Diffuse cutaneous systemic sclerosis: A case report

BACKGROUND: Systemic sclerosis (SSc) is a rare, connective tissue  disease  with  multisystem involvement.This is due to immunological processes,vascular endothelial cell injury  and extensive activation of fibrolast that commonly affects the skin and other internal organs such as the esophagus, lungs, heart, and kidneys. SSc has one of the highest mortality among  the  autoimmune  rheumatic  diseases,  hence  the  emphasis  on  the  early  recognition  and  management  to  prevent significant progression of the disease. CASE: A 22-year-old  female  presented  with  a  one-year history of multiple hard and hypopigmented patches on the face, neck, trunk and upper extremities. Further examination revealed mask-like facies, microstomia, frenulum sclerosis, Raynaud's phenomenon, pitted scars on the digital pulp of hands  and  sclerodactyly.Baseline  blood  chemistry,chest radiograph and electrocardiography  were  all  negative  for systemic involvement. Autoantibodies were positive for dsDNA, SS-A/Ro and Scl-70. Skin biopsy revealed sclerosing dermatitis, which was consistent with SSc. OUTCOME: The  patient  was  initially  started  with  oral prednisone 0.5 mg/kg/day and was increased to 0.75 mg/kg/day for eight weeks. Prednisone was slowly tapered to 5.0 mg/day and methotrexate 15.0 mg/week was included in  the  management for eight weeks which resulted in decreased joint pains, halted the progression of skin induration, decreased in pruritus and palmar edema. CONCLUSION: The characteristic dermatological findings of SSc are not only important signs to dermatologists, but these serves as diagnostic clues for clinicians from other disciplines as well. In our case, the presence of the autoantibody Scl-70 indicated the potential risk of pulmonary fibrosis and pulmonary arterial hypertension that accounts with high mortality.Hence,physicians should be aware of the possible risk of organ damage,even when asymptomatic because there is a high risk of disease progression. The importance of early recognition and a multidisciplinary approach lead to the good outcome in this case.

Knowledge, attitudes and practices concerning sun exposure and sun protection among adult triathletes in Metro Manila, Cebu and Davao City, Philippines: A cross-sectional study

BACKGROUND: Ultraviolet radiation is a major modifiable risk factor for aging and skin cancer. Studies assessing knowledge, attitudes and practices towards sun exposure and protection should be conducted on high-risk groups like the triathlete community. OBJECTIVES: To assess the knowledge, attitudes, and practices regarding sun exposure and protection among triathletes in Manila, Cebu and Davao City. To determine if these are associated with demographic characteristics, and if knowledge and attitudes are correlated with protective practices. METHODS: This was a cross-sectional study conducted among adult triathletes evaluating their knowledge, attitudes and practices concerning sun exposure and protection, using a self-administered e-questionnaire. RESULTS: There were 120 respondents. Almost half of the respondents had inadequate knowledge scores, while majority (83%) had desirable attitudes. Having at least a college degree significantly increased the odds ratio of having a desirable attitude (OR 6.0, 95% CI 1.36-26.45). Only 37.5% of the participants practiced good sun protection. Triathletes with Fitzpatrick III phototype had significantly increased odds ratio of having adequate sun protection practices (OR 2.22; 95% CI 1.04-4.72), while higher socioeconomic status was associated with poor protection practices (OR 0.42, 95% CI 0.19-0.90). Only 32.5% of the participants had adequate KAP scores combined. CONCLUSION: Even though more than half of the respondents had limited knowledge scores, most of them had desirable attitudes towards sun protection. Athletes with adequate knowledge and desirable attitude were more likely to exhibit adequate practice. These findings indicate the pressing need for public health strategies on sun protection for the triathlete community.