2.Seabather's eruption in two triathletes at Samal Island, Davao, Philippines.
Guevara Bryan Edgar K. ; Lacuesta Maricarr Pamela M. ; Dayrit Johannes F.
Journal of the Philippine Dermatological Society 2015;24(2):67-69
Seabather's eruption (SBE) is characterized by pruritic erythematous papules on the covered areas of the body that appear within 24 hours after exposure to seawater. SBE is known to be caused by the planula of a thimble jellyfish (Linuche unguiculata) or a sea anemone (Edward siellalineata). We report cases of two adult male triathletes who developed pruritic erythematous papules on the chest and back after a swim training along the coastal waters of Samal island, Davao City. Examination of samples of the seawater revealed multiple planulae or larval forms of cnidarians. The histopathologic examination revealed moderately dense superficial and deep perivascular and periadnexal inflammatory infiltrates consisting predominantly of lymphocytes, few eosinophils and neutrophils. Treatment with a short course of systemic corticosteroids proved beneficial in both patients. A review of published literature regarding this interesting aquatic sports dermatosis was also conducted.
Human ; Male ; Adult ; Adrenal Cortex Hormones ; Eosinophils ; Lymphocytes ; Neutrophils ; Scyphozoa ; Sea Anemones ; Seawater ; Skin Diseases
4.Diffuse cutaneous systemic sclerosis: A case report.
Janice Natasha C. NG ; Sime Raymond B. FERNANDEZ ; Victoria P. GUILLANO ; Bryan Edgar K. GUEVARA
Philippine Journal of Internal Medicine 2017;55(2):1-4
BACKGROUND: Systemic sclerosis (SSc) is a rare, connective tissue disease with multisystem involvement.This is due to immunological processes,vascular endothelial cell injury and extensive activation of fibrolast that commonly affects the skin and other internal organs such as the esophagus, lungs, heart, and kidneys. SSc has one of the highest mortality among the autoimmune rheumatic diseases, hence the emphasis on the early recognition and management to prevent significant progression of the disease.
CASE: A 22-year-old female presented with a one-year history of multiple hard and hypopigmented patches on the face, neck, trunk and upper extremities. Further examination revealed mask-like facies, microstomia, frenulum sclerosis, Raynaud's phenomenon, pitted scars on the digital pulp of hands and sclerodactyly.Baseline blood chemistry,chest radiograph and electrocardiography were all negative for systemic involvement. Autoantibodies were positive for dsDNA, SS-A/Ro and Scl-70. Skin biopsy revealed sclerosing dermatitis, which was consistent with SSc.
OUTCOME: The patient was initially started with oral prednisone 0.5 mg/kg/day and was increased to 0.75 mg/kg/day for eight weeks. Prednisone was slowly tapered to 5.0 mg/day and methotrexate 15.0 mg/week was included in the management for eight weeks which resulted in decreased joint pains, halted the progression of skin induration, decreased in pruritus and palmar edema.
CONCLUSION: The characteristic dermatological findings of SSc are not only important signs to dermatologists, but these serves as diagnostic clues for clinicians from other disciplines as well. In our case, the presence of the autoantibody Scl-70 indicated the potential risk of pulmonary fibrosis and pulmonary arterial hypertension that accounts with high mortality.Hence,physicians should be aware of the possible risk of organ damage,even when asymptomatic because there is a high risk of disease progression. The importance of early recognition and a multidisciplinary approach lead to the good outcome in this case.
Human ; Female ; Adult ; Autoantibodies ; Prednisone ; Methotrexate ; Cicatrix ; Microstomia ; Sclerosis ; Raynaud Disease ; Pulmonary Fibrosis ; Hypertension, Pulmonary ; Edema ; Rheumatic Diseases ; Scleroderma, Systemic ; Scleroderma, Diffuse
5.Whole-exome sequencing in the clinical setting: Establishing a foothold for precision medicine in genodermatoses and other diseases
Yu-Chen Lin ; Wilson Jr. F. Aala ; Bryan Edgar K. Guevara ; Rosa Beatriz S. Diaz ; Chao-Kai Hsu
Journal of the Philippine Dermatological Society 2021;30(2):4-8
The concept of “precision medicine” has been a mainstay in discourses about the future of medicine, although it was not until
the completion of the Human Genome Project that genetic associations to Mendelian diseases have risen dramatically. Since
genetic variations in most (85%) monogenic or oligogenic diseases reside in exons, whole-exome sequencing (WES) serves
as a pivotal tool in the identification of causative variants in genodermatoses and other diseases, leading to efficient and
timely diagnosis. Here, we share our current diagnosis protocol for genodermatoses using WES as a first-tier solution. Two
cases are presented to demonstrate the process of identifying germline variants and one case for a somatic variant. In the
first case, a germline missense mutation in COL7A1 (exon73:c.G6127A) was identified for a patient that presented with clinical
symptoms of dystrophic epidermolysis bullosa (DEB). Immunofluorescence study revealed decreased collagen VII expression in
the dermal-epidermal junction. In case 2, we detected a germline missense mutation in KRT16 (exon1:c.374A>G) in a patient with
palmoplantar keratoderma (PPK) and congenital pachyonychia. Sanger sequencing and segregation analysis confirmed the
variant detected in WES. For case 3, a patient with linear nevus comedonicus was found to have a somatic missense mutation
in NEK9 (exon4:c.500T>C), which was only detected in the lesional DNA sample. Thus, WES shows great potential as a diagnostic
tool for monogenic or oligogenic genodermatoses. Since omics is a technology-driven tool, we expect that reaching precision
medicine is ever closer.
Precision Medicine
6.The practical diagnostic approach for hereditary Epidermolysis Bullosa in the era of next generation sequencing
Bryan Edgar K. Guevara ; Wei-Ting Tua ; Ping-Chen Hou ; Hsin-Yu Huang ; Jessica Chen ; Chao-Kai Hsu
Journal of the Philippine Dermatological Society 2019;28(1):6-9
The new era of molecular diagnostics has provided new insights in both routine clinical work and research in hereditary epidermolysis bullosa
(EB). Several different approaches and techniques have provided significant advantages in terms of diagnostic accuracy, predict- ing prognoses,
clarifying the pathogenesis, and developing new therapies. In many developing countries, however, modern laboratory techniques remain
inaccessible. Therefore, a practical diagnosticmatrix has been developed to predictthe diagnosis and subtype of EB. In thisreview,we highlight
themolecular and practicaltechniquesin diagnosing hereditary EB.
Epidermolysis Bullosa
7.Cutaneous protothecosis: A case report
Bryan Edgar K. Guevara ; Yu-Chen Chen ; Johanna O. Flordelis ; Chao-Kai Hsu ; Julia Yu-Yun Lee
Journal of the Philippine Dermatological Society 2019;28(1):38-41
Introduction:
Cutaneous protothecosis usually presents as pyoderma-like lesions or infiltrating papules and plaques
on the extensor side of the extremities. It can be misdiagnosed as eczema, pyoderma, or a fungal infection. Although
it has been isolated from a swimming pool, sewers and rivers in the Philippines, there has been no reported case of
cutaneous protothecosis in the country.
Case summary:
A 78-year-old Taiwanese male farmer visited the dermatology clinic due to a six-month history of a
large, pruritic erythematous plaque studded with papulopustules on his left forearm. A potassium hydroxide (KOH)
examination showed negative for hyphae or spores. And a skin biopsy showed morula-like bodies, which were
highlighted by the Periodic acid-Schiff stain.
Conclusion
We report a case of cutaneous protothecosis from Taiwan so Filipino dermatologists will be aware of the
clinical and histopathologic manifestations and management of cutaneous protothecosis.
Skin Diseases, Infectious
;
Administration, Cutaneous
8.A literature review and clinical consensus guidelines on the management of Bullous Pemphigoid
Clarisse G. Mendoza ; Josef Symon S. Concha ; Cybill Dianne C. Uy ; Bryan K. Guevara ; Evelyn R. Gonzaga ; Maria Jasmin J. Jamora ; Jamaine L. Cruz‑Regalado ; Katrina C. Estrella ; Melanie Joy D. Ruiz ; Rogelio A. Balagat ; Mae N. Ramirez‑Quizon ; Johanna Pauline L. Dizon ; Marie Eleanore O. Nicolas
Journal of the Philippine Dermatological Society 2023;32(2):63-76
Bullous pemphigoid (BP) is the most common autoimmune blistering disease primarily characterized by
tense blisters and occasionally with urticarial plaques, affecting the skin and mucous membranes. These are
caused by autoantibodies against BP180 and BP230 which target antigens on the basement membrane zone.
The diagnosis relies on the integration of clinical, histopathological, immunopathological, and serological
findings. The management depends on the clinical extent and severity. We present in this article a literature
review and the clinical consensus guidelines of the Immunodermatology Subspecialty Core Group of the
Philippine Dermatological Society in the management of BP.
Pemphigoid, Bullous
9.Functional and integrative approach to dermatology: Useful tips for your practice
Maria Tricia B. Manlongat-Malahito ; Maria Jasmin J. Jamora ; Zharlah Gulmatico-Flores ; Elvira L. Henares-Esguerra ; Jennifer Aileen Ang-Tangtatco ; Beverly Ong-Amoranto ; Patricia V. Tin ; Vermé ; n M. Verallo-Rowell ; Lovell Cristina S. Magat ; Bryan Edgar K. Guevara
Journal of the Philippine Dermatological Society 2021;30(2):9-14