ABSTRACT
@#Atrophoderma of Pasini and Pierini (APP) is an idiopathic disorder of dermal atrophy, presenting as round or oval depressed lesions most commonly observed on the trunk and extremities. Herein, we report the first case of APP initially appearing on the head. Histopathologic examination of lesional skin demonstrated a decrease in elastic fibers. Serologic tests for Borrelia and antinuclear antibody titers were negative. There was no noted improvement after 6 weeks tretament with Hydroxycholoroquine 200 mg/tab BID. Definitive disease etiology and treatment of APP remains to be elucidated.
ABSTRACT
INTRODUCTION@#Referrals are the link between primary and specialty care. While the referring provider can be any type of physician, the focus in the literature has been on primary care physicians (PCPs). In their area of expertise, specialists are able to provide evidence-based care, and several studies have shown that specialists’ co-management of care with PCPs results in better health care outcomes for patients with chronic diseases.@*METHODOLOGY@#The research design used was cross-sectional. A validated self-made questionnaire was disseminated to the family physicians (FPs) who are active members of the Philippine Academy of Family Physicians (PAFP) from the National Capital Region (NCR).@*RESULTS@#Majority of FPs refer to dermatologists and more than half are affiliated with a hospital. Twenty percent had dermatology training which was not specified, and 44.2% took continuing medical education/seminars in dermatology. The top 3 most common dermatological diseases among the top ten existing dermatological diseases from January to December 2014 seen at the 11 accredited training institutions of the Philippine Dermatological Society (PDS) ranked by FPs as seen in their private practice were contact dermatitis, atopic dermatitis and acne vulgaris. The primary reason for referral of FPs to a dermatologist was for “treatment” and “difficult cases.” Average referral frequency within a month was two times while within a year it was more than five times. The criteria for choosing a particular dermatologist were good medical skill, geographic consideration and good FP-dermatologist communication. For the manner of referral, majority referred through letter, followed by phone calls and text messages. There were 53.8% FPs who were satisfied with the quality of communication with the dermatologists. Few FPs encountered difficulties in referring patients such as unavailability of the dermatologist, patient’s financial constraints, patient’s refusal, and the patient not being referred back to the primary physician by the dermatolo-gist. According to 68.6% of FPs, their patients followed-up after referral to a specialist.@*CONCLUSION@#The existing referral system among FPs and dermatologists, based on the study parameters, is generally properly implemented at the NCR. However, further studies should be done to determine the current state of referral system in the rural areas, where further health care management is needed, due to the unavailability of specialists like dermatologists.