subjects in the lepromatous pole, and assessments by a single trained dermoscopist. A longer study duration including a larger number of newly diagnosed leprosy patients is recommended.

Acupuncture as an adjunct to standard therapy for Pruritus in patients with Atopic Dermatitis: A patient- and assessor-blinded, randomized, placebo-controlled trial

Background@#Pruritus can impair quality of life in patients with atopic dermatitis. There is evidence that acupuncture reduces pruritus and disease severity, and improves quality of life. @*Objectives@#This study aimed to determine the efficacy of acupuncture in reducing pruritus intensity, disease severity, and medication use, and improving quality of life. @*Methods@#This was a patient- and assessor-blinded, randomized, placebo-controlled trial. Patients diagnosed with atopic dermatitis underwent twice-weekly acupuncture for 12 weeks, with an 8-week follow-up period. Baseline and weekly assessment were done using standard data collection forms and validated assessment tools. @*Results@#Thirty patients were randomized and 28 patients were eligible for the efficacy analysis. There were no significant differences in the baseline demographic and clinical characteristics between the True Acupuncture group (TA) (n=16) and Sham Acupuncture group (SA) (n=12). Both groups showed reduction in mean itch intensity (visual analogue scale, VAS) (p=0.024) but TA showed greater reduction (p=0.009) that was sustained after end of treatment. There was also a reduction in medication use in both groups. The comparable efficacy of SA to TA is attributed to similar peripheral receptive fields and stimulation of cutaneous C-fibers which depletes the neurotransmitters mediating pruritus and results in tachyphylaxis. Mild adverse events, such as petechiae and erythema, were noted in both groups and resolved spontaneously. @*Conclusion@#Acupuncture is a promising adjunct treatment in atopic dermatitis with significant reduction in pruritus, disease severity and medication use and a trend towards improved quality of life. Studies with larger sample size and comparison to acupuncture points farther from the true acupuncture points are recommended. @*Trial Registration@#Food and Drug Administration Philippine Health Research Registry ID PHRR171012-001696

Rapid review on the use of oral fatty acid supplements in the prevention or as adjunct treatment of COVID-19

Key Findings@#There is lack of clinical evidence supporting the role of oral fatty acid supplements as prevention and adjunctive therapy for COVID-19. Long-chain polyunsaturated fatty acids (PUFAs) mediate inflammation and adaptive immune responses. Omega-3 fatty acids promote anti‐inflammatory effects and reduce influenza virus replication. No clinical evidence supporting the use of oral fatty acid supplements as prevention and adjunctive therapy of COVID-19 was found. We found indirect evidence from one systematic review on acute respiratory distress syndrome (ARDS) and two longitudinal cohort studies on community-acquired pneumonia that showed non-significant and inconsistent results. The most common known side effects of omega-3-fatty acids are gastrointestinal in nature. They may also cause allergy and affect blood clotting if taken with other medications that affect clotting. There are 2 ongoing clinical trials on eicosapentaenoic fatty acids as an adjunctive therapy to standard oral nutrition supplements or standard of care in COVID-19 patients. WHO Interim guidelines, CDC interim guidelines, Infectious Diseases Society of America COVID-19 treatment guidelines, and the American Thoracic Society did not give any recommendation on the use of nutritional supplements in patients with COVID-19.

Systematic review and meta-analysis on Synthetic Antifungal versus Keratolytic Agents for Topical Treatment of Pityriasis Versicolor

Background@#Pityriasis versicolor is a common fungal infection of the superficial skin layer caused by Malassezia furfur, a normal commensal in the skin. Keratolytic agents are popular, cheap, and readily available over-the-counter treatments for pityriasis versicolor. Conventional antifungal agents are more expensive, requiring prescription, and may induce resistant strains. However, evidence of their comparative safety and efficacy is still lacking. @*Objectives@#To assess the efficacy and safety of synthetic antifungals compared to keratolytic agents in the topical treatment of pityriasis versicolor through a systematic review. @*Methods@#We searched the following databases: MEDLINE (from 1966) through PubMed, CENTRAL (Issue 9 of 12, September 2021), EMBASE (from 1974), LILACS (from 1987); Herdin (from 1970), www.clinicaltrials.gov, www. isrctn.com, www.trialregister.nl. We contacted researchers in the field, hand searched relevant conference abstracts, and the Journal of the Philippine Dermatological Society 1992-2019. We included all randomized controlled trials involving patients with diagnosed active pityriasis versicolor where topical antifungal was compared with a topical keratolytic for treatment. Two review authors independently applied eligibility criteria, assessed risk of bias using the Cochrane collaboration tool, and extracted data from included studies. We used RevMan 5.3 to pool dichotomous outcomes using risk ratios (RR) and continuous outcomes using the mean difference (MD), using random-effects meta-analysis. We tested for statistical heterogeneity using both the Chi² test and the I² test. We presented results using forest plots with 95% confidence intervals. We planned to create a funnel plot to determine publication bias but were unable to due to few studies. A Summary of Findings table was created using GRADE profile software for the primary outcomes. @*Results@#We included 8 RCTs with a total of 617 participants that compared azole preparations (ketoconazole, bifonazole and econazole) versus keratolytic agents (selenium sulfide, adapalene, salicylic-benzoic acid). Pooled data showed that azoles did not significantly differ from keratolytic agents for clinical cure (RR 0.99, 0.88, 1.12; 4 RCTs, N=274, I2=55%; very low-quality evidence), and adverse events (0.59 [0.17, 2.06]; very low-quality evidence) based on 6 RCTs (N=536). There were two patients given a keratolytic agent (selenium sulfide shampoo) who had acute dermatitis and discontinued treatment. @*Conclusion@#It is uncertain whether topical azoles are as effective as keratolytic agents in clinical clearance and occurrence of adverse events in patients with pityriasis versicolor. A wider search of grey literature and local studies are warranted. Larger RCTs with low risk of bias are recommended.

Validation of a Filipino translation of the children's dermatology life quality index text version

Background@#Skin diseases that are longstanding or highly symptomatic can have devastating consequences in the quality of life of children. There is a need to have a validated Filipino translation of a dermatology quality of life tool for young patients with skin diseases. @*Objectives@#To assess the validity and reliability of the Indeks ng Kalidad ng Buhay Pang-dermatolohiya ng mga Bata (IKPaB), a Filipino translation of the Children’s Dermatology Life Quality Index (CDLQI).@*Methods@#This cross-sectional study was conducted among children aged 4 to 16 years at a tertiary hospital outpatient department. The IKPaB was pretested and revised using focus group discussion until it was approved by the original developers for validation. Face validity was determined through cognitive debriefing interviews. Construct validity was determined by comparing IKPaB scores of participants with skin disease and without skin disease using Mann-Whitney U test. Criterion validity was determined by comparing IKPaB with a validated Filipino-translated PedsQL as the criterion, using Spearman rank correlation. Internal consistency reliability was determined using Cronbach’s coefficient. Multiple regression was used to correlate age, sex and disease duration.@*Results@#The IKPaB was assessed to be comprehensible, clear, and culturally appropriate. Among 288 participants, it showed satisfactory construct validity (U = 8849, Z= 0.87; P = 0.89) and internal consistency reliability (α = 0.89), with a negative but weak correlation with the PedsQL® (rho= -0.300, P = 0.000). @*Conclusion@#The IKPaB is a valid and reliable Filipino translation of CDLQI. We recommend further validation for use in clinical practice and research.

Acceptability of immunoprophylaxis and/or chemoprophylaxis for household contactsof patients with Hansen’s disease:A prospective, single-center, mixed methods study

Objectives@#Leprosy is an infectious disease affecting the skin and nerves caused by Mycobacterium leprae. Closer physical distance was found to increase risk transmission. Thus, targeted provision of prophylactic medications to household contacts of patients with leprosy could possibly aid in decreasing its incidence in a cost-effective manner. This study aimed to determine the attitudes towards disclosure of the diagnosis of leprosy and acceptance of immuno- and chemoprophylaxis for household contacts of patients undergoing treatment in a dermatology outpatient clinic of a tertiary hospital in the Philippines. @*Methods@#We conducted a prospective, single-center, cross-sectional and mixed methods study at a dermatology clinic of a tertiary hospital. All diagnosed leprosy patients, household contacts of leprosy patients, and individuals with no leprosy and no known contact with a leprosy case were invited. Eligible participants who gave consent were included in the cross-sectional survey, followed by in-depth interviews of selected participants. STATA 12 was used to analyze the data. Descriptive statistics were used to summarize information. Chi-square was computed to obtain a measure of association of important variables. The field notes and the verbatim transcriptions of the interviews and narratives were filed using an analytic memo system. @*Results@#Fifty-five participants (22 Hansen’s disease patients, 13 household contacts, and 20 individuals unaffected by and unexposed to leprosy) were enrolled. Mean age of respondents was 38 years, 60% were female, and 85% were living in an urban setting. Majority of the patients with leprosy were borderline lepromatous (45%) to lepromatous type (27%) with mean treatment duration of 13 months. Overall, the respondents were willing to disclose the diagnosis of leprosy to their household members to facilitate provision of prophylaxis. They were also generally willing to receive prophylaxis despite potential side effects, expense, incomplete protection, and the need for yearly assessment for the development of leprosy. All respondents felt hopeful about the availability of medications that can prevent the development of leprosy and its complications, with some feeling anxious and only a few being embarrassed about receiving them.@*Conclusions@#Prophylactic medications were found to be generally acceptable despite some concerns. There is also a willingness to disclose the diagnosis of leprosy to facilitate the targeted provision of prophylaxis to household contacts.

A rare case of bullous pyoderma gangrenosum in a patient with acute myelogenous leukemia

@#A 67-year-old female with acute myelogenous leukemia, presented with a two-week history of enlarging ecchymosis-like plaques with hemorrhagic bullae on the right forearm and anterior legs, associated with fever, pain, and swelling. Tissue cultures were persistently negative. Lesions progressed despite broad-spectrum antibiotic coverage. Histopathology showed neutrophilic dermatitis, consistent with pyoderma gangrenosum. The patient was diagnosed with the bullous type. This type is rare with only two reported cases in the Philippines since 2011. Systemic glucocorticoids were given with note of dramatic improvement of the lesions. 

Systematic review and meta-analysis on oral azoles for the treatment of pityriasis versicolor

@#<p style="text-align: justify;"><strong>Background:</strong> Oral azole drugs are a second-line option for the treatment of pityriasis versicolor but evidence on their efficacy and safety is unclear. Objectives. To determine the efficacy and safety of oral azoles in the treatment of patients with pityriasis Versicolor.</p><p style="text-align: justify;"><strong>Methods</strong>: We searched MEDLINE, CENTRAL, EMBASE, LILACS, and HERDIN, from inception to the period between January to February 2014. We did not restrict the search by language or publication status. We included randomized controlled trials (RCTs) that compared the efficacy of oral azoles with placebo or no treatment, with topical agents, other oral azoles or dosing regimens in the treatment of pityriasis Versicolor, and that measured any of the pre-specified outcomes (mycologic cure, clinical cure, recurrence, duration to cure, time-to-cure, and quality of life). For adverse effects, we also included non-randomized studies (NRS). We used Cochrane methods to select studies, extract data, assess the risk of bias, pool studies, and calculate for treatment effects.</p><p style="text-align: justify;"><strong>Results:</strong> We included 38 RCTs (n=2894) and 56 NRS (n=3452). Overall, there were few pooled studies and evidence was low to moderate quality. Oral azoles were more effective than placebo (mycologic cure, RR 11.34, 95% CI 4.90, 26.28; 3 RCTs, n=131; I2=0%; low quality of evidence) and as effective as topical agents (mycologic cure, RR 1.02, 95% CI 0.86, 1.21; 4 RCTs, n=232; I2=60%; moderate quality of evidence).There were few adverse effects and were mostly minor and transient.</p><p style="text-align: justify;"><strong>Conclusions:</strong> Oral azoles may be more effective than placebo, and are probably as effective as topical agents in the treatment of PV. Triazoles are probably as effective as ketoconazole. Adverse effects were few, mostly minor, and transient.</p>

Systemic review and meta-analysis on oral azoles for the treatment of pityriasis versicolor

Background: Oral azole drugs are a second-line option for the treatment of pityriasis versicolor but evidence on their efficacy and safety is unclear.Objectives: To determine the efficacy and safety of oral azoles in the treatment of patients with pityriasis versicolor.Methods: We searched MEDLINE, CENTRAL, EMBASE, LILACS, and HERDIN, from inception to the period between January to February 2014. We did not restrict the search by language or publication status. We included randomized controlled trials (RCTs) that compared the efficacy of oral azoles with placebo or no treatment, with topical agents, other oral azoles or dosing regimens in the treatment of pityriasis versicolor, and that measured any of the pre-specified outcomes (mycologic cure, clinical cure, recurrence, duration to cure, timeto- cure, and quality of life). For adverse effects, we also included non-randomized studies (NRS). We used Cochrane methods to select studies, extract data, assess risk of bias, pool studies, and calculate for treatment effects.Results: We included 38 RCTs (n=2894) and 56 NRS (n=3452). Overall, there were few pooled studies and evidence was low to moderate quality.Oral azoles were more effective than placebo (mycologic cure, RR 11.34, 95% CI 4.90, 26.28; 3 RCTs, n=131; I2=0%; low quality of evidence) and as effective as topical agents (mycologic cure, RR 1.02, 95% CI 0.86, 1.21; 4 RCTs, n=232; I2=60%; moderate quality of evidence). There were few adverse effects and were mostly minor and transient.Conclusions: Oral azoles may be more effective than placebo, and are probably as effective as topical agents in the treatment of PV. Triazoles are probably as effective as ketoconazole. Adverse effects were few, mostly minor, and transient.

Randomized assessor-blinded controlled trialon the efficacy and safety of virgin coconut oil versus mineral oil as a therapeutic moisturizer for Senile Xerosis

Background@#Xerosis is one of the most common dermatologic complaints in the elderly. People in the tropics, including the Philippines, have effectively used coconut oil as a traditional moisturizer for centuries. Its film-forming qualities allow it to act as a skin moisturizer and as a protectant against moisture loss. To date, only one randomized clinical trial has proven the efficacy and safety of coconut oil as a skin moisturizer for xerosis. With the increasing number of VCO products in the market, this study aimed to validate the use of an indigenous agricultural product, virgin coconut oil, for senile xerosis. With its moisturizing, antioxidant, and antiseptic effects, VCO may be superior and more cost-effective compared to the frequently used synthetic mineral oil.@*Objective@#This study aimed to determine the efficacy and safety of virgin coconut oil compared to mineral oil for the treatment of senile xerosis.@*Methods@#This was a community-based assessor-blinded, randomized controlled trial, which included elderly patients with mild to moderate senile xerosis of the legs. Participants were instructed to apply the test oil twice daily to the legs for 2 weeks. The following primary outcomes were measured at baseline and 2-weeks post treatment: skin dryness (over-all dry skin score, ODSS), skin hydration (corneometer readings), skin lipid content (sebumeter readings), and quality of life (Dermatology Life Quality Index). Secondary outcomes like patient-assessed clinical efficacy and adverse effects were also measured.@*Results@#A total of 148 participants (59 males, 89 females) with mean age of 68 years (SD 6.02) were included in the study. Eighty-one (81) were assigned under the VCO group and 67 under the mineral oil group. There was a total of 25 dropouts, 7 in the virgin coconut oil group, and 18 in the mineral oil group. The distribution of the patients’ ODSS after treatment with VCO and mineral oil showed a trend towards improvement: 43% in the VCO group had no visible signs of leg xerosis versus 22.4% in the mineral oil group. The proportion of participants with>1 point decrease in ODSS, was statistically greater in the VCO group at 74% (60/81) compared to the mineral oil group, 34% (23/67) (p<0.0001). VCO showed significantly greater skin hydration at 74% (60/81) as compared to 46% (31/67) in the mineral oil group (p<0.0010). Improvement in the skin lipid content using the sebumeter showed 82.7% (67/81) in the VCO group compared to 61.2% (41/67) in the mineral oil group (p=0.6591). Moreover, the patients’ perceived efficacy of the oil applied on their skin was 29.6% (24/81) in the VCO group compared to 5.9% (4/67) in the mineral oil group (p=0.0030). Baseline DLQI scores showed no significant difference in the assessed quality of life of the patients between the two treatments (p=0.0161).Over all, the VCO group showed 32.1% (26/81) treatment success compared to 8.9% (6/67) in the mineral oil group (p=0.004614). Adverse events in the 2 groups were all mild and transient with 8% (6/74) patients in the VCO group and 26.5% (13/49) in the mineral oil group (p=0.089).@*Conclusion@#Among elderly patients with mild to moderate xerosis, 2-week topical application of VCO was superior to mineral oil in the immediate improvement of leg xerosis based on primary outcome measures of the Over-all Dry Skin Score (ODSS), corneometer, sebumeter readings, and the Dermatology Life Quality Index.

Serum cytokines in erythema nodosum leprosum versus non-reactional leprosy: A systematic review and meta-analysis

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Erythema nodosum leprosum is an immune-mediated complication of leprosy whose underlying mechanism has not yet been fully elucidated, making management difficult.</p><p style="text-align: justify;"><strong>OBJECTIVES:</strong> To determine the serum cytokine profile of ENL compared to non-reactional leprosy states.</p><p style="text-align: justify;"><strong>METHODS:</strong> An open literature search was performed using MEDLINE, Cochrane Library, TRIP and HERDIN electronic databases using the keywords ("cytokines" or "inflammatory mediators") and ("erythema nodosum leprosum" or "ENL") and ("leprosy" or "lepra"). Studies were selected by two independent review authors. Risk of bias was assessed using the Newcastle-Ottawa Scale and statistical analysis was performed using RevMan 5.3 software.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Eight cross-sectional studies with 197 participants were included. Meta-analysis showed that both serum IL-17 and serum IFN-? were significantly decreased (Z 2.39, p = 0.02 and Z 2.74, p = 0.01, respectively) in ENL compared to non-reactional states. However, for IL-1?, IL-6, IL-10, IL-22, TNF-? and TGF-?, no significant differences were found between the two groups.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> ENL appears to be an exacerbation of the Th2 cytokine response seen in the lepromatous pole of leprosy. However, despite pooling of data, sample sizes remain small resulting in significant heterogeneity. Future studies involving large sample sizes and investigating a wider range of cytokines are encouraged.</p>

Recurrent ulcerations and neuropathy in a Filipino child with previously undiagnosed leprosy: A case of Lucio phenomenon in the Philippines

@#<p style="text-align: justify;">Lucio phenomenon is a distinct necrotizing lepra reaction arising from diffuse lepromatous leprosy that may easily be mistaken for other systemic conditions. We report a 17-year old female admitted for a 4-year history of recurrent, extensive ulcerations with crusting and purulent discharge, involving the arms, legs, face, and back. Clinical presentation, slit skin smear and skin biopsy confirmed the diagnosis of Lucio phenomenon and treatment with multidrug therapy resulted in resolution of the ulcerations.</p>

Validation of a Filipino version of the cardiff acne disability index

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study assessed the reliability and validity of a Filipino version of the Cardiff Acne Disability Index.<br /><strong>METHODS:</strong> In Phase 1, the Cardiff Acne Disability Index (CADI) was translated into Filipino as the Cardiff Indeks ng Kapansanan ng may Tigyawat (CIKT) following international guidelines on translation and cultural adaptation, and passed a cognitive debriefing test (a form of face validity testing). In Phase 2, the CIKT was administered to 400 public high school students (11-18 years old). Cronbach's ? was used to measure reliability while construct validity was determined by comparing 1) the CIKT scores of adolescents with acne and those without acne and 2) the CIKT scores with the scores of the Taluntunan ng Kalidad ng Buhay na Hinggil sa Dermatolohiya (TKBD), which is a validated Filipino version of the Dermatology Life Quality Index.<br /><strong>RESULTS:</strong> Cronbach's ? showed an adequate internal consistency of 0.7. The linear regression coefficient for those with and without acne was 0.98 (CI 0.59, 1.37) (p = 0.00) while the Spearman correlation showed a positive correlation between the CIKT and the TKBD (0.58, p=0.00), both indicating validity.<br /><strong>CONCLUSION:</strong> The CIKT is a reliable and valid Filipino translation of the CADI.</p>