INTRODUCTION: Acne Vulgaris is one of the most common dermatologic diagnoses in the world. It can persist for years, result in permanent scarring, and have serious adverse effects on psychosocial development.

OBJECTIVES: This study aims to determine the relationship between whole blood zinc levels and severity of acne.

METHODS: This is a cross-sectional comparative study. Whole blood zinc levels of 30 patients with acne vulgaris divided into mild (n=10), moderate (n=10), and severe (n=10), and 10 healthy patients were measured. Acne severity was evaluated using the Global Acne Grading System (GAGS).

RESULTS: A total of 40 patients participated in this study. The mean whole blood zinc level in acne patients and non-acne patients were 5.03 ± 1.92 mcg/mL and 7.39 ± 0.79 mcg/mL, respectively. The mean zinc level of the controls was significantly higher compared to that of the acne patients (p=0.0006). Furthermore, mean whole blood zinc level of the patients with severe acne was significantly lower compared to that of the controls, mild acne and moderate acne (p<0.001). Adjusting for age and sex, there is a significant association between severity of acne vulgaris and blood zinc levels (p<0.0001). Specifically, the mean blood zinc level of the patients with moderate and severe acne were significantly lower compared to that of the control group (p=0.019 and p<0.001, respectively).

CONCLUSION: Whole blood zinc levels were inversely correlated with acne vulgaris severity in the Filipino population. Further studies are recommended to determine the role of zinc in the pathogenesis of acne and the effects of oral zinc supplementation on acne patients.

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.

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.

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.

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.

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.

Background: Seborrheic dermatitis is a chronic, relapsing, inflammatory disease characterized by erythema, scaling, pruritus over the areas of the scalp, face, ears, sternum and upper back. Tea tree oil is rich in terpene alcohols such as terpinen-4-ol which is thought to be the active germicidal component. Objective: To determine the efficacy of 5% tea tree oil cleanser in the treatment of mild-moderate facial seborrheic dermatitis and to determine the adverse side effects. Methods: Forty-five patients with clinical signs of seborrheic dermatitis were randomly assigned to one of the two treatment groups: mild cleanser and the 5% tea tree oil group. This study was done as a double-blind randomized controlled trial for 4 weeks. The parameters - area involved, erythema, scaling, and Seborrehea Area and Severity Index were taken at baseline and weekly for 4 weeks. At the end of 4 weeks, the difference of the two groups were compared using paired t-test. Results: After 4 weeks, significant clinical improvement of the area involved, erythema, and scaling and the reduction of Seborrhea Area and Severity Conclusion The use of 5% tea tree oil cleanser provides significant improvement in the treatment of mild-moderate facial seborrheic dermatitis with no adverse side effects.
Dermatitis, Seborrheic ; Tea Tree Oil

Dermatitis, Allergic Contact ; Patch Tests

Introduction: Dermatologic diseases are one of the common reasons for consult in primary care. Primary care physicians such as the doctors to the barrios (DTTBs) assigned in geographically isolated areas play a critical role in providing primary skin health services since they are the first, and sometimes, only doctors patients rely on for consult. In managing skin diseases, adequate knowledge and skills are needed to arrive at a correct diagnosis, and a physician’s proper initial treatment and timely referral to dermatologists will lead to less affectation on quality of life. Identifying what is lacking in skin health services and referral system would aid dermatologists in finding out how to bridge the gap in knowledge and access to our specialized skin health care. Objectives: The study aimed to determine the knowledge, attitudes, practices, and perceptions of primary care physicians in the Philippines regarding common dermatologic conditions. Methods: This is a cross-sectional study that utilized a self-administered questionnaire to collect data from rural government primary care phy- sicians (doctors to the barrios). At the end of the study, the proponents collated the data and data analysis was done using STATA 13.1 guided by a statistician. Results: A total of 118 DTTBs were included in the study. The mean age of the physicians is 28 years old. One-half of the physicians were assigned to low-income class municipalities; 26.85% and 25% are from 4th class and 5th class municipalities respectively. Factors such as age, sex and clinical experience were not associated with level of knowledge of the respondents. Majority or 55% of the primary care physicians were classified as hav- ing insufficient knowledge on common skin diseases. The respondents have an average of 250 consultations per week and 6% of these are derma- tologic diseases. The most common skin diseases they encountered were impetigo (46.61%), scabies (46.61%), contact dermatitis (43.22%), fungal infection (25.42%) and cellulitis (20.34%). The most prescribed and available medications for skin diseases are oral and systemic antibiotics. Only 42.37% of the physicians are able to refer to dermatologists through various online communication platforms while the rest refer through phone calls or advise their patients to seek dermatologic consult. 25% of the respondents have direct access to dermatologists. DTTBs also have recog- nized the importance of having adequate knowledge on skin diseases and majority are very interested in learning more about these conditions. The top 3 barriers to the proper management of skin diseases were lack of training, lack of experience, and lack of medications. Most of the re- spondents have rated themselves as average to bad in their perceived competency in diagnosing and managing different common skin diseases. Conclusion The study showed that majority of the respondents had insufficient knowledge on the diagnosis and management of common der- matological diseases but had a strong interest to learn more. A significant number of the respondents do not always refer to dermatologists and have poor access to specialty care. Overall, our findings suggest that there are indeed barriers to delivery of skin-related health services that should be addressed.
Physicians, Primary Care

BACKGROUND: Melasma is an acquired hyperpigmentary disorder occurring in the sun-exposed areas of the face and neck. There is little information on its prevalence, epidemiology and clinical characteristics in the Philippines. OBJECTIVE: To determine the prevalence, epidemiology and clinical characteristics of melasma in Philippine dermatology patients METHODS: This was a multicenter, cross-sectional study conducted from July to December 2013. The investigators determined the prevalence of melasma in 12,068 dermatology patients from 6 government hospitals and private centers in Metro Manila, Philippines. The melasma patients, aged 18 years and above were examined and given self-administered questionnaires to determine the epidemiological and clinical characteristics of their melasma. RESULTS: Of the 12,068 dermatology patients who were seen at the selected hospitals and private centers, 153 (1.26%) were clinically diagnosed with melasma. Majority of the melasma patients were Filipinos (73.20%), aged 41-50 years old (37.91%), with an average age of 42.40 + 9.68 years, and Fitzpatrick skin types III and IV (29.41% and 57.52%, respectively). Melasma was more prevalent in females (81.70%), wherein majority had a prior history of pregnancy (76.8% of the females). Oral contraceptive use was also reported in 37.6% of the female patients and 63.83% of those who have used OCP, have used it for only 1 year or less. Majority had no thyroid disease (75.16%) and daily sun exposure was limited to 1 hr or less for most patients (43.14%). Their melasma was mostly malar in distribution (60.13%), epidermal (61.44%), and mild (51.63%) to moderate (27.45%) in severity. The average mMASI score was 4.63 + 3.32. CONCLUSION Prevalence of melasma was low among the Philippine dermatology patients sampled. Majority of the melasma patients were Filipinos, aged 41-50 years old, with Fitzpatrick skin type IV, limited sun exposure and no thyroid disease. They were mostly females, with a prior history of pregnancy. Their melasma was mostly malar, epidermal, and mild in severity. These descriptive data can serve as baseline information for further studies on melasma in the Philippines.
Philippines

Background: Human Immunodeficiency Virus (HIV) infection/Acquired Immunodeficiency Syndrome (AIDS) remains a major challenge worldwide. Physicians have a crucial role in the struggle against HIV/AIDS and must be equipped with proper knowledge, attitude and practices (KAP). No study has been done to assess the KAP of dermatologists related to HIV-AIDS. Objective: The study’s objective was to determine the KAP of Philippine Dermatological Society (PDS) members related to HIV/AIDS. Methods: A cross-sectional study was done among PDS members from February to November 2017 utilizing a questionnaire consisting of socio-demographic questions and KAP questions related to HIV. Results: Out of 210 participants, 71.43% show good working knowledge, 60.95% show negative attitudes, 55.71% show bad practices related to HIV/AIDS. Members aged 29 to 37 years old, having worked as dermatologists for 1 to 8 years, and having worked in the health care sector for 1 to 8 years have better working knowledge on HIV/AIDS. Although with lesser duration of work as dermatologist, these members have more positive attitudes towards HIV/AIDS. These findings may be attributed to greater exposure to HIV cases and better ability to access information by internet among younger dermatologists. Gender is not significantly associated with KAP related to HIV/AIDS. Practice related to HIV/AIDS is not significantly associated with any demographic variables. Bad working knowledge related to HIV/AIDS is associated with negative attitude and bad practices. This can be attributed to insufficient training in the field of HIV/AIDS. Conclusion Majority of PDS members show negative attitudes, bad practices, but good working knowledge related to HIV/AIDS.
HIV ; Acquired Immunodeficiency Syndrome ; Knowledge ; Attitude ; Dermatologists

Introduction: Atopic dermatitis (AD) is a complex disease with an interplay of genetic and environmental factors. In the United States, AD affects 10.7% of children andyc 7.2% of adults. Similarly in the Philippines, the prevalence of AD is 12.7% in the under 18 population, and 2% in the over 18 population. While AD affects all ages, the burden of the disease is greater in the pediatric population. The pathogenesis of AD is multifactorial. Variations in genes responsible for epidermal barrier function, keratinocyte terminal differentiation, and the innate and adaptive immune responses have been linked to AD. A null mutation involving the filaggrin gene is the strongest known risk factor for AD. This mutation results in a loss of filaggrin (FLG) protein by at least 50%. Filaggrin breakdown products form part of the natural moisturizing factor (NMF) of the skin, which is essential in skin hydration. A decrease in NMF and an increase in transepidermal water loss (TEWL) are observed in AD patients with FLG mutation. The defective barrier in AD patients decreases skin defenses against irritation and allergen penetration. Exposure to certain environmental chemicals like formaldehyde may worsen this barrier. This may lead to increased skin permeability to aeroallergens that leads to dermatitis in sensitized patients. Barrier defects may also play a role in epicutaneous sensitization and the subsequent development of other atopic conditions, such as bronchial asthma and allergic rhinitis. The Philippine Dermatological Society (PDS) consensus on AD aims to provide a comprehensive guideline and evidence-based recommendations in the management of this condition, with consideration of cultural factors that are often encountered in the Philippine setting. These guidelines are intended to provide practitioners with an overview of the holistic approach in the management of AD, ameliorating the negative effects of the disease and improving overall quality of life.. Methodology: A group of 21 board-certified dermatologists from the Philippine Dermatological Society (PDS) convened to discuss aspects in the clinical management of AD. Database and literature search included the full-text articles of observational studies, randomized controlled clinical trials, and observational studies using the Cochrane library, PubMed, Hardin (for Philippine based studies) as well as data from the PDS health information system. The terms used in combinations from the literature included “atopic dermatitis”, “atopic eczema”, “emollients”, “topical corticosteroids”, “topical calcineurin inhibitors”, “anti-histamines” and “phototherapy”. A total of fifty (50) full text articles were reviewed and found applicable for the scope of the study. Articles were assessed using the modified Jadad scale, with score interpretations as follows: (5- excellent, 3- good, 1– poor). Consensus guidelines for AD from within and outside of the region were also reviewed, from the 2013 Asia-Pacific guidelines, 2014 Taiwanese Dermatological Association consensus, 2016 guidelines in the management of AD in Singapore, 2014 American Academy of Dermatology guidelines, and the 2020 Japanese guidelines for AD. From the literature review, proposed consensus statements were developed, and a Delphi survey was conducted over two separate virtual meetings. Individual dermatologists provided Likert Scoring (1- strongly disagree to 5- strongly agree) based on consensus statements. A consensus was deemed reached at mean scores of > 4.00, a near consensus at > 3.5, and no consensus at <3.5. Summary: AD is a chronic relapsing condition with a significant burden of disease, most commonly affecting the pediatric population. The PDS AD Consensus Guidelines summarizes the standards of therapy and the therapeutic ladder in the management of AD based on published clinical trials and literature review. While these modalities remain the cornerstone of therapy, an individualized approach is the key to the holistic management of an AD patient. Knowledge and awareness of frequently associated conditions, whether in the realm of food allergies, contact allergies, or secondary infections, is paramount. In addition to the standard therapeutic armamentarium, the physician must also consider cultural practices and be knowledgeable of alternative therapeutic options. Referral to a specialist is recommended for recalcitrant cases of AD, or when initiation of systemic immunosuppressive agents, phototherapy, or biologic agents is contemplated.