Human immunodeficiency virus (HIV) leads to immunosuppression by depleting CD4+ T-cells. Psoriasis, a common immune-mediated inflammatory dermatosis, can paradoxically worsen or emerge as an initial presentation of HIV. The introduction of highly active antiretroviral therapy (HAART) in psoriatic patients with HIV may trigger severe psoriasis flare-ups, often linked to immune reconstitution inflammatory syndrome (IRIS).

This case involves a 31-year-old Filipino male with recurrent, resistant psoriatic plaques. Further testing revealed latent syphilis and HIV infection. The patient completed treatment for syphilis and began HAART, but developed erythrodermic psoriasis, likely due to IRIS. After an inadequate response to acitretin, guselkumab, an IL-23 inhibitor, was administered. The patient responded well, showing significant improvement after four months of treatment without adverse effects.

This case suggests that in severely immunocompromised patients with newly diagnosed HIV, adding guselkumab to conventional HAART may be a safe and effective option for controlling erythrodermic psoriasis flares triggered by immune reconstitution. However, further research is needed to assess the long-term safety and efficacy of guselkumab in HIV-associated psoriasis.

Klippel-Trenaunay syndrome (KTS) is a rare slow-flow congenital vascular disorder with an incidence of 1:100,000. 1 , 2 KTS is classically characterized by a clinical triad of capillary malformation, venous malformation, and bony or soft tissue hypertrophy. RAD50 and POLE genes act directly on deoxyribonucleicacid (DNA) and genome stability. Although distinct from the more studiedphosphatidylinositol-4,5-bisphosphate3-kinase catalytic subunit alpha (PIK3CA)gene, RAD50 and POLE genes coexist as a deficient gene in few vascular malformations and papillary thyroid carcinoma (PTC).

This is a case of a 7-month-old Filipino female patient clinically and radiologically diagnosed as KTS presenting with multiple capillary malformations and left limb length-girth discrepancies. Dermoscopy showed various vessel patterns in all affected areas. Soft tissue ultrasound and magnetic resonance imaging/angiography (MRI/MRA) of the left extremities revealed subcutaneous capillary malformations, hypertrophy of the subcutaneous structures and compartment muscles. Strong family history of PTC was elicited and genetic sequencing revealed detected RAD50 and POLE genes. She was treated using the mammalian target of rapamycin inhibitor sirolimus with careful monitoring of trough levels and radiographic tests. A significant outcome one year post-sirolimus revealed no abnormal vessels on ultrasound, a lesser degree of hypertrophy and capillary malformations were no longer appreciated in MRI/MRA of left extremities. Port-wine stains (PWS) and affected limbs showed a decrease in erythema and growth rate during the treatment period.

KTS detected with RAD50 and POLE genes successfully treated with sirolimus with trough-level monitoring. Radiographic evaluation and regular anthropometric assessment remain valuable in the diagnosis and monitoring.

BACKGROUND

Narrow-band ultraviolet B (NB-UVB) phototherapy is a mainstay in the treatment of psoriasis, with dosage related to the minimal erythema dose (MED), with initial dose at 50-70%, followed by dose increments.

To determine the MED of Filipino adult patients with psoriasis using NB-UVB phototherapy at a tertiary government hospital.

This is an analytical, observational, cross-sectional study with prospective data collection among Filipino adults with psoriasis, at Dr. Jose N. Rodriguez Memorial Hospital and Sanitarium, from March 2023 to June 2024. Participants underwent MED determination using NB-UVB phototherapy cabinet. MED was defined as the square with definite redness, very light pink, or faintly detectable erythema over the entire exposed site after 24 hours. Clinicodemographic information were gathered and analyzed for possible associations with obtained MED.

Forty-eight participants were enrolled with MED as follows: 600 mJ/cm² (47.92%), 800 mJ/cm² (25%), 1000 mJ/cm² (12.50%), 1200 mJ/cm² (10.42%), and 400 mJ/cm² (4.17%). Age appeared to be directly proportional to MED dose (p-value =0.047). A statistically significant association of having lower MED values (p=0.017) were observed in patients with concomitant diabetes mellitus. Sex, Fitzpatrick skin type, psoriasis severity, and the body site used for testing, had no association with obtained MED values.

The median MED was 600 mJ/cm². Based on this, the suggested initial dosage of NB-UVB at 50-70% is 300-420 mJ/cm². These findings demonstrate that the current starting dose being used at DJNRMHS can either be maintained at 300 mJ/cm² or can be safely increased up to 420 mJ/cm².

Calcemic uremic arteriolopathy or calciphylaxis is an uncommon disorder presenting clinically as skin ischemia and necrosis, and histologically as vascular calcification and thrombosis of dermal and subdermal vasculature. This study described two Filipino females with end-stage renal disease on chronic dialysis with non-healing ulcers on the lower extremities as a result of calcification in the vessels of the dermis and subcutaneous fat with associated fat necrosis. Current understanding of its various histologic features was reviewed for proper diagnosis.

Introduction: Intralesional purified protein derivative (PPD) is an affordable therapeutic option that has been studied for cutaneous warts. However, the lack of good evidence precludes its widespread use. Objective: To determine the efficacy and safety of intralesional PPD in the treatment of cutaneous warts. Methods: A systematic search for controlled clinical trials comparing intralesional PPD and placebo or any conventional therapy was conducted using electronic databases. The included studies were assessed for risk of bias, and data such as clearance rate of target and distant lesions, recurrence rate, and adverse events were extracted. Analysis was done through RevMan v5.3. Results: Four controlled clinical trials composed of 205 patients were included. All of the studies compared intralesional PPD to placebo as comparator. Intralesional PPD had a significantly higher clearance rate of target wart (RR=0.43[0.22,0.84], P=0.01) and a significantly higher clearance rate of distant lesions (RR=0.59[0.41,0.85], P=0.005) as compared to placebo. However, there was no significant difference in the recurrence rate (RR=0 [-0.07,0.07], P=0.98). Adverse events reported were only considered minor. Conclusion Intralesional PPD is an effective and safe treatment option for cutaneous warts. However, more well-structured RCTs with longer follow-up period and those comparing it with conventional treatment are needed to further support its use.
Warts ; Meta-Analysis ; Tuberculin

Objectives: Currently, there are no local studies examining wound dressing usage among pressure ulcers in Filipino patients. The study aims to provide preliminary Philippine data among in-patients with pressure ulcers: their demographic characteristics, wound characteristics, wound dressing usage, and associated outcomes per wound dressing. Methods: A retrospective chart review of patients admitted at the Philippine General Hospital from 2011 to 2017 with a diagnosis of pressure ulcer was conducted. Results: Eighty-five records were retrieved; 56% were female and 44% male, with a mean age of 47.67 ± 23.03 years. The mean number of ulcers per patient was 1.65 ± 1.37, mostly in Stages 2 and 3, and 90.6% were in the sacral area. Seventy-three (85.9%) had utilized at least one form of the wound dressing, mostly plain gauze (83.5%), usually with silver sulfadiazine or Dakin’s solution. Only a smaller subset used silver-impregnated dressings (10.55%) and hydrocolloid dressings (5.9%). Comparing advanced versus basic dressings for improved wound outcomes, the crude odds ratio was 3.81 (1.62 - 8.99; p-value 0.003), which on stratification accounting for bed turning, became 8.92 (1.66 - 47.97; p-value 0.009) for those bed turned and 3.05 (1.01-9.20; p-value 0.075) for those not bed turned. Conclusion Filipino in-patients with pressure ulcers were similar to those in the literature in terms of the mean number of ulcers and site of involvement. Basic gauze dressings, combined with topical agents, constitute the majority of wound dressing practice. Use of an advanced wound dressing showed a trend favoring improved outcomes, enhanced by pressure redistribution through bed repositioning.
Pressure Ulcer ; Retrospective Studies

Acquired perforating dermatosis represents one of the perforating skin disorders showing transepidermal elimination of dermal contents. Dermoscopy showing concentric zones of a central keratotic plug, white-gray structureless area and peripheral brown pigmentation may aid in diagnosis and in sample selection for biopsy.
Diabetes Mellitus, Type 2 ; Renal Insufficiency ; Dermoscopy

BACKGROUND AND OBJECTIVES: Potassium hydroxide (KOH) is effective and safe as treatment of viral dermatoses. No systematic review has been done reporting its efficacy as a treatment for anogenital warts.

METHODS: A systematic literature search for controlled clinical trials using KOH, any drug or ablative procedure measuring the clearance rate was conducted. Analysis was done using RevMan v5.3 software.

RESULTS: Four low quality trials, composed of 197 patients were included but only two qualified for meta-analysis. Two studies compared KOH to cryotherapy while the two other trials compared KOH to intralesional 5-fluorouracil (FU) + salicylic acid (SA) and carbon dioxide (CO2) laser vaporization. The KOH group showed a higher clearance rate compared to cryotherapy (RR= 1.40, P> 0.05, I2=39 %) and no recurrence was noted (RR= 0.17, P> 0.05, I2=0) but the difference is not statistically significant. Isik et al., 2014 and Asadi et al., demonstrated that there was no significant difference among groups receiving KOH, 5-FU+SA and CO2 laser vaporization in the mean lesion count and size at follow up visits. (P > 0.05).

CONCLUSIONS: Potassium hydroxide has comparable efficacy to the present treatment modalities but well-structured RCTs are needed to further support its use.

Objective: To determine the prevalence of complementary and alternative medicine (CAM) use and its association with quality of life (QOL) among Filipino adult psoriasis vulgaris patients. Methods: A cross-sectional study was conducted in an outpatient dermatology department of a tertiary hospital, using a semi-structured, interview-guided questionnaire, and a self-administered QOL questionnaire, the dermatology life quality index (DLQI). Results: A total of 135 Filipino adult patients with psoriasis vulgaris were included. The prevalence of CAM use was 47%, with most CAM users being female and single. Completion of tertiary education was found significantly associated with CAM use (p < 0.05). A greater body surface area involvement and longer disease duration were more common among CAM users but these were not statistically significant. Special diet (56.3%) was the most commonly used type of CAM, followed by herbal medicine (46.9%), bath therapy (18.9%) and faith healing (12.5%). Major sources of CAM information were families (43.8%), internet/social media (28.1%) and health professionals (25%). Around 40% of the participants used CAM out of curiosity. The mean DLQI score of the respondents was 11.3 (±7.3) corresponding to poor quality of life. CAM use was significantly associated with negative impact on physical symptoms and feelings, daily activities, and work and school (P = 0.044; P = 0.019; P = 0.047). After adjusting for confounding variables, patients with poor QOL were twice more likely to use CAM but this was not statistically significant (odds ratio [OR], 1.76; 95% confidence interval [CI], 0.78-3.95; P = 0.17). Conclusions The use of CAM is prevalent among Filipino adult patients with psoriasis vulgaris. The significant association between CAM use and a poor quality of life may reflect the unmet physical and psychosocial needs of patients. A patient-perspective approach should acknowledge the reasons for CAM use, which could guide the physicians in imparting available scientific evidence, or the lack thereof, for the use of CAM to these patients.
Complementary Therapies ; Psoriasis ; Quality of Life

Background: Leprosy, a chronic granulomatous disease affecting mainly the skin and peripheral nerves, has widely recognized ocular complications. It is a significant cause of visual impairment in countries where it is still prevalent, including the Philippines. Methods: This was a cross-sectional study that determined the clinical profile and distribution of ocular pathology among Filipino patients with leprosy seen at a tertiary institution in the Philippines. Results: A total of 67 patients consented to be included in the study and were evaluated by an ophthalmologist. Thirty-seven out of the 67 patients diagnosed with leprosy had reported ocular findings. The average age was 41.2 ± 13.1 years and the majority of patients were men (78%). Thirty-six patients were multibacillary cases, 10 (27%) had a lepra reaction, and 24 (65%) were undergoing multi-drug therapy. Three patients had varying degrees of visual acuity impairment (one was visually impaired with visual acuity [VA] 6/24-6/60, one with VA 3/60-5/60, and one with VA <3/60). Steroid-induced cataracts occurred in four patients (6%) with concurrent or previous systemic corticosteroid treatment for lepra reactions. Univariate logistic regression and Fisher’s exact test of patient-, disease-, and treatment-related variables on ocular morbidity revealed non-significant values for all variables except for age with an odds ratio of 1.1 (95% CI, 1.04, 1.16) (p = 0.001). Conclusions No ocular morbidities directly caused by leprosy were seen, and treatment-related ocular findings (steroid-induced cataracts) were the only morbidities documented. There is an age-related risk for developing ocular morbidity in patients with leprosy.
Cataract ; Cross-Sectional Studies ; Eye Diseases ; Leprosy