CONTEXT<p>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.p>AIMS<p>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.p>SETTINGS AND DESIGN<p>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.p>SUBJECTS AND METHODS<p>Participants underwent gross nail examination, dermoscopy, potassium hydroxide (KOH), and periodic acid-Schiff (PAS) examinations.p>STATISTICAL ANALYSIS USED<p>Sensitivity, specificity, predictive value, and likelihood ratios (LRs) of the dermoscopic patterns were obtained using KOH and PAS results as the reference standard.p>RESULTS<p>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.p>CONCLUSIONS<p>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.
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Human ; Dermoscopy ; Onychomycosis

BACKGROUND<p style="text-align: justify;" data-mce-style="text-align: justify;">Accurate diagnosis of onychomycosis is important because its treatment is long-term, costly, and sometimes with complications. KOH test is quick and cheap but has low sensitivity. Hence, the need for additional tests such as culture and/or PAS. However, these two tests are not readily available and expensive. Dermoscopy is an emerging tool for the diagnosis of nail conditions.p>OBJECTIVE<p style="text-align: justify;" data-mce-style="text-align: justify;">This study aims to evaluate the accuracy of dermoscopy as a point-of-care tool in diagnosing distal subungual onychomycosis (DSO).p>METHODS<p style="text-align: justify;" data-mce-style="text-align: justify;">This is a prospective, cross-sectional study of 22 clinically diagnosed DSO patients selected via convenience sampling in a tertiary hospital from November 2019 to March 2021. Participants had gross nail examination, dermoscopy, KOH and PAS tests. Measures of diagnostic accuracy for the different dermoscopic patterns were obtained, with KOH and PAS results as reference standard.p>RESULTS<p style="text-align: justify;" data-mce-style="text-align: justify;">Fifty-one nail samples were submitted for processing with only 49 nails accepted for analysis. The most common pattern was jagged edge with spikes (65.3%). Combining all 5 dermoscopic patterns increased the sensitivity to 91.2% (95% CI: 76.3, 98.1).p>CONCLUSIONS<p style="text-align: justify;" data-mce-style="text-align: justify;">Dermoscopy may be used as a first-step, point-of-care tool in the diagnosis of DSO. Addition of mycological and histopathological tests is still warranted for confirmation.p>
Dermoscopy ; Onychomycosis ; Potassium Hydroxide

INTRODUCTION<p style="text-align: justify;" data-mce-style="text-align: justify;">Lamellar ichthyosis (LI) is an inherited rare disorder characterized by generalized scaling presenting at birth and persisting throughout life. It presents at birth with a collodion membrane, later developing into large, brown scales across the skin. LI requires ongoing treatment and monitoring due to physical and psychosocial impacts. This study highlights siblings who showed substantial quality-of-life improvements with oral retinoid therapy.p>OBJECTIVE<p style="text-align: justify;" data-mce-style="text-align: justify;">To present and discuss a detailed case summary, explore management options, and evaluate the treatment outcomes.p>CASE SUMMARY<p style="text-align: justify;" data-mce-style="text-align: justify;">We report on a pair of siblings, a 24-year-old male and a 19-year-old female, who were born encased in a collodion membrane, and later presented with large, brown, plate-like scales all over the body. Skin changes were accompanied by intermittent heat intolerance and mild ectropion, which subsequently caused impaired quality of life while growing up. Histopathology results were consistent with lamellar ichthyosis. Both siblings responded well to oral Acitretin at 0.5 mglkglday, showing significant shedding of thick scales and a reduction of ectropion within the first two weeks of therapy.p>CONCLUSION<p style="text-align: justify;" data-mce-style="text-align: justify;">Lamellar ichthyosis, a severe, lifelong disorder with psychosocial repercussions, requires long-standing, continual therapy. Maximizing treatment options with oral acitretin, addressing the psychosocial implications of the disease and getting patients actively involved in its management results in better treatment outcomes.p>
Human ; Male ; Female ; Young Adult: 19-24 Yrs Old ; Ichthyosis, Lamellar ; Acitretin

<p style="text-align: justify;">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.p> <p style="text-align: justify;">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.p> <p style="text-align: justify;">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.p> <p style="text-align: justify;">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.p> <p style="text-align: justify;">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.p>
Human ; Male ; Female ; Multicenter Study ; Prevalence ; Patients ; Dermatology