November 2017

Volume 26, Number 2

Official Publication of the Philippine Dermatological Society
h

Editorial

Putting the spotlight on skin of color

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.

z

Let's Hear From a Colleague

Photoprotection: Review and updates

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

Sample size calculation 101: Unraveling the concepts behind the numbers

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

Clinical Trials

Observational Studies

n

Case Reports

A case of Lentigo Maligna in an elderly Filipino man

A case of Lentigo Maligna in an elderly Filipino man

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 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.

Paradoxical immune reconstitution inflammatory syndrome (IRIS) of Kaposi sarcoma in an HIV-infected African man

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 in two Filipino males

Lichen planus pigmentosus in two Filipino males

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.

Tropical Grove

What Lies Beneath

Touch me not: a report on 2 cases of Glomus tumors showing variation in clinical presentation

Touch me not: a report on 2 cases of Glomus tumors showing variation in clinical presentation

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.

Brief Communication

Pyoderma gangrenosum, acne, hidradenitis suppurativa and arthralgia: PASH or PAPA syndrome?

Pyoderma gangrenosum, acne, hidradenitis suppurativa and arthralgia: PASH or PAPA syndrome?

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).

Frontal fibrosing alopecia and lichen planus pigmentosus in an African female

Frontal fibrosing alopecia and lichen planus pigmentosus in an African female

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

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.

Special Articles

Frequently Asked Questions

Have any questions about how to use the JPDS?
Read about commonly asked questions and their answers.

Praesent non massa egestas?

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec ornare in neque rutrum imperdiet. Quisque ante ante, lobortis at dapibus et, congue a orci. Sit Etiam porttitor ligula id massa lorem ipsum dolor sit amet, consectetur amet

Praesent non massa egestas?

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec ornare in neque rutrum imperdiet. Quisque ante ante, lobortis at dapibus et, congue a orci. Sit Etiam porttitor ligula id massa lorem ipsum dolor sit amet, consectetur amet

Praesent non massa egestas?

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec ornare in neque rutrum imperdiet. Quisque ante ante, lobortis at dapibus et, congue a orci. Sit Etiam porttitor ligula id massa lorem ipsum dolor sit amet, consectetur amet

Praesent non massa egestas?

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec ornare in neque rutrum imperdiet. Quisque ante ante, lobortis at dapibus et, congue a orci. Sit Etiam porttitor ligula id massa lorem ipsum dolor sit amet, consectetur amet

Praesent non massa egestas?

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec ornare in neque rutrum imperdiet. Quisque ante ante, lobortis at dapibus et, congue a orci. Sit Etiam porttitor ligula id massa lorem ipsum dolor sit amet, consectetur amet

Praesent non massa egestas?

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec ornare in neque rutrum imperdiet. Quisque ante ante, lobortis at dapibus et, congue a orci. Sit Etiam porttitor ligula id massa lorem ipsum dolor sit amet, consectetur amet

Educational Grant by