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BACKGROUND

Psoriasis is an increasingly prevalent chronic disease commonly treated with topical corticosteroids (TCS), although these agents are often misused. There is a need to explore the factors influencing nonadherence to TCS among patients with psoriasis in the Philippines. This study aimed to determine the knowledge, attitude, and practice (KAP) regarding TCS among Filipino patients with psoriasis.

A cross-sectional survey was conducted on 76 Filipino patients with psoriasis at a tertiary hospital using a constructed validated questionnaire.

Patient scores clustered at the upper end of the distribution, indicating a generally good level of KAP regarding TCS. Increasing age was associated with a lower level of knowledge, while female respondents had a higher level of knowledge. Higher knowledge levels were associated with better patient attitude, and better patient attitude was associated with better practice.

Predictors of correct KAP regarding TCS are less likely influenced by sociodemographic and clinical factors; rather, these three domains significantly correlate with each other. Physicians can utilize these interrelationships by educating patients regarding their topical treatment to yield more positive attitudes regarding its efficacy and minimize their fear of side effects, which can motivate them to adhere to prescribed therapy.

BACKGROUND

Skin cancer is the most common cancer in fair-skinned populations. Ultraviolet (UV) radiation exposure is the most common and important modifiable risk factor. It is the target of most prevention strategies for cutaneous malignancies. Currently, data on knowledge, attitude, and practices (KAPs) of bikers on UV index in relation to sun protection are unavailable.

The objectives of this study were to develop a validated questionnaire, determine the demographic characteristics of bikers, and describe their KAPs on UV index in relation to sun protection.

The study was conducted among bikers at the outpatient department of a tertiary hospital, through a self-administered questionnaire. Patients included were occupational and/or recreational bikers, aged 18 years old and above, belonging to both sexes, biking at least 15 min per day, who were able to understand written English or Filipino. Exclusion criteria included bikers who have skin cancer.

One hundred and twenty-eight bikers were able to answer the validated questionnaire, with mostly male respondents, college graduates, with internet or social media as the source of information for knowledge on sun exposure and sun protection. One hundred and two of them know that forecasts of UV index from weather app on the phone are free and readily available. However, only 59 of them check the UV index regularly as a guide for sun protection.

Forecasts of UV index raise the awareness and alert the public to the need for sun protection to reduce skin cancer risk and modify health promotion and primary prevention strategies.

In 1963, Rowellet al. described a syndrome combining lupus erythematosus (LE) and erythema multiforme (EM)-like lesions. In this report, we present a 15-year-old female who presented with both systemic LE and EM-like skin lesions meeting all of the major and one of the minor criteria for a diagnosis of Rowell syndrome. Her condition improved with administration of systemic and topical corticosteroids, and hydroxychloroquine. Rowell Syndrome, a rare entity, is often debated as a coincidental overlap of other conditions according to Bonciolini,et al.[1]In light of Rowell Syndrome's infrequency and the paucity of available literature, we emphasize the clinical significance of recognizing this challenging condition.

Overlap syndrome is a rare condition involving the coexistence of at least two distinct autoimmune diseases, such as systemic lupus erythematosus and systemic sclerosis. This condition has limited studies on epidemiology probably because it is often under-recognized. We present a 22-year-old Filipino female with a 10-month history of hyperpigmented patches on the malar surface and extremities, with associated photosensitivity, fatigue, pallor, arthralgia, and oral ulcers, and positive antinuclear antibody titer. She was treated with oral Prednisone in tapering doses, leading to clinical improvement. Eight months later, there was a recurrence of hyperpigmented patches on the face and extremities with skin tightening and diffuse hair loss, development of shiny skin with facial fold loss, a beak-like nasal appearance, and episodes of dyspnea and malaise. Consistent with scleroderma, the patient was started on mycophenolate mofetil (MMF) 500 mg daily, with close monitoring for disease progression and systemic involvement. Overlap syndrome remains under-recognized due to its variable presentation and rarity. Treatment is individualized based on the specific connective tissue diseases involved and the patient’s symptoms. Multidisciplinary care is crucial for timely management and to adjust treatment as needed, given the potential for life-threatening complications involving cutaneous and internal organs.

Mammary Paget’s disease (MPD) is a rare form of intraepithelial adenocarcinoma occurring in the apocrine gland-bearing areas in patients older than 50 years old. This clinical disease presents as erythematous, scaly plaque that usually affects the unilateral nipple or areola and is frequently misdiagnosed as inflammatory or infectious dermatitis. In this report, we are presented with a 54-year-old Filipino female who came in with a 3-year history of persistent pruritic erythematous moist plaque on the right nipple gradually spreading to the surrounding areola previously treated as a case of fungal infection. Mammography revealed BI-RADS 4C. Skin punch biopsy showed nuclear atypia with pale staining cytoplasm and were consistent with MPD. Immunohistochemical stains showed positive for epithelial membrane antigen and carcinoembryonic antigen. We reiterate the importance of early diagnosis for appropriate treatment to prevent unwanted sequelae.

Tufted angioma (TA) is a rare, benign, vascular neoplasm of the skin. The diagnosis of this condition is infrequent due to its rare occurrence. Only 158 cases have been described as of 2015. The treatment reported in the literature is very limited with no clear guidelines on its management. Currently, there are no reported cases in the Philippines of TA treated with aspirin. This is a case of a 1-year-old Filipino boy presenting with multiple dusky red papules and plaques on the left side of the cheek, pre- and postauricular areas, parieto-occipital areas, chest, and upper back. His lesions started at 2 months of age, noted to increase in size, number, and thickness over time. Dermoscopy revealed homogenous erythematous background with perifollicular lacunae separated by thin septa. Histopathology revealed dilated vessels in the papillary dermis with proliferation of endothelial cells in lobules, surrounded by dilated crescent-shaped vascular channels in the dermis. The patient was treated with low-dose aspirin (5 mg/kg/day) once a day for 1 month with improvement. After 4 months from treatment, no new lesions, no increase in size, nor symptoms were noted. Low-dose aspirin is an effective and safe option for monotherapy of TA in pediatric patients.

Leukocytoclastic vasculitis (LCV) is a histopathologic descriptor for a prevalent type of small-vessel vasculitis (SVV) that affects arterioles, capillaries, and postcapillary venules. Although the association between vasculitis and malignancy only accounts for <5% of vasculitis cases, it has been recognized as a true paraneoplastic syndrome in several studies. A 57-year-old Filipino male presented with erythematous, nonblanching macules on his lower extremities, which rapidly progressed to violaceous lesions on his trunk, buttocks, and lower extremities. He also reported significant weight loss, decreased appetite, and vomiting. A skin biopsy confirmed LCV. Initially treated for meningococcemia, his condition did not improve. Abdominal imaging revealed an enlarged heterogeneous liver with retroperitoneal lymphadenopathy and a parenchymal nodule. He was eventually diagnosed with vasculitis secondary to an underlying hepatic malignancy and expired later from multiorgan failure.

CONTEXT

Accurate diagnosis of onychomycosis is important since misdiagnosis can lead to inappropriate therapy, delayed diagnosis of other nail conditions, and antifungal resistance. Dermoscopy is an emerging diagnostic tool, particularly valuable in the resource-poor settings.

The study aimed to evaluate the accuracy of dermoscopy as a point-of-care tool in diagnosing distal subungual onychomycosis (DSO) at a tertiary hospital.

An observational, prospective, and cross-sectional study was conducted among 22 clinically diagnosed DSO patients using convenience sampling at a tertiary hospital from November 2019 to September 2021.

Participants underwent gross nail examination, dermoscopy, potassium hydroxide (KOH), and periodic acid-Schiff (PAS) examinations.

Sensitivity, specificity, predictive value, and likelihood ratios (LRs) of the dermoscopic patterns were obtained using KOH and PAS results as the reference standard.

Fifty-one nails were submitted but 2 were lost during the processing, leaving 49 nails for analysis. The most common pattern was jagged edge with spikes (65.3%). Individual patterns yielded only low-to-moderate sensitivity (32.4%–73.5%). However, combining all patterns increased sensitivity to 91.2% (95% confidence interval: 76.3–98.1). Ruin appearance showed the highest specificity (100%) and positive predictive value (100%). LRs were not significant enough to draw the conclusions.

Dermoscopy may serve as an on-site, adjunct tool in the diagnosis of DSO, especially when the combination of patterns is considered. Ruin appearance maybe particularly useful in ruling in DSO. However, confirmation using mycological and histopathological tests remains essential.

BACKGROUND

Psoriasis is a chronic, inflammatory disorder of the skin, nails, and joints that develop in genetically predisposed individuals. Despite the low prevalence of pediatric psoriasis, it is not an uncommon condition since one-third of adults with psoriasis had its onset during childhood. At present, published literature on pediatric psoriasis in the Philippines is lacking.

This study aimed to determine the clinicodemographic and healthcare resource utilization profiles of pediatric psoriasis patients.

This is a 4-year retrospective study conducted at a tertiary public hospital in the Philippines utilizing chart review of patients aged 18 years and below, diagnosed with psoriasis.

The average age is 10.68 years while the mean age at diagnosis is 10.35 years. There is female predilection. For the initial psoriasis area and severity index (PASI) scores, 5.26% had mild, 8.77% had moderate, and 33.33% had severe PASI. Majority of the lesions at initial diagnosis were observed on the trunk, followed by extremities and then scalp. Only 5 out of 57 patients were noted to have been triggered by an infection. Eight out of 57 patients had a positive family history. The most common nail finding is onycholysis, followed by pitting and then oil spots and subungual hyperkeratosis. For the comorbidities, 17.5% have atopy-associated conditions. Majority of the patients were given topical anti-inflammatory treatments; 12% were prescribed systemic treatment while only 5.26% utilized phototherapy. The average cost of hospitalization is PHP 17,967.17.

Most of the data gathered and presented in the study are in agreement with published studies on pediatric psoriasis among Asian populations.