BACKGROUND: In vitro studies reported the antifungal activity of Zingiber officinale (ginger) rhizome extract against certain dermatophytes and Candida albicans. However, no in vivo studies had been made.
OBJECTIVES: (1) To determine in vitro the antifungal activity of commercially prepared ginger rhizome powder against common dermatophytes and Candida albicans.
(2) To determine the Minimum Inhibitory Concentration (MIC) of commercially prepared ginger rhizome powder against Trichophyton rubrum and Candida albicans.
(3) To compare the efficacy and safety of ginger 25 mg/g cream versus ketoconazole (Nizoral) 20mg/g cream on patients with tinea.
METHODS: Patients (n=24) with tinea corporis or tinea cruris were randomly allocated to two groups. They were instructed to apply either ginger or ketoconazole cream twice daily on lesions for eight weeks. Follow-up consultations were done every two weeks for a total of eight weeks. Photographs, KOH and recording of parameters (erythema, papules, scaling and pruritus) per lesion were used as outcome measures. An investigator's global response assessment was done at the end to determine the improvement of each lesion.
RESULTS: The disk diffusion method revealed that Trichophyton mentagrophytes,Trichophyton rubrum and Candida albicans were inhibited by the ginger powder at 2 mg/10?L. The MIC for C. albicans as 12.5 mg/ml and 25 mg/ml for T. rubrum. The age, gender distribution, and the severity index of the two treatment groups were comparable at baseline. There were significant improvements in erythema, papules, pruritus and scaling scores of patients in each group across different time points (Friedman's ANOVA p<0.05), with significant differences between the two groups noted during the initial observation periods (Wilcoxon p50% and >95% conversion rate to negative KOH at the fourth and eighth week of treatment for the ginger group respectively, while 100% conversion to negative KOH was noted at the second week of treatment for ketoconazole. One patient in the ginger group experienced increased erythema, pruritus and thickness of her lesions during the second week of treatment and the medication was discontinued.
CONCLUSION: While ketaconazole 20mg/g cream treatment resulted in faster clearance of fungal lesions, ginger 25mg/g cream yielded progressive improvement of tinea corporis and tinea cruris when used over an eight week period. Ginger cream may be an affordable alternative antifungal treatment. Future studies using a higher concentration and larger sample size are recommended although a possible case of contact dermatitis is seen using 25mg/g ginger cream.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Adolescent ; Antifungal Agents ; Candida Albicans ; Dermatitis, Contact ; Erythema ; Ginger ; Ketoconazole ; Microbial Sensitivity Tests ; Pruritus ; Tinea ; Trichophyton

Human ; Female ; Aged ; Paget Disease, Extramammary ; Tinea ; Vulvar Neoplasms ; Salicylic Acid ; Buttocks ; Hyphae ; Spores ; Itraconazole

INTRODUCTION: Referrals are the link between primary and specialty care. While the referring provider can be any type of physician, the focus in the literature has been on primary care physicians (PCPs). In their area of expertise, specialists are able to provide evidence-based care, and several studies have shown that specialists’ co-management of care with PCPs results in better health care outcomes for patients with chronic diseases. METHODOLOGY: The research design used was cross-sectional. A validated self-made questionnaire was disseminated to the family physicians (FPs) who are active members of the Philippine Academy of Family Physicians (PAFP) from the National Capital Region (NCR). RESULTS: Majority of FPs refer to dermatologists and more than half are affiliated with a hospital. Twenty percent had dermatology training which was not specified, and 44.2% took continuing medical education/seminars in dermatology. The top 3 most common dermatological diseases among the top ten existing dermatological diseases from January to December 2014 seen at the 11 accredited training institutions of the Philippine Dermatological Society (PDS) ranked by FPs as seen in their private practice were contact dermatitis, atopic dermatitis and acne vulgaris. The primary reason for referral of FPs to a dermatologist was for “treatment” and “difficult cases.” Average referral frequency within a month was two times while within a year it was more than five times. The criteria for choosing a particular dermatologist were good medical skill, geographic consideration and good FP-dermatologist communication. For the manner of referral, majority referred through letter, followed by phone calls and text messages. There were 53.8% FPs who were satisfied with the quality of communication with the dermatologists. Few FPs encountered difficulties in referring patients such as unavailability of the dermatologist, patient’s financial constraints, patient’s refusal, and the patient not being referred back to the primary physician by the dermatolo-gist. According to 68.6% of FPs, their patients followed-up after referral to a specialist. CONCLUSION The existing referral system among FPs and dermatologists, based on the study parameters, is generally properly implemented at the NCR. However, further studies should be done to determine the current state of referral system in the rural areas, where further health care management is needed, due to the unavailability of specialists like dermatologists.

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.