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.

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.

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.

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.

A case of disseminated granuloma annulare successfully treated with acitretin and narrowband UV-B phototherapy

Introduction@#Granuloma annulare(GA) is a benign, inflammatory skin condition characterized by asymptomatic, flesh colored or erythematous papules. The disseminated variant of granuloma annulare is uncommon, usually affecting women older than 40 years.@*Case Summary@#We report a case of a 52-year-old female, who presented with a 4-year history of skin colored to erythematous papules and annular plaques covering the entire skin surface. Correlation of the clinical presentation, histopathology and dermoscopy findings established the diagnosis of disseminated granuloma annulare. The patient was treated with 25 sessions of narrowband ultraviolet-B (NB-UVB) phototherapy and acitretin 20mg/day for 5 months.@*Conclusion@#Both histopathology and dermoscopy were noted to be valuable tools in the diagnosis of disseminated GA, as well as in monitoring response to the combined therapy.

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.

Stage III eumycetoma successfully treated with oral ketoconazole and surgical debulking

Mycetoma is a chronic, debilitating, granulomatous disease affecting the subcutaneous tissue, fascia, muscle, bone and adjacent organs characterized by triad of tumefaction, draining sinus, and grains. The ten-year incidence in our institution from 2000 to 2010 is 3 out of 81,015 cases. We present a 33-year-old man with a nine-year history of painless nodules and draining sinuses on the left foot which were unresponsive to oral antibiotics and topical antifungals. Biopsy of a nodule was consistent with mycetoma. Fungal culture revealed Madurella mycetomatis growth confirming eumycetoma. X-ray of the left foot showed poorly marginated lucencies on the calcaneus and navicular bones. Ultrasound revealed mixed hyperreflective echoes and multiple small cavities. We diagnosed the patient with Stage III eumycetoma based on the radiographic classification of bone involvement and prescribed oral ketoconazole 400 mg daily for nine months achieving 50-60% decrease in lesion size. Surgical debulking was done and ketoconazole was continued at the same dose for another nine months. There was good granulation tissue formation and no appearance of new lesions after surgery.

The misadventures of a traveler: Penicilliosis in a Filipino with HIV-AIDS

We report a case of penicilliosis in a Filipino man with HIV-AIDS who presented with skin-colored and erythematous to hyperpigmented, umbilicated papules and nodules on the face, trunk, and extremities associated with fever, lymphadenopathy, and anemia. The diagnosis was made through skin biopsy and fungal culture, which showed characteristic paintbrush-like hyphae and conidiophores. The patient was treated with intravenous amphotericin B at 0.6 mg/kg/day for 14 days followed by oral itraconazole 200 mg twice daily for 10 weeks resulting to flattening of lesions with hyperpigmentation, and prevention of appearance of new lesions. Resolution of fever, lymphadenopathy and improvement of anemia were also noted. He was placed on maintenance regimen with itraconazole 200 mg once daily to prevent relapse. Early diagnosis and appropriate management is important because mortality of disseminated disease is high if diagnosis and treatment are delayed.

A multi-center retrospective study on atopic dermatitis at the outpatient departments of Philippine Dermatological Society-accredited training institutions from 2007-2011

BACKGROUND: To date, no multicenter studies have been conducted on the prevalence and clinical profile of AD in the Philippines. Since AD is one of the top 10 skin diseases seen in the outpatients departments of all the Philippine Dermatologic Society (PDS)- accredited institutions, conducting a multicenter study provides important epidemiological information about this disease and serve as a valuable reference for future studies. OBJECTIVES: To determine the prevalence and clinical profile of patients with atopic dermatitis (AD) seen at the outpatient departments (OPD) of Philippine Dermatological Society (PDS) - accredited training institutions from 2007 to 2011. METHODS: Records of patients with a diagnosis of AD seen from January 1, 2007 to December 31, 2011 were retrieved and clinical data were collected. RESULTS: There were 744,673 dermatological consults in the 10 PDS-accredited outpatient clinics from 2007-2011. A total of 4,275 records of atopic dermatitis were reviewed for this study. The prevalence of atopic dermatitis was determined to be 0.57%. Most institutions reported a prevalence rate of less than 1% except for St. Luke's Medical Center (3.36%), and Research Institute for Tropical Medicine (7.07%). More than half of the patients (65.1%) were children between 1 to 12 years old. Twenty-four percent (24%) were infants less than one year. The average age was seven years old while the youngest was one month and the oldest was 94 years old. There were more females (56.1%) than males (42.75%). Bronchial asthma was the most prevalent co-morbid medical condition. Majority of AD patients seen in institutions were newly diagnosed. Those with previous consultations were mostly seen by dermatologists and pediatricians. Moisturizers and topical corticosteroids were the most commonly used topical preparation while antihistamines followed by oral antibiotics were the commonly prescribed oral medications. Follow-up rate was low. CONCLUSION: The prevalence of atopic dermatitis among the 10 PDS-accredited institutions is low except for SLMC and RITM. The clinical profile of patients is consistent with published literature. However, this study revealed the patient follow-up is low. This practice needs to be addressed since optimal management of this chronic disease requires close and regular follow-up to prevent complications and irrational drug use.

Bubbly orange baby: A rare case of diffuse cutaneous mastocytosis, bullous type

Mastocytosis is an uncommon, sporadic, heterogenous illness resulting from hyperplasia of mast cells. Diffuse cutaneous mastocytosis is the rarest subtype of mastocytosis affecting children, with bullous mastocytosis being its least common variety. Systemic manifestations like nausea, vomiting, bone pain, diarrhea, and central nervous system abnormalities are less common in children than adults. We report a four-month old male who presented with a two-month history of generalized yellowish to tan macules, papules and plaques with peau d'orange texture, with some blisters and erosions on the back, abdomen and scalp. Darier's sign was positive. Baseline laboratory workup were negative for systemic involvement. CD117 and Giemsa staining were positive for mast cells. Based on the clinical findings and histopathologic results, a diagnosis of bullous mastocytosis was made. Treatment included ketotifen drops, mupirocin cream and cetirizine drops, which resulted in flattening of most lesions and resolution of blisters and erosions.

Correlation of disease severity and quality of life (using scoring atopic dermatitis index and Filipino translation of children's dermatology life quality index-cartoon version) in children with atopic dermatitis

BACKGROUND: Atopic dermatitis is a chronic, relapsing inflammatory condition of the skin that is commonly diagnosed among infants and children. Although it is known that AD can affect the quality of life of children, there is ambiguous information about the relationship of disease severity and quality of life in children with AD. To the best of our knowledge, such correlation study has not yet been conducted within the Philippine population.OBJECTIVE: To determine if disease severity using Scoring Atopic Dermatitis (SCORAD) index and quality of life using the Filipino translation of the Children's Dermatology Life Quality Index (CDLQI)-cartoon version is correlated in Filipino children with ADMETHOD: Children aged 4-12 years diagnosed with atopic dermatitis at the outpatient dermatology clinic of a tertiary government hospital were recruited in the study. The severity of their disease was assessed by the investigator using the SCORAD index. Quality of life was evaluated using the Filipino translation of the CDLQI-cartoon version. Both were measured at initial consultation and at the follow-up visit one month after. The relationship between these parameters was statistically analyzed using Spearman's correlation.RESULTS: Forty children were included in the analysis. The mean SCORAD index was 41.08 (SD= +16.54) at baseline and 14.3 (SD = +8.52) on follow-up, while the mean CDLQI score was 12.92 (SD = +5.64) at baseline and 3.35 (SD = +1.98) on follow-up. Majority of the participants had moderate negative effect on QOL at baseline and only a small negative effect on follow-up. Spearman's correlation showed a high positive correlation between the SCORAD index and CDLQI both at initial consultation (Spearman's p= 0.8647) and follow-up visit (Spearman's p= 0.8058). Majority of the children were affected by symptoms of pruritus and sleep disturbance.CONCLUSIONS: Disease severity (using SCORAD index) and quality of life (using the Filipino translation of the CDLQI-cartoon version) were positively correlated among Filipino children with AD. The Filipino translation of the CDLQI-cartoon version is a valid tool which may be used as an additional subjective measure to the clinical objective scoring tools used in the assessment of AD in the Philippines.

Safety and efficacy of oral fusidic acid as a steroid-sparing agent in the treatment of lepra reactions : A randomized controlled assessor-blinded clinical trial

BACKGROUND: Lepra reactions occur in 10-30% of patients with leprosy. The standard of treatment is prednisone. However , prolonged steroid use may cause side effects such as osteoporosis, hypertension, hyperlipidemia, atherosclerosis and infections. Fusidic acid targets cytokine systems responsible for the production of Type 1 lepra reaction (T1R) and erythema nodosum leprosum (ENL). It may be given as a steroid-sparing agent in treating lepra reactions. OBJECTIVE: To determine the safety and efficacy of fusidic acid as a steroid-sparing agent in the treatment of  Type 1 and Type 2  lepra reactions. METHODS: A randomized controlled trial was conducted on 67 subjects with lepra reactions, aged 18-60, each assigned to receive either prednisone or prednisone + fusidic acid for 12 weeks. Severity of lepra reactions were graded quantitatively using a modified scale by Walker et al and van Brakel et al, and qualitatively using modified National Leprosy Control Program (NLCP) Guidelines at baseline, weeks 2,4,6,8,10 and 12. Doses of prednisone needed to control lepra reactions were also noted at each follow up and statistical analyses were done . Adverse reactions were noted. RESULT: Sixty subjects (89.55%) completed the study. The prednisone + fusidic acid group had lower quantitative and qualitative scores compared to the prednisone group. There were significant differences between the two groups for the quantitative severity scores (p=1.44x10-11) and qualitative severity grading (p=9.36x10-14) at week 12. The mean dose of prednisone was 21.5 mg in the prednisone group and 2 mg in the prednisone + fusidic acid group at week 12 (p=1.01x10-12). No adverse reactions were reported. CONCLUSION: Fusidic acid tablet 250mg/tab two tablets three times a day is an effective and safe steroid-sparing agent for the treatment of lepra reactions.

Lessons from implementing a mass vaccination campaign in a highly-urbanized city in the Philippines

OBJECTIVE: To document the the processes and outcomes of a measles-rubella supplemental immunization activity implemented in Pasay City, Philippines.METHODS: Review of proceedings of meetings, memoranda, manuals, and reports. Interviews with field monitors, supervisors and vaccination teams, and key members of the project technical group.RESULTS: A total of 60,685 children age 9 to >72 months were reached during the campaign, representing 75% of the estimated eligible population. On the other hand, 1,453 children were unimmunized because of [a] scheduled or documented prior immunization with a measles-containing vaccine (n = 1,154), and [b] refusal of parents due to religious or cultural reasons (n = 237). The successful completion of the measles-rubella supplemental immunization activity (MR-SIA) was grounded on appropriate timing of project implementation; a clearly identified problem; the existence of linkages between stakeholders at the national and sub-national level; strong local chief executive support; the availability of resources to support project implementation; a clear policy statement; and implementation policy guided by an organizational structure and tailored project plans.CONCLUSION: In this paper, we have shown that the success of public health programs and projects rely not only on technical soundness of the intervention or adequate resource mobilization, but require wide grassroots support that is guided by an able leadership and clear policy.

Urticaria pigmentosa in an 11-month-old patient: A case report

This is a case of an 11-month-old male who presented with multiple scattered mildly pruritic brown macules, papules and patches on the face, trunk and extremities, sparing the palms and soles. Darier sign was positive. Patient did not present with hepatosplenomegaly, lymphadenopathy and gastrointestinal symptoms. He was treated with emollients, potent topical steroids, antihistamines and a mast cell stabilizer with clinical improvement of cutaneous lesions after two weeks.