Recalibrated scales: The use of low-dose Isotretinoin in a case of Epidermolytic Ichthyosis-NPS1 in a Filipino child

@#Epidermolytic Ichthyosis (EI) is a rare non-syndromic keratinopathic ichthyosis without definitive treatment. This is a case of EI in a 5-year-old Filipino female who presented with hyperkeratotic scales sparing the palms and soles. Histopathology revealed epidermolytic hyperkeratosis. A trial of treatment with isotretinoin 0.3 mg/kg/day, together with keratolytic agents, urea lotion and lactic acid lotion, resulted in a marked decrease in the thickness of the scales and odor. Interestingly, rebound effects were noted at 0.6 mg/kg/day. Taking into account that EI presents with more skin fragility compared to non-EHK ichthyosis, the authors surmise that there may be a smaller treatment window for patients with EI, which is notably lower than recommended for ichthyosis in general.

Bullous Mastocytosis in a Filipino infant: A case study

Introduction@#Mastocytosis is a disease defined by the proliferation of mast cells in organs, most commonly the skin. It may affect any age group but is usually found in children in the first year of life. We present a case of diffuse cutaneous mastocytosis manifesting in the rare bullous form. @*Case@#A 4-month-old Filipino male presented with multiple bullae on the head, trunk, and extremities after applying chamomile oil. Biopsy of the skin demonstrated numerous mast cells, confirming the diagnosis of bullous mastocytosis. The patient was treated with oral antihistamines and corticosteroids, which was followed by a good response. @*Conclusion@#Diagnosis of diffuse cutaneous mastocytosis may be challenging due to its rarity. Proper management requires preventive measures, symptomatic treatment, as well as communication of prognosis with the stakeholders.

The clinical profile, wound dressings, and clinical outcomes of in-patients with pressure ulcers at a tertiary hospital in the Philippines: A seven-year retrospective study

Objectives@#Currently, there are no local studies examining wound dressing usage among pressure ulcers in Filipino patients. The study aims to provide preliminary Philippine data among in-patients with pressure ulcers: their demographic characteristics, wound characteristics, wound dressing usage, and associated outcomes per wound dressing. @*Methods@#A retrospective chart review of patients admitted at the Philippine General Hospital from 2011 to 2017 with a diagnosis of pressure ulcer was conducted. @*Results@#Eighty-five records were retrieved; 56% were female and 44% male, with a mean age of 47.67 ± 23.03 years. The mean number of ulcers per patient was 1.65 ± 1.37, mostly in Stages 2 and 3, and 90.6% were in the sacral area. Seventy-three (85.9%) had utilized at least one form of the wound dressing, mostly plain gauze (83.5%), usually with silver sulfadiazine or Dakin’s solution. Only a smaller subset used silver-impregnated dressings (10.55%) and hydrocolloid dressings (5.9%). Comparing advanced versus basic dressings for improved wound outcomes, the crude odds ratio was 3.81 (1.62 - 8.99; p-value 0.003), which on stratification accounting for bed turning, became 8.92 (1.66 - 47.97; p-value 0.009) for those bed turned and 3.05 (1.01-9.20; p-value 0.075) for those not bed turned. @*Conclusion@#Filipino in-patients with pressure ulcers were similar to those in the literature in terms of the mean number of ulcers and site of involvement. Basic gauze dressings, combined with topical agents, constitute the majority of wound dressing practice. Use of an advanced wound dressing showed a trend favoring improved outcomes, enhanced by pressure redistribution through bed repositioning.

Acupuncture as an adjunct to standard therapy for Pruritus in patients with Atopic Dermatitis: A patient- and assessor-blinded, randomized, placebo-controlled trial

Background@#Pruritus can impair quality of life in patients with atopic dermatitis. There is evidence that acupuncture reduces pruritus and disease severity, and improves quality of life. @*Objectives@#This study aimed to determine the efficacy of acupuncture in reducing pruritus intensity, disease severity, and medication use, and improving quality of life. @*Methods@#This was a patient- and assessor-blinded, randomized, placebo-controlled trial. Patients diagnosed with atopic dermatitis underwent twice-weekly acupuncture for 12 weeks, with an 8-week follow-up period. Baseline and weekly assessment were done using standard data collection forms and validated assessment tools. @*Results@#Thirty patients were randomized and 28 patients were eligible for the efficacy analysis. There were no significant differences in the baseline demographic and clinical characteristics between the True Acupuncture group (TA) (n=16) and Sham Acupuncture group (SA) (n=12). Both groups showed reduction in mean itch intensity (visual analogue scale, VAS) (p=0.024) but TA showed greater reduction (p=0.009) that was sustained after end of treatment. There was also a reduction in medication use in both groups. The comparable efficacy of SA to TA is attributed to similar peripheral receptive fields and stimulation of cutaneous C-fibers which depletes the neurotransmitters mediating pruritus and results in tachyphylaxis. Mild adverse events, such as petechiae and erythema, were noted in both groups and resolved spontaneously. @*Conclusion@#Acupuncture is a promising adjunct treatment in atopic dermatitis with significant reduction in pruritus, disease severity and medication use and a trend towards improved quality of life. Studies with larger sample size and comparison to acupuncture points farther from the true acupuncture points are recommended. @*Trial Registration@#Food and Drug Administration Philippine Health Research Registry ID PHRR171012-001696

Five percent potassium hydroxide for the treatment of anogenital warts: A systematic review and meta-analysis

@#<p><strong>BACKGROUND AND OBJECTIVES:</strong> Potassium hydroxide (KOH) is effective and safe as treatment of viral dermatoses. No systematic review has been done reporting its efficacy as a treatment for anogenital warts.</p><p><strong>METHODS:</strong> A systematic literature search for controlled clinical trials using KOH, any drug or ablative procedure measuring the clearance rate was conducted. Analysis was done using RevMan v5.3 software.</p><p><strong>RESULTS:</strong> Four low quality trials, composed of 197 patients were included but only two qualified for meta-analysis. Two studies compared KOH to cryotherapy while the two other trials compared KOH to intralesional 5-fluorouracil (FU) + salicylic acid (SA) and carbon dioxide (CO2) laser vaporization. The KOH group showed a higher clearance rate compared to cryotherapy (RR= 1.40, P> 0.05, I2=39 %) and no recurrence was noted (RR= 0.17, P> 0.05, I2=0) but the difference is not statistically significant. Isik et al., 2014 and Asadi et al., demonstrated that there was no significant difference among groups receiving KOH, 5-FU+SA and CO2 laser vaporization in the mean lesion count and size at follow up visits. (P > 0.05).</p><p><strong>CONCLUSIONS:</strong> Potassium hydroxide has comparable efficacy to the present treatment modalities but well-structured RCTs are needed to further support its use.</p>

A case of Mucocutaneous Colloid Milium in an adult Filipino female with chronic kidney disease

@#A 65-year-old female with chronic kidney disease (CKD) presented with a six-month history of asymptomatic translucent skin-colored and yellow plaques on the face. Similar yellow papules and nodules were noted in the oral cavity and eyelid margins. Biopsies were taken from the face and oral cavity showed homogeneous eosinophilic deposits with clefts in the dermis consistent with colloid milium. The patient was treated with fractional and surgical carbon dioxide (CO2) laser with improvement after one session.

A case of adult Filipino male presenting with co-localized Psoriasis and segmental Vitiligo

@#A 29-year-old male presented with a four-year history of recurrent generalized pruritic erythematous scaly annular plaques followed by a solitary depigmented patch on the right hemiabdomen extending to the back with abrupt midline demarcation. Skin biopsies confirmed the rare case of co-existing and colocalized psoriasis and segmental vitiligo. Treatment with topical steroids, tacrolimus, and narrowband ultraviolet B phototherapy resulted to the improvement of the psoriatic lesions but no change in the depigmented patch.