Cutaneous Drug Reactions in a tertiary government hospital in the Philippines 2009-2011

OBJECTIVES: To determine the frequency of cutaneous drug reactions (CDRs), thier associated drugs, and morphological presentation min the Philippine General Hospital (PGH) from 2009 to 2011 and to identify new or uncommon drugs causing CDRs. METHODS: This is a 3-year retrospective record review. The Naranjo algorithm was used to score drug causality. RESULTS: One hundred and forty-three (143) patient records were retrieved, with 218 associated drugs identified. The most common drug classes were antibiotics (29%), anti-tuberculosis medications (17%), and NSAIDs (9%). The most common drugs were isoniazid, rifampicin, pyrazinamide, ethambutol (HRZE) combination drug (9%); amoxicillin (6%); and cotrimoxazole (5%). A morbiliform reaction (49%) was the most common morphological presentation. There were several identified drugs, including anti-fungals and beta-blockers, which caused a single drug reaction but had a sufficient Naranjo score to warrant inclusion. CONCLUSION: The most common drug classes, drugs, and cutaneous morphological presentation found in this study are similar to those seen in existing literature. However, there were several drugs identified causing single drug reactions. This may reflect the need for improved documentation, diagnosis, and follow-up of CDR cases in the PGH.

Complementary and alternative medicine for skin diseases: Knowledge, attitudes and practices of Philippine-based dermatologists

BACKGROUND: The ubiquity of complementary and alternative medicine (CAM) mirrors patient interest and use. Nonetheless, many physicians are still hesitant to recommend and use CAM.Objective: To determine the knowledge, attitudes and practices of Philippine-based dermatologists regarding CAM.METHODS: This was a cross-sectional survey using a self-administered questionnaire. An in-depth interview was conducted among selected respondents.RESULTS: A total of 148 dermatologists responded. Most had adequate knowledge (58.78%) and a positive attitude about CAM (81.08%). Most respondents reported patient interest in CAM (70.95%) and recommended CAM (87.24%) for dermatologic conditions. Among respondents who recommended CAM, most recommended CAM as a complement to conventional treatment (73.76%) rather than as an alternative. Personal CAM use was reported by 30.41%. A positive attitude about CAM was directly related to increased likelihood of recommending CAM to patients (p=0.00) and to personal use of CAM (p=0.003).CONCLUSIONS: Respondents generally had a positive attitude about CAM and were open to recommending CAM as a complement to conventional treatment for dermatologic conditions.

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.

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.