An atypical case of a 14-year-old Filipino female with non-classical congenital adrenal hyperplasia presenting with alopecia universalis

Introduction@#Non-classical congenital adrenal hyperplasia (CAH) represents a group of inherited, autosomal recessive disor- ders that typically presents with androgenetic alopecia, but may present with alopecia universalis on rare occasions.@*Case report@#We report a case of a 14-year-old Filipino female with non-classical congenital adrenal hyperplasia presenting with alopecia universalis, treated with a combination of Tretinoin and Minoxidil solution, low dose prednisone and an oral supplement containing zinc gluconate, nicotinamide, superoxide dismutase, vitamin E and selenium, with noted gradual hair regrowth and improvement in Dermatology Life Quality Index (DLQI).@*Conclusion@#Alopecia universalis in a patient diagnosed with non-classical congenital adrenal hyperplasia is a rare and atypical manifestation, with no case reports available to describe its occurrence. Due to its rarity, there is no standard treatment for pa- tients with this condition. However, the combination of tretinoin and minoxidil solution, low dose prednisone and an oral supple- ment containing zinc gluconate, nicotinamide, superoxide dismutase, vitamin E and selenium shows promising results.

AIDS-associated Kaposi sarcoma: A case series in the Philippine setting

Introduction@#Acquired immunodeficiency syndrome-Kaposi sarcoma (AIDS-KS) has unique clinical characteristics, often dis- seminated on presentation, a rapidly progressive course, and often fatal outcome. Describing the epidemiology and clinical characteristics of AIDS-KS in the Philippines may lead to early recognition, diagnosis, and management of this condition, which are the keys to preventing significant complications.@*Case Series@#AIDS-KS in 11 Filipino MSM patients with a mean age of 36.55 years (SD 11.54) was described. Violaceous plaques and nodules were present for an average of 5.1 months prior to diagnosis confirmed by biopsy. Histopathologic findings from all pa- tients were consistent with KS. The median CD4+ count of patients was 44 cells/microliter (range, 4 to 181). Six patients presented with opportunistic infections (OI)/AIDS-related conditions (ARC). The most common OIs observed were pulmonary tuberculosis, oropharyngeal candidiasis, and Pneumocystis jiroveci pneumonia. Nine patients improved with highly active antiretroviral therapy (HAART). One patient required modification on his HAART regimen, which was shifted to 2 NRTI and ritonavir-boosted protease inhibitor, and one patient died due to AIDS-related complications.@*Conclusion@#This series of 11 cases of AIDS-KS showed similar demographic, clinical and histopathologic characteristics to pre- viously published studies. Findings suggest the need for earlier recognition and diagnosis. While HAART afforded clinical improve- ment in a majority of patients, other treatment options such as chemotherapy should be considered for appropriate patients.

HIV and leprosy in a 27-year-old Filipino male: A case report

Introduction@#Hansen’s disease or leprosy is a chronic infectious disease caused by Mycobacterium leprae associated with inflammation that may damage the skin and peripheral nerves. In countries where leprosy is still endemic, an increasing preva- lence of human immunodeficiency virus (HIV) can be seen, hence increasing the possibility of HIV-leprosy co-infection. Hansen’s disease, if not treated promptly, can cause scars and deformities associated with leprosy reaction. Immunosuppressive drugs like corticosteroids used in the treatment of leprosy reaction may put the patient at risk of opportunistic infections.@*Case report@#This is a case of a 27-year-old Filipino male with HIV-leprosy co-infection, who manifested with erythema nodosum leprosum reaction, treated with tapering dose of oral corticosteroids and multidrug therapy (MDT) for multibacillary leprosy showing good response to treatment after 5 months without recurrence of reaction. The use of chronic oral corticosteroids, despite its immunosuppressive effects, has been beneficial in the management of reactions in this patient with HIV-leprosy co-infection.@*Conclusion@#Considering that both Hansen’s disease and HIV directly affects T helper CD4+ lymphocytes in its pathogenesis, there seems to be little to no alteration in the course of patients with HIV-leprosy co-infection. Hence, treatment of HIV-leprosy co-infection does not differ from that of a seronegative leprosy patient. This case highlights the occurrence of erythema nodo- sum leprosum reaction in HIV-leprosy co-infection and the need for immunosuppressive drugs to control reaction and prevent nerve damage. Close monitoring is imperative to weigh the risk-benefit ratio of medications given to patients with HIV-leprosy co-infection.

Cutaneous Rosai-Dorfman disease in a 40-year-old female: A case report

Introduction@#Rosai-Dorfman disease is a rare disease that manifests with painless cervical lymphadenopathy, fever, anemia, an elevated erythrocyte sedimentation rate (ESR), and hypergammaglobulinemia. Extranodal lesions occur in 1/3 of patients, and the skin is involved in more than 10% of cases. Purely cutaneous disease is uncommon and only about more than 100 cases have been reported. Cutaneous Rosai-Dorfman Disease (CRDD) appears to be a distinct entity with different age and race predilection from cases with lymph node involvement.@*Case report@#This is a case of a 40-year-old Filipino female who presented with multiple erythematous papules and plaques with pustules on the cheeks. Skin punch biopsy showed a dense dermal infiltrate of polygonal histiocytes with abundant cytoplasm and vesicular nuclei. Emperipolesis was also present. The histiocytes were highlighted by the immunohistochemical stains S-100 and CD68 and was CD1a negative. Complete blood count and ESR were normal. Cervical lymphadenopathy was absent. Findings were consistent with Cutaneous Rosai-Dorfman disease. The patient was started on methotrexate at 15mg/week with folic acid supplementation. Mild soap, benzoyl peroxide 5% gel and tretinoin 0.05% cream once daily were maintained during the treatment course. There was significant decrease in erythema and size of existing lesions after 2 months. The patient was referred to a hematologist for monitoring of possible future systemic involvement.@*Conclusion@#Because of its rarity, clinicopathological correlation is always mandatory to establish a diagnosis of CRDD. Immu- nohistochemical stains are required to differentiate this entity form other forms of Langerhans cell histiocytosis. Multidisci- plinary referral is required to rule out concomitant systemic involvement.

Impetigo herpetiformis in a 33-year-old Filipino female

@#Introduction: Impetigo herpetiformis is a rare pustular disorder that affects pregnant women. It is also otherwise termed as “pustular psoriasis of pregnancy”, owing to the fact that the pustules are sterile and are not associated with a viral etiology. The classic lesions are erythematous patches or plaques with margins studded with subcorneal pustules spreading centrifugally. A cardinal feature of this disorder is the rapid resolution of lesions after delivery. Case Summary: This is a case report of a 33-year-old female, gravida 3, para 2 (2-0-0-2) at 36 weeks age of gestation who presented with one week history of multiple well defined irregularly shaped erythematous annular patches and plaques with marginal pustules on the trunk and extremities. The lesions began on the trunk spreading centrifugally, sparing the face, palms, soles and mucus membrane. Biopsy showed scale crust in the stratum corneum, the epidermis showed acanthosis, spongiosis and neutrophilic microabscesses with focal vacuolar alteration and small sub-epidermal nests on the basal cell layer. The dermis revealed dilated blood vessels and mild superficial perivascular lymphocytic infiltrates. Patient was given Prednisone and Cetirizine with noted resolution of lesions. Conclusion: Recurrences of impetigo herpetiformis in subsequent pregnancies are common with earlier onset in gestation and are characteristically more severe. The complications are placental insufficiency, stillbirth or neonatal death. Early detection is of utmost importance. Management must be multidisciplinary involving a dermatologist, obstetrician and pediatrician.

Relapse rate among smear-positive leprosy cases after 12 blister packs and 24 blister packs of multibacillary drug therapy in a tertiary hospital

@#BACKGROUND: Several trials on relapse rates on duration of multibacillary regimens have varying results. OBJECTIVE: To compare the relapse rate among smear-positive Leprosy patients receiving 12 blister packs of multibacillary drug therapy and 24 blister packs of multibacillary drug therapy. METHOD: A review of records of smear positive Leprosy patients seen from 2002 to 2006 was done. Demographic, clinical and therapeutic data were collected. Bacteriologic index was determined from Leprosy Laboratory records. RESULT: A total of 391 patients were found to have complete records for review and analysis. Relapse rate was 11.9%(28) for patients who received 12 blister packs and 1.91%(3) for patients who received 24 blister packs and the difference was found to be statistically significant (p<0.01). Distribution of relapse was statistically significant according to age (p<0.01), bacteriologic index (p<0.01) and clinical spectrum (p<0.01). CONCLUSION: Relapse rates shown among smear positive leprosy patients receiving 12 blister packs vs. those receiving 24 blister packs was statistically higher which differs from previously published studies. Significant predictors were clinical spectrum, bacteriologic index of >3.5, and >4 and number of blister packs.

Primary cutaneous anaplastic large cell lymphoma in a 73-year-old Filipino male

Introduction@#Primary cutaneous anaplastic large cell lymphoma (PCALCL) is an uncommonly encountered subtype of cutaneous lymphoma under the classification of CD30-positive lymphoproliferative disorders which presents histologically as large atypical lymphocytes with pleomorphic and anaplastic cytology that localizes to the dermis. Although recurrent, PCALCL usually carries a good prognosis, with 5-year survival rates ranging from 85% to 95%.@*Case Summary@#We report a 73-year-old elderly male who consulted at our out-patient department with a 3-year and 6-month history of multifocal, gradually enlarging, erythematous nodules with dry, necrotic areas on the scalp, right auricular area, left axillary area, right forearm, and right thigh, accompanied by loss of appetite and nontender cervical, left axillary, and right inguinal lymphadenopathy. Previous skin punch biopsy and immunohistochemical stain done by the patient’s preceding dermatologist was signed out as “suggestive” of pseudolymphoma. However, management with intralesional corticosteroid injections provided no improvement. Skin punch biopsy done at our institution revealed ALK negative (-) anaplastic large cell lymphoma. Patient was then referred to an oncologist, however, the patient was lost to follow-up and succumbed to community acquired pneumonia.@*Conclusion@#This case highlights the importance of a thorough diagnostic assessment as recent studies indicate a poorer prognosis of ALK (-) cases, with overall 5-year survival rates consistently below 50%.

A randomized, double-blind, controlled study on the safety and efficacy of 25% Tinospora Rumphii (Makabuhay) cream versus 2% Mupirocin cream on superficial pyodermas caused by Staphylococcus aureus

Background@#Superficial pyoderma is an infection most commonly caused by Staphyloccoccus aureus. The drug of choice is 2% mupirocin cream. However, high cost and emerging drug resistance affect compliance and overall cure. Tinospora rumphii has demonstrated antibacterial activity in vivo rendering it a potential cost-effective alternative treatment.@*Objectives@#To determine the safety and efficacy of 25% T. rumphii cream versus 2% mupirocin cream in the treatment of superficial pyodermas caused by S. aureus.@*Methods@#A randomized, double-blind, controlled study of 60 patients with superficial pyodermas caused by S aureus, aged 18-60, were given either 25% T. rumphii or 2% mupirocin cream for two weeks. Bactericidal activity, erythema, edema, induration and size of lesion were evaluated at baseline, days 3, 7, and 14. Participants Global Assessment (PGA) score and adverse events were noted. Statistical analysis was done using Mann-Whitney U and Pearson Chi square test. RESULTS: Fifty-one subjects (85%) completed the trial. There were no statistically significant differences between the two treatment groups for bactericial activity against Staphylococcus aureus (p=0.687) at day 14, for erythema (p=0.923, 0.5335, 0.3726, 0.6949), edema (p=0.0972, 0.5967, 0.2052, 0.2783), induration (p=0.0855, 0.3113, 0.281, 0.3161), and size of lesions (p=0.7262, 0.169, 0.15, 0.3988) at baseline, days 3, 7 and 14. There was no significant difference in PGA score (p=0.3086, 0.3483, 0.2234) at Days 3, 7 and 14 in both groups. No adverse events were noted.@*Conclusion@#Twenty five percent T. rumphii cream is equally safe and effective as 2% mupirocin cream for treatment of superficial pyodermas caused by S. aureus.

Cross-sectional survey on the knowledge, attitudes and practices of Philippine Dermatological Society members related to HIV/AIDS

Background@#Human Immunodeficiency Virus (HIV) infection/Acquired Immunodeficiency Syndrome (AIDS) remains a major challenge worldwide. Physicians have a crucial role in the struggle against HIV/AIDS and must be equipped with proper knowledge, attitude and practices (KAP). No study has been done to assess the KAP of dermatologists related to HIV-AIDS.@*Objective@#The study’s objective was to determine the KAP of Philippine Dermatological Society (PDS) members related to HIV/AIDS.@*Methods@#A cross-sectional study was done among PDS members from February to November 2017 utilizing a questionnaire consisting of socio-demographic questions and KAP questions related to HIV.@*Results@#Out of 210 participants, 71.43% show good working knowledge, 60.95% show negative attitudes, 55.71% show bad practices related to HIV/AIDS. Members aged 29 to 37 years old, having worked as dermatologists for 1 to 8 years, and having worked in the health care sector for 1 to 8 years have better working knowledge on HIV/AIDS. Although with lesser duration of work as dermatologist, these members have more positive attitudes towards HIV/AIDS. These findings may be attributed to greater exposure to HIV cases and better ability to access information by internet among younger dermatologists. Gender is not significantly associated with KAP related to HIV/AIDS. Practice related to HIV/AIDS is not significantly associated with any demographic variables. Bad working knowledge related to HIV/AIDS is associated with negative attitude and bad practices. This can be attributed to insufficient training in the field of HIV/AIDS.@*Conclusion@#Majority of PDS members show negative attitudes, bad practices, but good working knowledge related to HIV/AIDS.

Mistaken identity: Eumycetoma masquerading as Squamous cell carcinoma

@#We report a case of eumycetoma in a Filipino patient who presented with a solitary reddish brown, moist, multinodular tumor on the dorsum of the left foot of 2 years duration. Biopsy with Periodic acid Schiff (PAS) & Gomori methenamine silver (GMS) staining, fungal culture, ultrasound and X-ray of the foot were done in our institution which confirmed the diagnosis of eumycetoma. The patient was successfully treated with itraconazole 400/day for 3 months, followed by 200mg/day for the succeeding 9 months, leading to complete resolution of the lesion leaving an atrophic hypopigmented scar. A high index of suspicion supported by diagnostic tests aided in the early detection of the disease which also resulted to complete resolution of the disease.

A randomized, double-blind, comparative study on the safety and efficacy of virgin coconut (Cocos nucifera l.) oil against 1% Hydrocortisone lotion as an anti-inflammatory and anti- pruritic preparation for mosquito reactions

Background@#Virgin coconut oil (VCO) has been reported to have anti-inflammatory and anti-pruritic properties and can be used as an alternative to corticosteroids for mosquito bites. No studies on VCO for mosquito bites have been published.@*Objective@#To compare the safety and efficacy of VCO against 1% Hydrocortisone as an anti-inflammatory and anti- pruritic preparation for mosquito bites.@*Method@#This is a randomized, double-blind study comparing the anti-inflammatory and anti-pruritic effect of VCO versus 1% Hydrocortisone on Aedes aegypti bites, by measuring the mean lesion size, subjective assessment of the effects on bites, pruritus intensity through the visual analog, and verbal rating scale in 91 subjects at baseline, 1 hour, days 1, 3, and 7.@*Results@#During the first hour and throughout the seven-day period, there was a decrease in the mean lesion size, visual, and verbal scale score for both VCO and Hydrocortisone groups. The mean lesion size for both groups were not statistically significant on the 1st and 24th hour. On day 3, the mean lesion size for the VCO group was 0.02 and 0.71 for the Hydrocortisone group which was statistically significant in favor of VCO. The mean visual and verbal scale scores for pruritus for both treatment groups were not statistically significant. As early as the 1st hour, the proportion of patients who reported total clearance of lesions in the VCO group was 34.09% compared to 6.38% in the Hydrocortisone group. On day 7, both treatment groups had resolution of lesions. No adverse reactions were noted.@*Conclusion@#Virgin coconut oil is safe, cost-effective, and comparable to 1% Hydrocortisone as an anti- inflammatory and anti-pruritic agent.