Official Publication of the Philippine Dermatological Society
My fascination with pigmentary disorders started in 2015 when I gave a lecture titled “Controversial 50 shades of grey”, in one of the pre-congress sessions during the World Congress of Dermatology in Vancouver. The special meeting was a global consensus forum on conditions that are considered rare but may be found on pigmented skin such as ashy dermatosis, erythema dyschromicum perstans, lichen planus pigmentosus, Riehl’s melanosis and idiopathic eruptive macular pigmentation. After a series of discussions and E-mail communications among members of the group, a consensus on terminologies was formulated and the report is now awaiting publication.
Let's Hear From a Colleague
The sun emits electromagnetic radiation, of which the portions of concern to us are ultraviolet radiation (UVR, 200-400nm), visible light (400-700nm), and infrared (700nm-1mm). UVR is broken down into UVC (200-290nm), which is largely filtered out by the ozone layer and does not reach the earth’s surface; UVB (290-320nm); and UVA, which is further broken down into UVA II (320-340nm) and UVA I, or long-wave UVA (340-400nm) (Fig. 1). UVA, which comprises 95 percent of UVR that reaches the earth, is relatively stable throughout the day. Being longer than UVB, it penetrates deeper into the skin, down to the deep dermis. On the other hand, UVB makes up the remaining 5 percent of UVR that reaches the earth’s surface, and its strength peaks between 10am and 2pm. It has a shorter penetration into the skin, generally reaching down to the basal layer, or at best to the upper dermis.
ABC’S (Application of Basic Concepts) in Dermatology Research
Because the objective of a clinical trial is to provide reliable evidence of the efficacy and safety of a treatment, a major issue in the design of clinical trials is ensuring we have a sufficient number of patients to provide the required level of evidence. Essentially, we need to have enough subjects in our trial to give a good chance of detecting a clinically important treatment difference if such a difference exists, while being able to reasonably conclude that no such difference exists if our results do not show it. The focus of this article is the sample size calculation for superiority trials. There are different methods in determining the sample size in trials with a non-inferiority design, or those that are randomized by cluster rather than individually. In order to appreciate the basics of sample size requirements for a trial, some understanding of key statistical concepts is essential.
Systematic Review and Meta-analysis
Non-MDT treatment for paucibacillary leprosy: a systematic review and meta-analysis of randomized controlled trials
Leprosy continues to pose a public health problem, especially in developing countries. Although the overall incidence of newly diagnosed cases have declined significantly, the rate of decline has been static. This static rate of decline, and an increasing number of persister cases and relapses, are thought to be brought about by increasing antibiotic resistance.
A randomized, double-blind, controlled trial on the safety and efficacy of bee propolis 5% ointment versus clobetasol propionate 0.05% ointment for lichen simplex chronicus
Lichen simplex chronicus (LSC) is a chronic, pruritic, inflammatory skin condition that occurs in about 3 to 7.1% of the population. Topical corticosteroids like clobetasol propionate 0.05% ointment, are the first-line treatment for acute pruritus associated with inflammatory skin diseases like LSC.
A validation study of the United Kingdom diagnostic criteria for atopic dermatitis in 2 to 16-year-old Filipino children
Atopic dermatitis is a chronic, relapsing and pruritic skin disease, for which there is no specific diagnostic test. The United
Kingdom (UK) diagnostic criteria has been extensively validated but no Filipino translation is available.
Cutaneous manifestations of patients with HIV infection at the Research Institute for Tropical Medicine Dermatology Outpatient Department: A 10-year review
Cutaneous manifestations are common clinical findings among HIV-positive patients and may be the first presentation of HIV disease. The causes are bacteria, viruses, fungi and other non-infectious agents. In the Philippines, data on prevalence of skin diseases in HIV and association with CD4 counts is limited.
Lentigo maligna (LM) is a form of melanoma in situ (MIS) occurring as a melanocytic lesion mostly on the head and neck of the elderly. It mainly affects Caucasians and is associated with light skin color. The occurrence of LM in Asians is rare. This report highlights the occurrence of lentigo maligna in an elderly Filipino male with Fitzpatrick skin phototype IV.
Eosinophilic pustular folliculitis in a 31-year-old Filipino male treated with narrowband ultraviolet B radiation: A case report
Eosinophilic Pustular Folliculitis (EPF) is a chronic cutaneous manifestation of Human Immunodeficiency Virus (HIV), which manifests as folliculo-papular lesions commonly appearing on the chest, arms, head, and neck. The associated pruritus is so intense that it has been described to be akin to scabies. Various treatment options include Antiretroviral Therapy (ART), oral antihistamines, topical corticosteroids, prednisone, isotretinoin, itraconazole, metronidazole, narrowband ultraviolet B (NBUVB), and ultraviolet A with and without psoralen in order to address the pruritus.
Scleromyxedema is a rare skin disorder characterized by fibroblast proliferation and mucin deposition in the dermis, in the absence of thyroid disease. The precise mechanisms whereby increased fibroblast activity results in mucin deposition remain to be defined, but the etiology of the disorder still remains to be unknown.
Paradoxical immune reconstitution inflammatory syndrome (IRIS) of Kaposi sarcoma in an HIV-infected African man
Immune reconstitution inflammatory syndrome (IRIS) is worsening of the clinical status of an HIV patient upon recovery of the immune system leading to reactivation of clinical manifestations associated with infectious or noninfectious agents.1 Kaposi sarcoma (KS) has been estimated to lead to IRIS in 6.4-31% of cases after initiation of highly active antiretroviral therapy (HAART).1-3 Based on the Philippine Dermatological Society Health Information System for 2011-2016, there have been 40 recorded cases of Kaposi Sarcoma with a male to female ratio of 19:1.4
Lichen planus pigmentosus (LPP) is a rare variant of lichen planus that presents with pruritic, slate gray to black macules and patches on both sun and non-sun exposed areas. Lesions may be clinically similar to ashy dermatosis. The etiology of LPP is not fully elucidated and the condition may spontaneously regress or remain active for years. Several literatures have mentioned improvement with topical calcineurin inhibitors however, no standard treatment exist.
Dermatomyositis (DM) is a multisystem inflammatory disorder, primarily affecting skin and muscle. While it has been associated with various forms of malignancies, its association with nasopharyngeal carcinoma (NPC) is rare, with an incidence of less than 1/1000.
Tuberculosis verrucosa cutis (TVC) is a cutaneous form of paucibacillary tuberculosis in individuals with moderate to high degree of immunity to Mycobacterium tuberculosis infection. This report highlights that TVC may present with atypical morphology and mimic other etiologies of diffuse plantar keratoderma.
What Lies Beneath
Glomus tumor is a benign tumor arising from the glomus body, a temperature-controlling arteriovenous anastomosis. It appears as solitary or multiple painful reddish-blue papule(s). Pain is paroxysmal, spontaneous or may be triggered by pressure and alteration in temperature. Glomus tumor is usually located on the distal extremities, most commonly beneath the nail. Extradigital lesion is less common and may be misdiagnosed. Two cases of Glomus tumor occuring in digital and extradigital location will be discussed.
Auto inflammatory diseases (AIDs) are a group of disorders characterized by the dysregulation of innate immune system and the absence of circulating autoantibodies and autoreactive T-cells.1 The AIDs characterized by neutrophilic dermatoses includes PAPA (pyogenic arthritis, pyoderma gangrenosum (PG) and acne), PASH (PG, acne and hidradenitis suppurativa), PAPASH (pyogenic arthritis, acne, PG and hidradenitis suppurativa) ,PASS (pyoderma gangrenosum, acne and sterile spondyloarthritis), PsAPASH (psoriatic arthritis, PG, acne, and hidradenitis suppurativa) and PAC (PG, acne, and ulcerative colitis).
A 47 yr old black female of African descent presented with a one-year history of hair loss involving the frontotemporal hairline (Figure 1). This was preceded by a 6-month history of hyperpigmentation of the face and other sun exposed areas such as the arms and v-neck line. There was no history of using chemical hair straighteners, drugs, contact dermatitis, lupus or HIV infection. The family history was also non-contributory. She had no prior medical illness. Examination
of the scalp revealed scarring alopecia in a frontotemporal distribution with perifollicular erythema and plugging. There were no signs of traction alopecia. Brown- grey macules and patches were distributed on the face, neck and upper limbs with sparing of the mucosa and nails. Laboratory investigations
to exclude HIV and connective tissue disease where all negative. Scalp biopsy showed decreased follicles with a perifollicular lichenoid infiltrate and prominent perifollicular scarring. Skin biopsy showed mild epidermal atrophy, vacuolar alteration of the basal cell layer with keratinocyte apoptosis with pigment incontinence.
Eruptive syringoma presenting clinically as verruca plana in a 51-year-old Filipino female: A case report
Syringoma is a common benign intraepidermal tumor affecting 0.6% of the general population and is more frequent among women at 75-90%.1,2 Lesions appear as multiple, skin colored to slightly yellowish firm papules in a bilateral symmetrical distribution.3 It is commonly located in the lower eyelids, however the scalp, axillae, abdomen, forehead, penis, and vulva can often be affected.4 Syringomas located over the forearms are unusual and rarely reported.
A physician’s career path is a never-ending track full of trainings, lectures and certifications. Technologic advances in medicine progress at such a fast pace and medical professionals need to stay up-to-date with the latest treatments and management guidelines.