INTRODUCTION: Costs associated with chronic psoriasis impart a significant economic burden.

OBJECTIVES: This study aims to determine the direct and indirect cost of psoriasis patients in a tertiary government hospital in Davao City.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

INTRODUCTION: Acne Vulgaris is one of the most common dermatologic diagnoses in the world. It can persist for years, result in permanent scarring, and have serious adverse effects on psychosocial development.

OBJECTIVES: This study aims to determine the relationship between whole blood zinc levels and severity of acne.

METHODS: This is a cross-sectional comparative study. Whole blood zinc levels of 30 patients with acne vulgaris divided into mild (n=10), moderate (n=10), and severe (n=10), and 10 healthy patients were measured. Acne severity was evaluated using the Global Acne Grading System (GAGS).

RESULTS: A total of 40 patients participated in this study. The mean whole blood zinc level in acne patients and non-acne patients were 5.03 ± 1.92 mcg/mL and 7.39 ± 0.79 mcg/mL, respectively. The mean zinc level of the controls was significantly higher compared to that of the acne patients (p=0.0006). Furthermore, mean whole blood zinc level of the patients with severe acne was significantly lower compared to that of the controls, mild acne and moderate acne (p<0.001). Adjusting for age and sex, there is a significant association between severity of acne vulgaris and blood zinc levels (p<0.0001). Specifically, the mean blood zinc level of the patients with moderate and severe acne were significantly lower compared to that of the control group (p=0.019 and p<0.001, respectively).

CONCLUSION: Whole blood zinc levels were inversely correlated with acne vulgaris severity in the Filipino population. Further studies are recommended to determine the role of zinc in the pathogenesis of acne and the effects of oral zinc supplementation on acne patients.

INTRODUCTION: Oral ivermectin is an approved first-line option to topical permethrin in Europe and Japan for the treatment of classic scabies, while combination oral ivermectin and topical permethrin is used in clinical practice for extensive or recurrent cases. There is unclear evidence on comparative efficacy and safety.

OBJECTIVES: To review the evidence on efficacy and safety of oral ivermectin versus topical permethrin or its combination in the treatment of classic scabies.

METHODS: We searched PubMed from January 1, 2016 up to August 7, 2021 for systematic reviews that included RCTs comparing oral ivermectin versus topical permethrin or its combination in the clinical treatment of scabies. We described the characteristics of included studies, assessed reporting quality, and summarized results and conclusion.

RESULTS: We included five systematic reviews. Permethrin did not differ from oral ivermectin in cure rate at the 3 to 6-week time point but had an earlier cure at 1-2 weeks. Adverse effects did not significantly diff er and were few, mild, and transient with both treatments. The evidence ranged widely from low to high certainty and mainly came from three moderate-to-high quality systematic reviews. Combination oral ivermectin and topical permethrin was ranked higher in efficacy but lower in safety compared to either drug alone in one moderate validity network meta-analysis.

CONCLUSION: There is varying certainty of evidence suggesting comparable efficacy and safety of oral ivermectin versus topical permethrin. Limited evidence suggest higher efficacy and lower safety of combination oral ivermectin and topical permethrin compared to either drug alone. An updated systematic review and network meta-analysis is warranted.

KEYWORDS: scabies, ivermectin, permethrin, effectiveness, efficacy, safety

INTRODUCTION: Telemedicine is the practice of remote consultations that utilize computer-mediated communication. Given the visual nature of dermatology, it is most well-suited to adopt telecommunication practices. This enables remote medical care during public health emergencies like the current COVID-19 pandemic; limiting the risk of exposure for both patients and doctors alike.

OBJECTIVES: This study aimed to describe the demographic and clinical profile of teledermatology patients from April to August 2020. Data were also compared with face-to-face consultations during the same period in 2019 in order to establish whether telemedicine can be a viable and reliable substitute to face-to-face consultations during a pandemic.

METHODS: We retrospectively analyzed chart data during a 5-month period in 2020; wherein the number of online consultations were observed to be the highest. We noted demographic and clinical features and compared some of these data to those obtained in the same period in 2019.

RESULTS: A total of 1,632 patients were seen via teledermatology in 2020 versus 7,219 face-to-face patients in 2019. Mean age for both groups were 26.59 and 36.89 respectively. Most patients in both years were from Davao. However, there was an increase in consults from other regions in 2020. Overall, the majority of cases for both periods were non-urgent inflammatory conditions.

CONCLUSION: This study showed that providing remote dermatologic care is now possible with the advent of technology even during a pandemic. Teledermatology may serve as an effective adjunct to traditional consultations.

KEYWORDS: telemedicine, dermatology, COVID-19, pandemic

INTRODUCTION: Bullous pemphigoid (BP) is a chronic, relapsing autoimmune blistering disorder commonly found in adults older than 60 years of age. It is mediated by autoantibodies directed against the hemidesmosomal proteins BP180 and BP230, which trigger an inflammatory cascade leading to blister formation. BP may present with pruritus, followed by an erythematous plaque or urticaria, and subsequently by bullae formation with or without mucosal involvement. It develops sporadically but can also be triggered by ultraviolet light exposure, radiation therapy, and medications such as dipeptidyl peptidase-4 inhibitor (DPP4i). Since 2006, the increasing use of DPP4i (also known as gliptins) for their good safety profi le in treating Type II Diabetes Mellitus has led to a further increase in the incidence of bullous pemphigoid.

CASE REPORT: This is a case of a 65-year-old hypertensive and diabetic elderly Filipino female presenting DPP4i (linagliptin)-induced bullous pemphigoid with an atypical dyshidrosiform pattern, negative direct immunofluorescence (DIF), and Enzyme-linked immunosorbent assay (ELISA) that is negative for anti-BP180 antibodies but positive for anti-BP230 antibodies.

CONCLUSION: The increasing use of DPP4i for diabetes mellitus for its good safety profile may be an essential contributing factor to the increasing incidence of BP in elderly hypertensive and diabetic patients with a simultaneous increasing incidence of atypical BP presentations such as the dyshidrosiform variant. Inability to recognize these factors carries significant therapeutic implications, including prolonged multidrug immunosuppression and increased patient morbidity and mortality.

KEYWORDS: Bullous pemphigoid, gliptin, ELISA

INTRODUCTION: Cutaneous involvement is relatively uncommon representing a small fraction (1-2%) of the localizations of extrapulmonary tuberculosis. Cutaneous TB presents with several clinical forms, wherein one of the most common is scrofuloderma resulting from the direct extension of a tuberculous focus from a deeper structure such as the lymph node into the overlying skin. Tuberculous gumma is a rare form which occurs due to hematogenous spread of the TB bacilli. Although presenting with a wide clinical spectrum, it is believed that the association of different morphologies as well as numerous lesions and sites of cutaneous TB in a same patient is very rare.

CASE REPORT: This is a case of a 20-year-old Filipino male presented with a fi ve-month history of several progressive cutaneous lesions initially presenting as subcutaneous nodules evolving into well-demarcated suppurative painless ulcers which were unresponsive to topical antibiotic. Skin punch biopsy from the medial malleolar area of the right foot revealed dilated blood vessels with a diffuse inflammatory infiltrate of lymphocytes, histiocytes, and few multinucleated giant cells. Clinical and laboratory findings were consistent with cutaneous tuberculosis. Patient was started on anti-Koch's treatment regimen and presented an excellent response to treatment showing resolution of the skin lesions on the neck and forearms and notable regression of the lesions on the right foot within four (4) months.

CONCLUSION: This case serves as a reminder that cutaneous tuberculosis can manifest with a wide spectrum of clinical presentation which can mimic diverse dermatological conditions and may present with high rates of negative or equivocal diagnostic testing results. This report highlights the importance of a high index of suspicion in the timely diagnosis and management of tuberculosis in countries wherein tuberculosis remains a significant health burden such as the Philippines.

KEYWORDS: Cutaneous tuberculosis, Scrofuloderma, Tuberculous gumma, Metastatic tuberculous abscess

INTRODUCTION: Subungual squamous cell carcinoma is rare, though it is the most common primary malignant neoplasm in the nail unit. Fingernails are more commonly involved than toenails with nonspecific and mild features. Histopathologic presentation may be difficult to distinguish from other tumors. With this, there is often a delay in diagnosis.

CASE REPORT: A 64-year-old male presented with a subungual yellowish granulomatous plaque, eventual dystrophy, and persistent bleeding on the fi rst digit of the right foot of two years' duration. Initially diagnosed as pyogenic granuloma through skin punch biopsy, debridement with ungiectomy was done. Upon recurrence, he underwent wide excision with matricectomy, wherein deeper sections revealed features of basosquamous carcinoma. A positive Epithelial Membrane Antigen and negative BerEP4 staining later confirmed a diagnosis of SCC. Since bone involvement was repeatedly suspected in magnetic resonance imaging after postoperative radiotherapy, amputation was eventually done.

CONCLUSION: We report a case of subungual SCC initially diagnosed as a pyogenic granuloma. Full-thickness biopsy should be done in persistent nail conditions using special stains to confirm the diagnosis. Surgical treatment or radiotherapy with or without systemic therapy is the first line of treatment for subungual SCC. In cases of bone involvement, amputation may be warranted.

KEYWORDS: nail, pyogenic granuloma, squamous cell carcinoma, tumor

INTRODUCTION: Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous disorder causing a mutation in the tumor suppressor genes, TSC1 or TSC2. Loss of function of these genes leads to dysfunction of hamartin and tuberin, resulting in hamartoma formation. It usually manifests with cutaneous manifestations at childhood. However, it also affects other organ systems. Based on the Philippine Dermatological Society Health Information System census, there have been 104 cases of TSC from 2011-2018. Currently, limited data is available regarding the treatment options in the local setting.

CASE REPORT: The case involves a 4 year-old boy, with a two year history of flesh-colored to dusky red fi rm papules on the centrofacial areas and neck. Lesions have been increasing in number since first appearance. He had a normal birth history. Family history was insignificant. However, delay in expressive speech development was noted. Physical examination revealed multiple well-defined angiofibromas on centrofacial areas and neck; fibrous cephalic plaque on the left temporal area, and several ash-leaf spots on the trunk. Periungual and subungual fibromas, confetti macules, shagreen patch and dental pits were absent. Based on the clinical manifestations, he was diagnosed with TSC. Histopathology of a papule on the chin was consistent with angiofibroma. Parents were concerned with the appearance of the lesions and preferred conservative management. Hence, topical sirolimus 0.2% ointment was applied once daily on the angiofibromas for 4 months. Monthly follow-up showed marked improvement, manifested by the decrease in number and by flattening of the lesions.

CONCLUSION: To the best of our knowledge, this is the fi rst case report of successful treatment of topical sirolimus for TSC in the Philippines.

KEYWORDS: tuberous sclerosis complex, topical, treatment success, conservative management, hematoma

INTRODUCTION: Primary cutaneous aggressive epidermotropic CD8+ T-cell lymphoma (PCAECTCL) is a rare subtype of cutaneous T-cell lymphoma characterized by widely distributed ulcerated lesions, epidermotropic infiltrates of CD8+ cytotoxic T cells, aggressive course, high tendency to spread to extranodal sites, poor response to conventional therapies and unfavorable prognosis.

CASE REPORT: We report a 76-year-old Filipino male presenting with eight-month history of erythematous scaly patches evolving into widespread ulcerated nodules, unresponsive to topical and systemic steroids. Histopathology revealed prominent epidermotropism and lichenoid infiltrate of atypical lymphocytes. Immunohistochemistry showed positivity for CD3, CD8, Ki67 (5-15%), CD7, CD2; indeterminate for TIA-1, with high background staining; and was negative for CD20, CD30, CD4, CD5, CD56, granzyme-B, TdT, Epstein-Barr encoding region in situ hybridization (EBER-ISH), consistent with PCAECTCL. No overt metastasis was detected. The patient underwent interferon alfa 2B therapy followed by three full cycles of CHOP chemotherapy. Improvement was seen as thinning of plaques and nodules and re-epithelialization of ulcers however, severe anemia and leukopenia ensued with therapy. He then succumbed to septic shock secondary to pneumonia during the height of the COVID-19 pandemic.

CONCLUSION: This case emphasizes that despite accurate diagnosis, polychemotherapy, and favorable response to therapy, complications may still arise contributing to the poor prognosis and low fi ve-year survival rate of this condition.

KEYWORDS: T-cell lymphoma, CD8 positive, neoplasms

INTRODUCTION: Trichoepithelioma is a benign hamartoma which may exhibit similar clinical and histopathological features with basal cell carcinoma. Since prognosis is dissimilar, differentiating between them is important. Literature reveals fifteen reports of malignant transformation of multiple trichoepitheliomas into basal cell carcinoma, with none in the local setting. In Brooke-Spiegler syndrome, the incidence rate of malignant transformation of benign neoplasms has been reported in 5-10 % of patients.

CASE REPORT: A 53-year-old Filipino-American female presented with multiple discrete to coalesced, well-defined, skin-colored to hyperpigmented, smooth, dome-shaped, rubbery papules and nodules on the face since childhood. Throughout the years, lesions increased in number and size and spread to the scalp, chest, abdomen, back, upper and posterior right thigh. Some developed ulceration, telangiectasia and pigmentation.

Chest radiography, radiographs of the jaw, whole abdominal ultrasound, cranial CT scan, ophthalmology and otorhinolaryngology assessments were normal. Based on clinical and histopathologic findings, the final diagnosis was Brooke-Spiegler syndrome with transformation into basal cell carcinoma. Carbon dioxide (CO2) laser was used to excise large and ulcerated lesions with good cosmetic results.

CONCLUSION: A case of a Filipino-American adult female diagnosed clinically and histologically with Brooke-Spiegler syndrome with transformation into basal cell carcinoma was presented. Given the similarities in clinical and histopathologic features of trichoepithelioma and basal cell carcinoma, accurate diagnosis should be made because of their difference in prognosis. The use of an acceptable treatment modality such as carbon dioxide (CO2) laser in this case is an important emerging fi eld of study.

KEYWORDS: trichoepithelioma, basal cell carcinoma, Brooke-Spiegler syndrome, malignant transformation, carbon dioxide laser