BACKGROUND

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

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).

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.

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.

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

Hailey-Hailey Disease (HHD) is a rare, chronic skin condition characterized by relapsing episodes and spontaneous remissions, significantly affecting patients’ quality of life, especially in severe cases. Due to its rarity, there are no established evidence-based treatment guidelines or extensive clinical trials. This case report highlights the rapid improvement of HHD in a 55-year-old Filipino woman treated with a combination of 5-fluorouracil and excimer phototherapy, suggesting that this treatment approach may be an effective alternative for managing the disease.

Cutaneous squamous cell carcinoma (cSCC) is one of the most common skin cancers, with an increasing incidence worldwide. Chronic sun exposure is a major risk factor and lesions are usually seen on sun-exposed areas such as the face, neck, scalp, and hands. Imiquimod cream, an immune response modifier, has shown promising results in the management of SCC.

A 70-year-old, Filipino male presented with 3-year history of a slow growing erythematous plaque on the abdomen. Physical examinaPon done showed a solitary, well- defined, erythematous plaque measuring 5cm on the leR lower quadrant of the abdomen. Histopathologic examination revealed SCC. In an initial attempt to decrease the size of the tumor, Imiquimod 5% cream 2x a week was initiated. However with continuous use for 24 weeks the patient achieved complete clinical resolution which was confirmed with biopsy.

This case report showcases imiquimod cream as a valuable therapeutic option for giant (5cm)cutaneous squamous cell carcinoma, offering a non-surgical alternative with promising outcomes. This treatment approach has the potential to expand the management options for cSCC and benefit patients who may not be suitable candidates for conventional surgical excision.

INTRODUCTION

Allergic contact dermatitis remains a commonly encountered condition in dermatology. Contact allergen prevalence fluctuates over time, making ongoing surveillance essential for detecting trends and identifying emerging allergens.

To determine the prevalence and trends of top allergen patch test-positive patients over a 10-year period.

The medical records of 906 patients who underwent patch testing at the hospital between 2012 and 2021 were retrospectively reviewed. Clinical data and patch tests results with clinical relevance from consultation records were extracted and analyzed.

In the 10 years, data from 996 patients patch tested with European baseline series of contact allergens were analyzed. The overall positivity rate was 64.25%. The predominant allergens investigated during the previous decade include nickel sulfate (19.60%), fragrance mix I (8.70%), potassium dichromate (5.99%), cobalt chloride (5.92%), and p-phenylenediamine base (5.92%). The trend in our study aligns with global patch test data, with nickel sulfate consistently leading as the most frequent allergen.

The study emphasizes the need for regular monitoring and updating of the standard patch test series to ensure its clinical relevance and improve patient care.

BACKGROUND

Postpartum abdominal laxity is a growing concern for women. Noninvasive options like microwave technology and fractional carbon dioxide (CO2) laser show promise, but their combined efficacy and safety require further investigation.

To compare the efficacy and safety of microwaves versus combined microwaves and fractional CO2 laser in the treatment of postpartum abdominal laxity among Filipino patients.

Thirty-two patients with Fitzpatrick skin type III-V and postpartum abdominal laxity received three microwaves sessions, with one side randomly assigned an additional fractional carbon dioxide laser session (designated as side B, while the other as side A). Global aesthetic improvement scale (GAIS) scores and patient satisfaction (PS) scores were determined at every follow-up. Baseline and completion body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) were taken, and adverse effects were recorded.

Significant improvements in GAIS and PS scores were noted for both sides across all sessions, with side B showing superior scores post-CO2 laser. These improvements were attributed to epidermal thickening and dermal collagen and elastin remodeling, the latter seen histologically in a representative patient. Adverse effects were mild and noted only with CO2 laser.

The combined use of the microwaves system and fractional CO2 laser is safe and well-tolerated and is superior to microwaves alone in the treatment of postpartum abdominal laxity.

In recent years, there has been a significant global increase in skin cancer incidence, which continues to pose a significant challenge to public health. This retrospective study aimed to comprehensively characterize the epidemiology of histopathologically diagnosed skin cancers at the Department of Dermatology, Jose R. Reyes Memorial Medical Center from January 2013 to December 2022. The research encompassed an analysis of demographic and clinical profiles in 352 cases. The cases consisted of basal cell carcinoma (BCC) (161, 46%), squamous cell carcinoma (SCC) (62, 18%), melanoma (21, 6%), mycosis fungoides (MF) (37, 11%), other cutaneous T-Cell lymphomas (11, 3%), mammary Paget’s disease (7, 2%), extramammary Paget’s disease (6, 1.7%), Langerhans cell histiocytosis (LCH) (8, 2%), sebaceous carcinoma (3, 1%), Merkel cell carcinoma (MCC) (1, 0.3%), dermatofibrosarcoma protuberans (1, 0.3%), angiosarcoma (2, 0.6%), Kaposi sarcoma (3, 0.9%), and cutaneous metastasis (29, 8%). Among the primary cutaneous malignancies, BCC, SCC, MF, and melanoma were the most frequently encountered types. The findings reveal a notable upward trend in all skin cancer incidence, and projections suggest a continued increase in the next five years. BCC and SCC were more common in males and affected predominantly sun-exposed areas, while melanoma exhibited a slight female preponderance and primarily affected the lower extremities (acral melanoma). These skin cancers were more common among elderly individuals. The study highlights the need for standardized documentation to improve data quality on epidemiology. This, in turn, can lead to improved early detection, prevention, and better management of this escalating global public health issue.

Poroid hidradenoma is a rare adnexal neoplasm that presents with slow‑growing solitary dermal or subcutaneous nodules with pink, red, or blue coloration. Malignant transformation has been reported in about 1%; however, clinical and histologic characteristics may present similarly with malignant neoplasms. A 60‑year‑old, Filipino, female presented with a 1‑month history of a solitary, brownish‑black papule on the right cheek progressing to a translucent friable nodule with associated bleeding after minimal trauma. The patient was initially assessed as a case of basal cell carcinoma due to its rapid growth. Hence, the patient was referred to a dermatologic surgeon for biopsy. Poroid hidradenoma was confirmed histologically and was managed with local excision. Poroid hidradenoma presenting with rapid growth is a very rare occurrence.
Neoplasms

Introduction: Basal cell carcinoma (BCC) is the most common type of malignancy worldwide. The incidence of BCC is positively associated with increasing age; thus, centenarians, defined as those aged 100 years and above, become a vulnerable population to developing malignancy. As a person ages, risk factors such as chronic sun exposure, ionizing radiation, and immunosuppres- sion induce mutations that contribute to tumor formation. Impaired DNA repair capacity in response to carcinogens and immune function dysfunction also increases BCC risk in the elderly. Currently, studies among centenarians with high-risk basal cell car- cinoma treated with surgical interventions are limited. Case report: Presented herewith is a case of a 101-year-old female with a 15-year history of hyperpigmented, hyperkeratotic plaque over the right malar area and a one-year history of progressive pain (PS 10/10) and enlargement of the lesion, forming an ulcerated, hyperpigmented tumor. Laboratory workup showed normal findings. Histopathology was signed out as a pigmented nodulocystic basal cell carcinoma. Moh’s micrographic surgery (MMS) and cheek advancement flap were performed with good wound healing and no perioperative complications. Conclusion Despite the limited options of medical and physical management due to decreased life expectancy of centenar- ians, MMS remains the standard of therapy in high-risk BCC. MMS with reconstructive surgery is generally a safe and effective modality with no increased risk of peri- and post-operative complications.
Carcinoma, Basal Cell ; Centenarians

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.