The economic burden of psoriasis: A cross-sectional study in a tertiary hospital in the Philippines

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Costs associated with chronic psoriasis impart a significant economic burden.</p><p style="text-align: justify;"><strong>OBJECTIVES:</strong> This study aims to determine the direct and indirect cost of psoriasis patients in a tertiary government hospital in Davao City.</p><p style="text-align: justify;"><strong>METHODS:</strong> Plaque-type psoriasis patients who were actively seeking care at the Southern Philippines Medical Center Department of Dermatology for at least 6 months prior to the study period were included. The participants reported on socioeconomic status, productivity loss and monetary funding through questionnaires. Work impairment was evaluated using the Work Productivity and Activity Impairment questionnaire and was used to compute the indirect cost. A 6-month retrospective review of the health information system and medical charts generated the healthcare resource utilization data as well as the medical data used to compute the direct cost.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Among the 43 participants enrolled, 53% had a monthly household income of less than PHP8,000 (USD157) and 27% were unemployed. There was an overall work impairment of 65.4%, and 55% had experienced a change in employment status due to psoriasis. The mean 6-month direct cost of psoriasis was PHP22,672.28 ($445). The mean 6-month indirect cost was PHP 26,071.20 ($511) for employment status change and PHP 75,804.30 ($1,486) for work impairment. Government agencies provided financial aid for treatment but majority of the costs came from the participants' own pockets.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> The economic burden of psoriasis increased substantially due to the indirect cost, which in turn increased remarkably due to work impairment and employment status change.</p>

Psoriasis Foundation of the Philippines, Inc

@#The Psoriasis Foundation of the Philippines, Inc. (PFPI), is a non-profit organization in Davao City. The organization was founded in 1997 by dermatologists from Mindanao, with Dr. Carlos Pacheco as the founding president. In the same year, the PFPI was registered at the Securities and Exchange Commission (SEC). The foundation was established with the goal of improving the quality of life of patients with psoriasis. Its founders believed that they can achieve these goals by: 1. facilitating patient access to medical consultations and medications for psoriasis; 2. carrying out activities that provide social and financial support to patients and their families, and 3. promoting the conduct of research that can be used to improve the management of psoriasis. In order to do this, the PFPI partnered with the Southern Philippines Medical Center (SPMC) Department of Dermatology as it caters to numerous dermatological patients covering the Visayas and Mindanao region. With this, the PFPI was able to garner a wider grasp of psoriasis patients as well as the opportunity to work closely with their health care providers and aid patients not only medically but also in addressing various aspects of their well-being. This led to the establishment of the Psoriasis Club. The Psoriasis Club currently has at least 30 members, composed of patients who have been diagnosed with psoriasis in the SPMC Department of Dermatology Clinic. The club holds monthly meetings and functions as a support group for patients and their family members, along with their healthcare providers. This has led to better monitoring of patients, increase in compliance to treatment, and stronger patient-doctor relationships. Further, the club has been able to build and strengthen relationships among psoriasis patients and their families, thereby increasing the size of their social support team. The club also implemented livelihood programs such as soap-, candle-, and Christmas decor-making in order to provide patients with skills and offer them financial security. In addition, the SPMC Department of Dermatology organizes fundraising events (e.g. postgraduate courses or conferences, advance movie screenings, pop-up thrift shops) every year to raise funds for psoriasis patients in order to generate revenue for their livelihood and medications. The PFPI, together with the Philippine Dermatological Society, celebrates World Psoriasis Day every October. This annual event is attended by patients with psoriasis, family members, and healthcare workers. It is a time when patients are given an opportunity to share their personal health experiences to dispel stigma and myths regarding psoriasis. It also impels the lay people to partner with them as they lobby for better access to health care and affordable treatments. The event also provides entertaining activities and offers free dermatological consultations. In 2015, the PFPI, in partnership with the SPMC Department of Dermatology, also started the Psoriasis Registry (PsoReg) in Davao City to keep track of psoriasis patients’ disease progression or improvement. This registry contains the sociodemographic information, clinical profiles, efficacy or failure of treatment, and quality of life among patients with psoriasis in a tertiary government hospital and private dermatology clinics. The PsoReg also aims to facilitate further studies in the disease, influence health policies, and promote the creation of a unified national registry for the country. Currently, the PFPI is under the leadership of Dr. Victoria P. Guillano. As a partner institution of PFPI, the SPMC Department of Dermatology provides support to the foundation, especially in terms of human resources, financial assistance, and technical expertise from its pool of consultants, residents and health staff. Since the establishment of the PFPI, efforts toward improving psoriasis healthcare have been geared towards lobbying for the inclusion of psoriasis in the list of subsidized medical cases by the Philippine Health Insurance Corporation (PhilHealth). This is done with the help of Rep. Scott Davies Lanete, MD, who principally authored the House Resolution 1818 that would make treatment readily available for patients with psoriasis. In 2019, the PFPI received a pharmaceutical company-funded grant that enabled the foundation to implement project Psoriasis Health Innovations (Psor-HI). This project aims to link the patients, healthcare providers, and policy makers to develop and strengthen dermatologic care for psoriasis patients. Through this project, the PFPI was able to easily reach patients and their families in Davao City, Zamboanga City, Tagum City, and Cebu City. Psor-HI was able to connect with municipal health workers, allied medical professionals, and general practitioners in these areas and connect them to the PFPI where they were able to provide vital information on psoriasis and its appropriate management. In addition, health workers with limited access to specialized dermatologic care were properly guided and enhanced their capacities to provide the best care for their psoriasis patients. The PFPI plans to engage local partners in the community in the future to strengthen patient engagement. Since psoriasis is currently not included in the health programs of the Department of Health (DOH), the PFPI envisions the integration of psoriasis education in the list of non-communicable diseases being addressed and monitored by the DOH. The PFPI will continue to be an active advocate in the achievement of accessible and affordable health services for patients with psoriasis.

Schimmelpenning syndrome with Didymosisaplasticosebacea in an infant

Introduction@#Schimmelpenning syndrome may encompass abnormalities of the cardiovascular, skeletal, ophthalmologic and urogenital systems. Nevus sebaceous is a hallmark finding and ophthalmologic findings are seen in 59% of the cases which include colobomas and choristomas.@*Case Summary@#A 1-month-old female presented with a verrucous plaque over the scalp and right zygomatic area upon birth. Physical examination reveals a linear yellowish alopecic verrucous plaque over the right frontal region, yellowish alopecic verrucous plaque topped with a skin colored papule over the right zygomatic region, conjunctival mass over the right eye and an atrophic patch with areas of circular erosion over the right occipital region. Ballard score and reflexes were appropriate for gestational age. Newborn screening was normal and otoacoustic-emission-test revealed no hearing loss. She was referred to an ophthalmologist and was assessed to have a lipodermoid, right upper eyelid and optic nerve coloboma. Cranial CT scan is unremarkable. Histopathology showed an increase in number of sebaceous glands with malformed hair units. She was managed holistically and does not have seizures and no secondary development of tumors in the nevus sebaceous.@*Conclusion@#Schimmelpenning syndrome is usually associated with the clinical triad of nevus sebaceous, mental retardation and seizures. In this case, seizures were absent, however, there is an associated lipodermoid, right upper eyelid and right optic nerve coloboma. In addition, she also presented with aplasia cutis congenita. Hence, it is important to look for other manifestations when patients present with nevus sebaceous because management requires collaboration with different specialties.

Demographic and clinical profiles of adult Filipino patients with psoriasis in Davao City: A cross sectional study

Background@#The Psoriasis Registry (PsorReg) was created by the Psoriasis Foundation of the Philippines with the goal of assessing the true magnitude of psoriasis in Davao City.@*Objectives@#To determine the demographic and clinical profiles of Filipino patients enrolled in PsorReg.@*Methods@#Cross-sectional study among adult patients enrolled in PsorReg.@*Results@#A total of 131 patients were included in the study. Mean age was 43.89 ± 15.8 years old. Chronic plaque psoriasis (96.2%) was the most common clinical pattern. 63.4% had nail involvement, while 35.1% had psoriatic arthritis. BMI was normal in 51.1% of patients. Common co-morbidities were hypertension (19.1%), diabetes (10.7%), and dyslipidemia (9.2%). Most common treatment were topical medications, while biologics were the least common. 42.7%, 49.6% and 37.4% had moderate psoriasis using BSA, PASI, and PGA, respectively. Majority (47.3%) reported a large effect of psoriasis on their quality of life.@*Conclusion@#This study determined the demographic and clinical profiles of adult Filipino patients registered in PsorReg in Davao City.

Diffuse cutaneous systemic sclerosis: A case report

@#<p style="text-align: justify;"><strong>BACKGROUND: </strong>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. <br /><strong>CASE:</strong> 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. <br /><strong>OUTCOME:</strong> 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. <br /><strong>CONCLUSION:</strong> 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.</p>

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.