A 46-year-old male presented with an erythematous papule progressing into a vegetative plaque on the right cheek that resolved with cribriform scarring. Eight months after, a similar looking erythematous papule appeared on his left cheek. This papule rapidly progressed into a vegetative plaque within a week, and was associated with a pain score of 7 out of 10. Histopathology of the second lesion revealed suppurative dermatitis with diffuse dense infiltrates composed mostly of neutrophils. Cultures revealed few colonies of Enterobacter cloacae which was inconclusive. Pathergy test was negative. High dose systemic corticosteroids were started, with an observed rapid reduction of pain, inflammation, and ultimately resolution of the lesion with formation of cribriform scarring, confirming a case of vegetative pyoderma gangrenosum. It is important to note that not all inflamed and purulent lesions are infectiousneutrophilic dermatoses should always be considered.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Pyoderma Gangrenosum ; Face ; Glucocorticoids

BACKGROUND

Seborrheic keratosis is a common benign skin tumor treated with invasive methods like electrodessication, cryotherapy, or surgery. Topical therapy with trichloroacetic acid (TCA) may be a cheaper, non-invasive alternative with less complications. While TCA has been studied for other skin conditions, more research is needed on its use for seborrheic keratosis.

OBJECTIVE

To compare the safety and efficacy of one time application of 80% TCA peel to 65% TCA peel in the clearance of raised seborrheic keratosis in Filipino patients.

METHODOLOGY

One hundred one patients were randomized to either 80% or 65% TCA groups. Each participant underwent one session of treatment and was followed up after a month. Pre- and post-test size and thickness of lesions were compared between groups.

RESULTS

Based on Physician’s Lesion Assessment (PLA), both concentrations of TCA achieved high treatment success (TCA80: 66.7%, TCA65: 68%, p-value 0.89). A similar trend was observed based on Subject’s Self-Assessment (TCA80: 74%, TCA65: 74.5%, p-value 0.95). Similar reductions in lesion size and thickness were observed in both concentrations. In terms of safety, pain, pruritus, and erythema were mostly observed during and immediately after treatment, with little to no adverse events observed after 1 month in both groups.

CONCLUSION

One time application of either 80% or 65% TCA is effective in decreasing the size and thickness of seborrheic keratosis with little to no complications 1 month post- treatment. Both concentrations were safe, causing minimal and non-persistent pain, pruritus, and erythema immediately after application.

Human ; Keratosis, Seborrheic ; Trichloroacetic Acid

A 4-year-old female with Congenital Hemidysplasia with Ichthyosiform erythroderma and Limb Defects (CHILD) syndrome, with a pathogenic variant of the NSDHL gene, c.130G>A (p.Gly44Ser), and unilateral right-sided erythematous verrucous plaques with scaling and ipsilateral limb defects, was started on 5% simvastatin ointment. It was applied twice daily for four months, with improvement already seen starting week 2. Monotherapy with 5% simvastatin ointment was able to decrease the thickness of the verrucous plaques seen in our patient, highlighting that the accumulation of toxic metabolites may play a more crucial role in its disease pathogenesis.

Human ; Female ; Child Preschool: 2-5 Yrs Old ; Child Syndrome ; Congenital Hemidysplasia With Ichthyosiform Erythroderma And Limb Defects

Topical corticosteroids (TC) are among the most commonly prescribed topical agents and are used to treat various dermatoses. This study aimed to determine the prevalence, factors associated and reasons patients inappropriately use TC. Incidence of AE and risk of the development of AE due to inappropriate TC. Out-patient dermatology patients in a tertiary hospital in the Philippines were screened for TC use and interviewed using a questionnaire. Descriptive analysis and logistic regression to determine odds ratios were done. Out of 801 patients recruited, 260 (32%) used TC. Among those who used TC, 147 (56.53%) inappropriately used TC. Among the factors associated with inappropriate use of TC were: 1) Diagnosis of dermatitis as primary dermatosis (OR = 2.82, 95% CI 0.497, 1.276), 2) Lack of awareness of the FDA advisory (OR = 2.1, 95% CI 1.245, 3.601), 3) Lack of knowledge that TC cannot be applied for prolonged periods (OR = 5.5, 95% CI 3.201, 9.334), and 4) Lack of knowledge that TC use can result into AE (OR = 4.5, 95% CI 2.637, 7.657). Relatives and friends as source of information (OR=437, 95% CI 25.997, >1000), procurement (OR=60, 95% CI 3.081, >1000) and instruction (OR=337, 95% CI 19.827, >1000) were highly associated with inappropriate use. Twenty-two percent of those who inappropriately used TC self-medicated upon recommendation by family and friends. Hypopigmentation was the most common AE. There is a 3.8 times (OR= 3.8, 95% CI: 1.918, 7.662) likelihood for a person who has inappropriately used TC to have an AE as compared to a person who has appropriately used TC. There is a need to educate the general public regarding proper TC use. Patient encounters at the clinic may be a good opportunity to reinforce guidelines on the use of TC.
Adrenal Cortex Hormones ; Philippine