BACKGROUND: There is a paucity of local literature focusing on childhood psoriasis.
OBJECTIVE: To describe the clinico-demographic profile of childhood psoriasis patients seen in the Philippine General Hospital (PGH) dermatology outpatient clinic.
METHODS: Records of psoriasis patients aged 18 and below seen at the PGH dermatology outpatient clinic from January 2004 to December 2009 were reviewed.
RESULTS: A female preponderance of childhood psoriasis with a male-to-female gender ratio of 1:2 was found. Mean age of onset was earlier in males (7.89 ± 5.77) than females (12.27 ± 5.35) (p-value = 0.026). Chronic plaque type psoriasis was most frequent (71.43%), followed by guttate (16.67%), erythrodermic (7%) and pustular psoriasis (5%). The scalp (61.9%) was the most common overall initial site of onset followed by the trunk (50%). Nail involvement was seen in 29% while 11.9% had joint involvement. Topical steroid application was the most commonly used treatment.
CONCLUSION: This retrospective study reveals a female predominance of childhood psoriasis in the Filipino population. The most common overall initial site of onset is the scalp and the most frequent psoriasis phenotype overall is plaque-type psoriasis.

Human ; Male ; Adolescent ; Ambulatory Care Facilities ; Dermatology ; Exanthema ; Hospitals, General ; Nails ; Phenotype ; Philippines ; Psoriasis ; Scalp ; Skin Diseases, Vesiculobullous

BACKGROUND: Psoriasis is a chronic inflammatory disease occurs worldwide. At the Philippine General Hospital dermatology clinic, psoriasis accounted for 2.2% -2.4 % of new consults seen in 2004-2010. Its pathogenesis remains obscure but current studies indicate that activated Thai and Thai response mechanisms mediate inflammation and are implicated as key players in psoriasis genesis. Ustekinumab is a fully human monoclonal antibody that targets two interleukins (IL): IL-12 and IL-23 which influence T-cell differentiation into Thi and Thai, respectively. These naturally occurring proteins help regulate the immune system secondary to their role in linking innate and adaptive immune responses.
CASE SERIES: This is a retrospective chart review on the use of ustekinumab in 22 adult Filipinos (10 males and 12 females) conducted at six (6) dermatologists' clinics in 2010. Included were patients enrolled in the Named Patient Program (NPP) of Janssen Pharmaceutical Companies of Johnson & Johnson Philippines, diagnosed with moderate to severe long-standing plaque psoriasis and contraindicated for, or with inadequate response to, conventional systemic treatment. Patients received ustekinumab subcutaneously at loading doses of 45mg during the initial visit and at four weeks. Subsequently, it was given every twelve weeks. For patients who weighed 100 kg or more, 90mg of ustekinumab was administered. Clinical responses to the drug were assessed using Psoriasis Area and Severity Index (PASI) at initial visit and at the end of the program (52 weeks). At the end of the one-year program period, the median (range) PASI score of patients was 1.50 (0-29.2). Sixteen of the twenty-two subjects (72.73%) were able to achieve ±75% improvement from baseline (PASI 75). There was a significant (94.52%) reduction in median PASI scores of the patients from baseline to end visit (p < 0.0001). Overall, 27% (6/22) of patients with plaque psoriasis achieved complete clearance. Adverse events reported were relatively mild, including increased appetite, weight gain and body weakness/fatigue.
CONCLUSION: Ustekinumab was shown to significantly reduce the median PASI scores of 22 adult Filipino patients with moderate to severe plaque psoriasis. It was also shown to be well tolerated, with relatively mild adverse events.

Human ; Male ; Female ; Ustekinumab ; Psoriasis ; Dermatology ; Philippines

BACKGROUND: Narrow-band UVB and topical corticosteroids are treatments for vitiligo. The possible synergistic effect of these modalities has not yet been investigated.
OBJECTIVE: This study aims to compare the efficacy of combining narrow-band UVB (NB-UVB) and 0.05% clobetasol propionate ointment (CP) with that of NB-UVB and placebo in inducing initial and overall repigmentation and control of disease activity after 6 months of therapy. Moreover, it aims to assess the safety and determine the permanence ofrepigmentation within I year post-treatment in both regimens.
METHODS: Randomized, placebo-controlled, double-blind, left-right comparison was conducted on generalized vitiligo patients with 5-50% body surface area involvement, having at least 2 bilateral, comparative lesions. CP or placebo was applied once daily on either side of the body, each combined with NB-UVB thrice weekly for 6 months.
OUTCOME MEASURES: (1) number of exposures and cumulative dose (CD) of NB-UVB that induced initial repigmentation; (2) quantity of repigmentation after 6 months estimated by comparing pre- and post-treatment photographs; (3) effect on disease activity by comparing pre- and post-treatment VIDA (vitiligo disease activity) scores; and (4) permanence of repigmentation and development of new lesions within 1 year post-treatment documented by photographs.
ANALYSIS: Sample size was calculated using formula for testing two proportions at 0.05 level of significance and a power of 0.80. Data was analyzed with Student t test (paired), Exact test for symmetry and Wilcoxon signed rank test, depending on the data set involved.
RESULTS: Twenty-five patients were recruited, but only 20 were evaluable at the end of the study. Initial repigmentation was noted after a mean of 9.30 +/- 3.54 exposures (mean CD 1,887.8 +/- 1195.81 mJ/cm2) of NB-UVB on the CP-treated side, and after a mean of 15.85 +/- 5.61 exposures (mean CD 4,152.2 +/- 2231.9 mJ/cm2) on the placebo side. After 6 months, 55% (11/20) and 40%(8/20) of patients exhibited marked (>75 %) repigmentation in the NB-UVB with CP side, and NB-UVB with placebo side, respectively. Adverse events were minimal and transient. VIDA scores improved and repigmentation induced by both treatment regimens remained stable in majority within one year post-treatment.
CONCLUSIONS: Combination NB-UVB and CP induced repigmentation earlier, requiring significantly lower cumulative dose of NB-UVB than NB-UVB plus placebo. Over all quantity and permanence of repigmentation, as well as control of disease activity and safety, were comparable in the two regimens.

 

 

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; Adrenal Cortex Hormones ; Clinical Protocols ; Clobetasol ; Dermatologic Agents ; Outcome Assessment (health Care) ; Ultraviolet Therapy ; Vitiligo

BACKGROUND: Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma. Diagnosis relies on clinicopathological correlation.

OBJECTIVE: To describe the clinicodemographic characteristics of patients with MF and to identify histologic criteria that will signify adequate treatment.

METHODS: Registries from years 2004 to 2009 were searched for biopsy-proven MF. Charts were retrieved and clinicodemographic data gathered. Pre- and post-treatment biopsy slides were reviewed by a dermatopathologist blinded to the patients's treatment status. Pre-selected histologic criteria were evaluated for each slide. Pearson's chi-square and Fisher's exact test were used to analyze for statistical significance of each criteria.

RESULTS: There were 34 biopsy-proven MF from years 2004 to 2009. Male-to-female ratio was 1:1.8. Mean age at initial diagnosis was 46.7 years (13-81). Among the 16 patients with fully retrievable records, the most common presentation was that of hypopigmented patches. Age ? 60 years seemed to have significant association with relapse (P=0.02). Epidermotropism of ? 5 (P=0.03), absent to focal lymphocyte tagging (P=0.04), and dropping of haloed lymphocytes from >10 to ? 10 (P=0.01) somehow differentiated treated from untreated MF.

CONCLUSIONS: The hypopigmented variant of MF may be more common in Asian countries. Age ? 60 years old may be associated with higher risk of relapse. Grading epidermotropism, lymphocyte tagging and haloed lymphocytes may be helpful in determining adequacy of treatment of MF. However, given the small sample size of the present study, future larger studies are needed to confirm these findings.

Human ; Male ; Female ; Mycosis Fungoides ; Lymphocytes ; Lymphoma ; Biopsy

BACKGROUND: This is the first study to assess the level of sun awareness among Filipinos, and the need for a formal campaign to promote sun protection.
OBJECTIVE: To assess the knowledge, attitude and practices concerning

BACKGROUND: Uremic xerosis is the most common dermatologic condition present in patients with chronic kidney disease. Emollients were shown to be beneficial and are considered to be the first-line of treatment.
OBJECTIVE: To assess the efficacy and safety of virgin coconut oil (VCO) compared to mineral oil as a therapeutic mosturizer for uremic xerosis.
METHODS: Adult patients undergoing hemadialysis who have uremic xerosis were randomized using a computer-generated list and were instructed to apply either VCO or mineral oil twice daily on the legs for 4 weeks. Primary outcome measures included investigator-assessed clinical efficacy based on overall dry skin score (ODSS), change in skin hydration (corneometer readings), change in skin lipids (sebumeter readings), and quality of life scores. Secondary outcome measures included patient-assessed efficacy and advent of adverse effects. Overall therapeutic response was determined in which treatment success was defined as total clearance of xerosis or reduction of ODSS score and increased objective measurements (i.e., corneometer and sebumeter readings) plus moderate to marked patient-assessed efficacy, while treatment failure was defined as failure in any one of these parameters.
RESULTS: A total of 45 (22 VCO group, 23 mineral oil group) were recruited and 36 (18 VCO group, 18 mineral oil group) completed the study. The majority of patients in both treatment groups showed improved ODSS, corneometer readings, and quality of life scores. Most patients considered both treatment oils to be moderately to markedly effective. Analysis of overall therapeutic response revealed treatment success of 4 out of 22 in the VCO group and 4 out of 23 in the mineral oil group. VCO demostrated a trend to benefit in improving xerotic skin (RRR = 1.0%, 95% CI: -30, 26.3; RR = 0.99, 95% CI: 0.76, 1.3) but results are inconclusive due to the wide confidence interval.
CONCLUSION: The application of VCO or mineral oil for 4 weeks may be equally beneficial and safe in improving uremic xerosis. VCO showed a trend to benefit compared to mineral oil in terms of overall therapeutic response but this needs to be confirmed in larger randomized controlled trials.

Human ; Male ; Female ; Adult ; Coconut Oil ; Emollients ; Mineral Oil ; Lipids ; Plant Oils ; Treatment Outcome ; Skin ; Treatment Failure ; Renal Insufficiency, Chronic

A 29-year-old male presented with a four-year history of recurrent generalized pruritic erythematous scaly annular plaques followed by a solitary depigmented patch on the right hemiabdomen extending to the back with abrupt midline demarcation. Skin biopsies confirmed the rare case of co-existing and colocalized psoriasis and segmental vitiligo. Treatment with topical steroids, tacrolimus, and narrowband ultraviolet B phototherapy resulted to the improvement of the psoriatic lesions but no change in the depigmented patch.
Psoriasis ; Vitiligo

Background: Androgenetic alopecia (AGA), also known as pattern hair loss, is the most common type of hair loss in men and women. Due to very limited therapeutic options, search for other effective and safe drugs is necessary. Objectives: This review aims to evaluate the efficacy and safety of a potential treatment option, topical adenosine, for AGA in male and female adults. Methods: A search of databases (Cochrane Library, Pubmed Medline, and others) was performed with no time limitations placed. We included human interventional studies published in English involving the use of topical adenosine for AGA in healthy adult males and females. Risk bias assessment was performed using the Cochrane Collaboration criteria. Results: All four trials in this review, with a total of 260 participants, used 0.75% topical adenosine lotion twice a day for a period of 6-12 months. Comparators were placebo, topical niacinamide, and topical minoxidil. Evaluated parameters include improvement in baldness grading as assessed by dermatologists and investigators, improvement and satisfaction as assessed by participants, anagen growth, thick/thin/vellus hair ratio, and hair density. Two trials found significant improvement with thick hair ratio (>60 or >80 μm) with the use of topical adenosine while two trials showed higher overall participant satisfaction with topical adenosine. Few to no adverse effects were reported with its use. Conclusion This is the first systematic review involving topical adenosine for AGA. Topical adenosine may be effective in increasing thick hair ratio and improving the self-perception of hair growth. With minimal to no adverse effects, it may serve as an adjunct or alternative to present treatment options. However, more studies are needed to strengthen these findings.
Alopecia

Introduction: Sneddon-Wilkinson disease (SWD) is a rare, recurrent neutrophilic dermatosis presenting as sterile pustules, with a predilection for flexural and intertriginous areas. Case summary: A 49-year-old Filipino female presented with a three-year history of recurrent pustules and papules on the flexural areas of trunk and extremities. Skin punch biopsy was done and histopathology was consistent with subcorneal pustular dermatosis/SWD. She was started on Dapsone but after two weeks of intake, the patient developed generalized erythematous desquamating plaques on the trunk and extremities, with palmoplantar involvement. The patient did not have fever, jaundice, lymphadenopathy, and abdominal tenderness. Laboratory investigation such as complete blood count and liver function tests were normal. The final diagnosis was SWD with hypersensitivity to Dapsone. Dapsone was immediately discontinued and she was shifted to oral colchicine. After six weeks of oral colchicine therapy, the lesions have completely resolved. Patient was in remission for six months thereafter. Conclusion SWD is rare and the drug of choice is dapsone. In instances where dapsone is not suitable, oral colchicine can be an ideal alternative treatment.
Skin Diseases, Vesiculobullous ; Dapsone ; Colchicine

OBJECTIVES: To assess the efficacy and safety of excimer laser in combination with topical standard therapies for treatment of plaque-type psoriasis in comparison to excimer laser alone, standard topical treatment alone, or placebo.

METHODS: A literature search using Medline, Cochrane and HERDIN was conducted. Data were analyzed using mean difference at 95% confidence interval, with heterogeneity determined by I2 test.

RESULTS: Three articles with total of 130 patients fulfilled the inclusion criteria. Topical treatments studied were vitamin analog (calcipotriol), anthralin (dithranol), and steroid (flumethasone pivalate). A subgroup analysis comparing combination therapy and excimer laser alone showed a greater reduction in pooled PASI score reduction (-2.52; 95% CI: -4.28, -0.77) in the combination group after five to six weeks. There was also a significantly greater reduction in cumulative UVB dose (-3.29; 95% CI: -4.29, -2.30) needed for clearing in the combination group. Pigmentation was the commonly observed adverse event in both groups.

CONCLUSIONS: Excimer laser, in combination with topical treatment, is more effective than excimer laser alone, with significantly lower cumulative UVB dose, but the quality of current evidence is low. Long-term controlled trials are warranted to increase our confidence in the estimates of these outcomes.

Lasers, Excimer ; Psoriasis ; Calcipotriene ; Anthralin ; Flumethasone ; Meta-analysis ; Systematic Review