BACKGROUND

With the utility of nail dermoscopy to supplement the diagnosis of onychomycosis, studies have been done in describing common findings. However, most of these were based in Europe and the Americas. Given the geographical variation of onychomycosis, a local study is needed.

OBJECTIVE

The general objective of this cross-sectional study is to determine the different patterns among the clinical subtypes of laboratory diagnosed onychomycosis patients seen at the Philippine General Hospital (PGH).

METHODOLOGY

Clinically suspected Filipino onychomycosis patients seen at the PGH - Department of Dermatology, and at the PGH inpatient wards were recruited. All patients underwent the following: direct KOH microscopy, fungal culture studies, and nail clipping with PAS staining.

RESULTS

A total of 75 samples were included; 93.33% of the samples were categorized as DLSO subtype, 5.33% as TDO, and 1.33% as PSO. The three most common onychoscopic patterns were subungual hyperkeratosis (93.33%), chromonychia (85.33%), and longitudinal striae in 81.33%. KOH was positive in 57.33% of the cases, cultures in 38.67% and PAS stain in 80%. Onychoscopic pattern was not associated with clinical type of onychomycosis and causative organism. Negative KOH result was associated with linear edges (p=0.02).

CONCLUSION

Among patients with clinical and laboratory diagnosed onychomycosis, linear edges and jagged proximal edges were associated with negative KOH microscopy and fungal CS, respectively. Hence, in situations where such examinations are negative despite a strong clinical suspicion of onychomycosis, the above onychoscopic findings can be used for empirical diagnosis.

Human ; Culture ; Onychomycosis ; Potassium Hydroxide

A 32-year-old Filipino male managed as a case of acute myeloid leukemia presented with a 6-month history of generalized, red-brown papules. After chemotherapy, the patient was advised 30-minutes daily sun exposure as a form of natural phototherapy. On follow-up, most lesions flattened. This case demonstrates chemotherapy’s potential role in controlling the patient’s inflammatory state and using ultraviolet light therapy in the form of sunlight to manage generalized purpuric lichen nitidus.
Lichen Nitidus ; Dermoscopy ; Phototherapy

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