Randomized controlled trial on the efficacy and safety of virgin coconut oil compared to mineral oil in the treatment of uremic xerosis

BACKGROUND: Uremic xerosis is the most common dermatologic condition present in patients with chronic kidney disease. Emollients were shown to be beneficial and are considered to be the first-line of treatment.OBJECTIVE: To assess the efficacy and safety of virgin coconut oil (VCO) compared to mineral oil as a therapeutic mosturizer for uremic xerosis.METHODS: Adult patients undergoing hemadialysis who have uremic xerosis were randomized using a computer-generated list and were instructed to apply either VCO or mineral oil twice daily on the legs for 4 weeks. Primary outcome measures included investigator-assessed clinical efficacy based on overall dry skin score (ODSS), change in skin hydration (corneometer readings), change in skin lipids (sebumeter readings), and quality of life scores. Secondary outcome measures included patient-assessed efficacy and advent of adverse effects. Overall therapeutic response was determined in which treatment success was defined as total clearance of xerosis or reduction of ODSS score and increased objective measurements (i.e., corneometer and sebumeter readings) plus moderate to marked patient-assessed efficacy, while treatment failure was defined as failure in any one of these parameters.RESULTS: A total of 45 (22 VCO group, 23 mineral oil group) were recruited and 36 (18 VCO group, 18 mineral oil group) completed the study. The majority of patients in both treatment groups showed improved ODSS, corneometer readings, and quality of life scores. Most patients considered both treatment oils to be moderately to markedly effective. Analysis of overall therapeutic response revealed treatment success of 4 out of 22 in the VCO group and 4 out of 23 in the mineral oil group. VCO demostrated a trend to benefit in improving xerotic skin (RRR = 1.0%, 95% CI: -30, 26.3; RR = 0.99, 95% CI: 0.76, 1.3) but results are inconclusive due to the wide confidence interval.CONCLUSION: The application of VCO or mineral oil for 4 weeks may be equally beneficial and safe in improving uremic xerosis. VCO showed a trend to benefit compared to mineral oil in terms of overall therapeutic response but this needs to be confirmed in larger randomized controlled trials.

A case of a 42-year-old Filipino male with bilateral lower extremity swelling

A 42-year-old male was admitted at the University of the Philippines-Philippine General Hospital (UP-PGH) for a 3-month history of non-healing wound in the medial side of his right leg in spite of multiple antibiotics. The wound worsened with multiple ulcerations and draining sinuses. The wound was shown to have suppurative and granulomatous infiltrates that yielded Mycrobacterium tuberculosis. An algorithm in the approach to a chronic or non-healing wound is discussed.

Multiple basal cell carcinomas in an 11-year-old Filipino-American girl with basal cell nevus syndrome

Basal cell nevus syndrome (BCNS) is a rare autosomal dominant multisystem disorder due to a mutation in the PTCH1 gene. Dermatologic manifestations include basal cell carcinoma (BCC) and palmoplantar pits. This case of childhood-onset BCC arising in a child of Filipino descent with BCNS illustrates the importance of early detection and diagnosis, which will then facilitate early counseling and management of this lifelong condition. An 11-year-old Filipino-American girl presented with multiple variegated pearly papules on the face, clavicular area and upper back. She also had multiple palmoplantar pits. Shave biopsy of a papule showed BCC. Trans-abdominal ultrasound revealed bilateral ovarian calcifications. Jaw and chest radiography were unremarkable. Skin lesions were initially treated with ablative erbium:YAG laser and later recurred after 3 months. Imiquimod cream was then started which resulted in partial resolution of lesions after 12 weeks. The dermatologist's role in the diagnosis of BCNS is integral, especially in this case where the patient is a seemingly well child with predominantly dermatologic manifestations. Clinical findings of BCNS, including BCC, are recurrent. Lifetime monitoring, counseling and adequate patient education and appropriate treatment of lesions are central to the management of this condition.

Reactive epidermal hyperplasia to ?-sitosterol and berberine moist exposed burn ointment (MEBO): A case report

Moist exposed burn therapy is a therapeutic principle based on the moist environment of the wound, using an ointment of herbal origin that enhances epithelial repair. This is the case of a 42-year-old female who sustained partial thickness burn wounds on her face and upper extremities. Patient was started on wound dressing with 13-sitosterol and berberine moist exposed burn ointment (MEBO) and noted the formation of erythematous verrucous plaques overlying the burned areas after four weeks. Histopathological examination of the lesions revealed papillomatosis, acanthosis, and hyperkeratosis. The lesions resolved upon discontinuation of MEBO and application of a combination of topical steroid, keratolytic, and emollient. The reactive epidermal hyperplasia seen in the case presented may have been due to increased levels of basic fibroblast growth factor in burn wounds treated with MEBO. Careful instructions and close monitoring of patients applying the ointment must be reinforced due to the possibility of reactive inflammatory skin reactions.

Multiple basal cell carcinomas in an 11-year-old Filipino-American girl with basal cell nevus syndrome

Basal cell nevus syndrome (BCNS) is a rare autosomal dominant multisystem disorder due to a mutation in the PTCH1 gene. Dermatologic manifestations include basal cell carcinoma (BCC) and palmoplantar pits. This case of childhood-onset BCC arising in a child of Filipino descent with BCNS illustrates the importance of early detection and diagnosis, which will then facilitate early counseling and management of this lifelong condition. An 11-year-old Filipino-American girl presented with multiple variegated pearly papules on the face, clavicular area and upper back. She also had multiple palmoplantar pits. Shave biopsy of a papule showed BCC. Trans-abdominal ultrasound revealed bilateral ovarian calcifications. Jaw and chest radiography were unremarkable. Skin lesions were initially treated with ablative erbium:YAG laser and later recurred after 3 months. Imiquimod cream was then started which resulted in partial resolution of lesions after 12 weeks. The dermatologist's role in the diagnosis of BCNS is integral, especially in this case where the patient is a seemingly well child with predominantly dermatologic manifestations. Clinical findings of BCNS, including BCC, are recurrent. Lifetime monitoring, counseling and adequate patient education and appropriate treatment of lesions are central to the management of this condition.