OBJECTIVE: To investigate the different treatment modalities employed for melasma by practicing dermatologists in the Philippines. BACKGROUND: Melasma is a prevalent skin condition among Filipinos due to our skin type and climate. To date, no local studies have been done investigating the different treatment regimens practiced/ employed by Filipino dermatologists in treating melasma. METHODS: This is a descriptive study investigating the different treatment strategies used by Filipino dermatologists using a questionnaire.The questionnaires were given to practicing Filipino dermatologists personally during conferences and conventions held in 2005 as well as to the different Philippine Dermatological Society accredited training institutions and private clinics of the doctors. The total sample size was 117. RESULTS: Melasma is frequently seen among Fitzpatrick skin type IV (50%),females, 41-50 year-old age group (50%) and commonly on the cheeks (98%). Grade 2 severity melasma was often seen by 75% of the respondents. The top 3 topical depigmenting agents of choice are tretinoin, hydroquinone and combination therapy. Microdermabrasion was preferred by 43.5% of the respondents over laser. Once combination treatment regimens fail, laser treatment more than doubled to 28.7%. Vitamin C (37.7%) and glutathione (31.6%) are the most common oral maintenance therapy given by the respondents. Half of all the respondents advise continuous maintenance therapy while a third of them advise maintenance for a year. The most common side effect of melasma treatment is erythema according to 51% of the respondents followed largely by hyperpigmentation (23%) and scaling (22%). More than half of the dermatologists surveyed stop the treatment regimen when side effects are observed. Almost all respondents advise patients to use sunblock daily and majority of respondents prescribe both UVB and UVA sunblocks.

Human ; Female ; Ascorbic Acid ; Cheek ; Dermatologists ; Erythema ; Glutathione ; Hydroquinones ; Hyperpigmentation ; Melanosis ; Philippines ; Skin Lightening Preparations ; Sunscreening Agents ; Surveys And Questionnaires ; Tretinoin

BACKGROUND

Psoriasis is a chronic, incurable inflammatory disease that often frustrates patients and negatively impacts quality of life, affecting treatment satisfaction.

OBJECTIVE

This study evaluated treatment satisfaction, medication adherence, and dermatological quality of life in Filipino patients with plaque-type psoriasis.

METHODS

Ninety-five patients at a tertiary dermatology clinic completed surveys using the Treatment Satisfaction Questionnaire for Medications (TSQM 1.4), Morisky Medication Adherence Scale-4 (MMAS), and Psoriasis Disability Index (PDI). Disease severity was measured using the Psoriasis Area Severity Index (PASI).

RESULTS

Patients reported moderate to high treatment satisfaction, medium medication adherence, and minimal quality of life impairment across all treatments. Convenience satisfaction was significantly correlated with educational attainment. Satisfaction with effectiveness and convenience was strongly linked to medication adherence, while overall satisfaction was tied to disease severity. Additionally, satisfaction with side effects was significantly related to quality of life.

CONCLUSION

All three treatment modalities remain vital for managing psoriasis in low- resource settings. Emphasizing medication side effects, treatment convenience, and their impact on quality of life can foster a more patient-centered approach.

Human ; Psoriasis ; Quality Of Life ; Personal Satisfaction ; Treatment ; Therapeutics

BACKGROUND

Striae distensae are common disfiguring atrophic dermal scars. Fractonal lasers have been utilized to improve the appearance of this condition.

OBJECTIVES

To compare the efficacy and safety of picosecond fractional 1064-nm Nd:YAG (PS Nd:YAG) laser versus fractional 10,600-nm Carbon Dioxide (CO2) laser in treating abdominal striae alba (SA).

METHODS

Thirty-two women with Fitzpatrick skin types III-V and abdominal SA participated in a split-abdomen study, receiving four sessions of fractional PS Nd:YAG and CO2 laser treatments on each side at four-week intervals. Striae texture, atrophy, clinical improvement, and satisfaction were assessed for each side at one and three months, with striae length and width compared pre- and post-treatment. Adverse reactions were noted at each visit.

RESULTS

Abdomen treated with both lasers had significantly improved skin texture, atrophy and clinical improvements (assessed by physicians and patients) at both follow-ups (p < 0.05), with no difference between the two. Striae length and width did not change significantly (p = 0.203 and p = 0.558). Patients reported greater improvement on the CO2-treated side at 1 month, but not at the final follow-up. High satisfaction was noted for both lasers. Adverse reactions noted after both lasers include erythema, edema, crusting/scaling, pruritus, pain and post-inflammatory hyperpigmentation. The PS Nd:YAG laser was associated with greater pain (p < 0.05), but shorter healing time of 10.26 days.

CONCLUSION

Both fractional PS Nd:YAG and CO2 lasers were effective, well-tolerated and safe treatment options for SA.

Lasers ; Striae Distensae

BACKGROUND

Pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are rare, chronic autoimmune blistering diseases primarily treated with systemic glucocorticoids. Long-term use of glucocorticoids can result in significant adverse effects, leading to the exploration of steroid-sparing adjuvants. This meta-analysis aimed to evaluate the efficacy and safety of glucocorticoids alone versus in combination with adjuvants for treating PV and PF.

OBJECTIVE

The main objective of this study was to compare the efficacy and safety of oral glucocorticoids alone versus with steroid-sparing adjuvants in treatment of PV and PF.

METHODS

This research was a systematic review and quantitative meta-analysis of randomized controlled trials (RCTs) that compared systemic glucocorticoids with or without steroid-sparing adjuvants in treating PV and PF. A total of 20 RCTs were included after meeting the inclusion criteria, comprising 1169 patients diagnosed with PV or PF. Primary outcomes were remission rates, while secondary outcomes included relapse rates, disease control, and the occurrence of adverse events.

RESULTS

Studies involving rituximab and cyclophosphamide demonstrated significantly higher remission rates compared to other adjuvants or glucocorticoid monotherapy. Adverse events were common, particularly with high-dose glucocorticoids.

CONCLUSIONS

The meta-analysis found that rituximab and cyclophosphamide were superior steroid-sparing adjuvants in the treatment of PV and PF. Other adjuvants, such as azathioprine and mycophenolate mofetil, also showed efficacy but had a higher incidence of adverse events. Further studies were needed to optimize treatment protocols and reduce long-term complications.

Meta-analysis ; Pemphigus ; Pemphigus Foliaceus ; Pemphigus Vulgaris

Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive dermal and subcutaneous mesenchymal neoplasm that often presents as a slow-growing lesion on the trunk, proximal extremities, head and neck. We report a rare case of DFSP arising on the dorsum of the left hand. A 35-year-old male, who presented with a solitary verrucous nodule on the dorsum of the left hand and had experienced two recurrences of the lesion following local excision and electrocautery. Histopathologic examination was consistent with DFSP. CD34 immu-nostain was positive. Wide surgical excision with a three centimeter margin and direct skin closure was done. Although metastasis is rare, DFSP is associated with marked tendency towards local recurrence after surgery hence patient is for follow-up every six to twelve months post operatively.
Dermatofibrosarcoma

Atrophoderma of Pasini and Pierini (APP) is an idiopathic disorder of dermal atrophy, presenting as round or oval depressed lesions most commonly observed on the trunk and extremities. Herein, we report the first case of APP initially appearing on the head. Histopathologic examination of lesional skin demonstrated a decrease in elastic fibers. Serologic tests for Borrelia and antinuclear antibody titers were negative. There was no noted improvement after 6 weeks tretament with Hydroxycholoroquine 200 mg/tab BID. Definitive disease etiology and treatment of APP remains to be elucidated.