A 45-year-old female came to our clinic due to multiple pustules on her fingers. The lesions first appeared when she was 15 years old, starting as a few erythematous macules on her left thumb that eventually developed into painful pustules. The patient claimed that no relief was provided by analgesics and oral antibiotics. Over the next 11 years, the lesions on her left thumb gradually spread to all her fingers including those on her right hand, accompanied by the development of erosions, fissures, and scales, as well as intermittent joint pains and swelling. These symptoms remained unresponsive to multiple topical products, the names of which the patient could not recall. At 24 years old, the patient experienced onycholysis in the first to third digits of her left hand, which progressed to anonychia and eventually affected all the fingers in her left and right hands. When the patient was 38 years old, similar pustules, erosions, fissures, and scaling appeared on several toes. Due to increasing discomfort from lesions spreading to her toes, making it difficult to put on footwear, the patient sought consultation at our dermatology clinic. No symptoms related to pulmonary, gastrointestinal, and genitourinary systems were reported. The patient denied pain or immobility in other joints of her right hand, hair or scalp changes, and oral mucosal lesions. There was no family history of psoriasis, hypertension, peripheral arterial diseases, or other conditions with similar lesions. The patient denied any history of cigarette smoking, chronic alcohol intake, or illicit drug use. On physical examination, the patient appeared comfortable with no signs of distress. We observed multiple erythematous pustules, some coalescing into pus-filled lakes, and thick white hyperkeratotic plaques with scales located on the distal interphalangeal joints, extending to the tips of all digits on both hands. Similar pustules and plaques with scales were seen on the first metatarsophalangeal joint of the right foot and the first digit of the left foot, sparing only the patient’s palms and soles (Figure 1). Anonychia affected all fingers, and there was shortening of all digits on both hands. No hair changes, oral mucosal lesions, or lymphadenopathies noted. The rest of the physical examination findings were unremarkable. Based on the history and clinical findings, we initially assessed the patient as having a form of acropustulosis. Differential diagnoses included infections (e.g., herpetic whitlow, staphylococcal felon, candidal paronychia), which were ruled out due to finger involvement and lack of systemic symptoms. Malignant conditions (e.g., squamous cell carcinoma, acrometastasis) were excluded from the differential diagnoses due to the absence of other typical indicators like trauma, chronic paronychia, exposure to radiation or arsenic fumes, a history of cigarette smoking, or a primary tumor.1 2 Inflammatory conditions (e.g., dyshidrotic eczema, chronic hand contact dermatitis) were also ruled out due to the lack of prominent pruritus, burning sensation, and exposure to common irritants.3 4 Immune-mediated conditions (e.g., palmoplantar pustulosis, palmoplantar psoriasis) were considered but eventually ruled because the patient's lesions did not involve her palms and soles.4 At the time of our evaluation, the patient had normal results in hematology, lipid panel, and liver and kidney function tests. Radiography of the hands showed shortening of the distal phalanges on the first to third digits on both hands, good alignment of osseous structures, intact outlines and trabecular patterns, and normal joint spaces and soft tissue shadows. These findings are consistent with brachydactyly, frequently observed in cases of psoriasis manifesting with dactylitis. Gram stain of the pustules yielded negative results. Histopathology from a skin punch specimen taken from an erythematous plaque on the third digit of the left hand showed focal parakeratosis overlying a spongiotic epidermis with hypogranulosis and psoriasiform hyperplasia. The dermis showed superficial dermal edema and moderately dense perivascular inflammatory infiltrates composed predominantly of lymphocytes and some neutrophils (Figure 1). The final histopathologic impression was psoriasiform dermatitis, ruling out other possible differential diagnoses, including infectious, malignant, and inflammatory conditions. Given the histopathologic consistency with psoriasis, coupled with the clinical presentation of multiple pustules on the tips of the digits and nail changes, the clinicopathologic final diagnosis was acrodermatitis continua of Hallopeau. We initiated oral methotrexate at 10 mg/week for 3 weeks, followed by an increase to 15 mg/week for 7 weeks, reaching a cumulative dose of 135 mg. The patient also received oral folic acid 5 mg daily on days without methotrexate and topical clobetasol propionate 0.05% ointment applied twice daily with occlusion at night. We provided counseling and education about the chronic nature of her condition, emphasizing the need for follow-up every 3 to 6 months. Most pustules resolved, and no new lesions were observed during the tenth week of treatment. No adverse events were reported, and erythema and scaling were significantly lessened. Acrodermatitis continua of Hallopeau (ACH) is a rare form of localized pustular psoriasis characterized by recurrent chronic eruptions of sterile pustules, especially affecting the distal regions of the fingers and toes, and occasionally the nail beds.4 5 The pathophysiology remains poorly understood, but a few authors attribute it to mutations in the interleukin-36RN gene.6 7 8 Diagnosis of ACH can be established based on clinical features. Histopathologic examination and laboratory tests may be helpful in difficult cases, but they are not necessarily performed in all patients.4 6 9 ACH is associated with a wide range of differential diagnoses including infectious paronychia of viral, bacterial, or fungal etiology, dishydrotic eczema, and infected contact dermatitis.4 10 11 Rarely, osteitis and osteolysis of the phalanges may occur in persistent or severe cases.4 6 12 Due to its chronic and relapsing nature, long-term therapeutic control of ACH is necessary to prevent complications.<13 Cirone et al> ACH is recalcitrant to available therapies, with no clear management guidelines or drugs achieving lasting remission.5 Progression to severe disease with irreversible complications is common, and even with treatment, ACH often recurs, affecting patients' physical and psychological well-being.

Background: Allergic contact dermatitis (ACD) is a common skin inflammatory reaction occurring at the site of challenge with a contact allergen in sensitized individuals and one of the most common causes for consultation in dermatology clinics. Patch testing is a method for detecting the causative component in suspected cases of ACD. Awareness about the causative allergen aids in reducing morbidity and can significantly minimize the impact of ACD in the affected people. Objectives: The study aimed to measure the number of relevant positive reactions in patch tests being performed in our institution in patients with ACD to cosmetic products. Methods: A total of 60 patients who were diagnosed with ACD to cosmetics and underwent patch testing were reviewed to identify the clinico‑epidemiological and patch test profiles of these patients. Results: The study showed that the mean age of patients was 42 comprising mostly of females. Most of the patients were unemployed, office workers, and medical workers. The most common cosmetic products that caused ACD include soaps, shampoos, lotions, and moisturizers. Nickel is still the most tested positive among these patients, followed by fragrance mixes and 4‑phenylenediamine base. They are widely distributed in cosmetic products, especially in soaps and lotions. The pattern of dermatitis revealed facial dermatitis to be the most common reason for consult of these patients. Conclusion Patch test is valuable in the setting of establishing the etiology of ACD to cosmetic products.
Dermatitis, Allergic Contact ; Cosmetics ; Patch Tests

Erythema elevatum diutinum (EED) is a rare, chronic leukocytoclastic vasculitis characterized by erythematous to violaceous plaques and nodules, typically on extensor surfaces like the hands, elbows, and knees. It results from immune complex deposition in blood vessels, leading to inflammation and fibrosis. EED is often associated with infections, autoimmune disorders, or hematologic malignancies, but can also occur idiopathically. Although globally documented, EED is extremely rare in the Philippines, particularly in adolescents, highlighting its significance in local literature.

A 14-year-old Filipino female presented with a 5-month history of asymptomatic, skin-colored papules on her right elbow, gradually spreading to both elbows and knees, with occasional mild pruritus and knee joint pain. Past medical and family history were unremarkable. After temporary relief from an unrecalled cream prescribed by a private dermatologist, she was referred for skin punch biopsy, which revealed spongiotic epidermis with papillary dermal edema, moderate inflammatory infiltrates, eosinophilic inclusion bodies, and nuclear dusts surrounding the blood vessels, consistent with EED. The patient was treated with dapsone 50 mg/day, clobetasol propionate ointment twice daily for two weeks, and cetirizine 10 mg as needed for pruritus, resulting in clinical improvement.

This case highlights the extreme rarity of EED in the Philippines, particularly in adolescents. It emphasizes the need to consider EED in chronic papular eruptions and demonstrates the effectiveness of dapsone and topical steroids in managing the condition. Early diagnosis and timely intervention are crucial for preventing disease progression and improving patient outcomes, as seen in this case.

Cutaneous metastases are uncommon dermatologic manifestations, occurring in 0.7–0.9% of cancer patients. They typically originate from malignancies of the breast, lung, or gastrointestinal tract, with only a few reported cases arising from malignant cardiac tumors. Herein, we present a rare case of cutaneous metastasis from a primary cardiac myxofibrosarcoma (MFS). Based on available literature, this is the first documented case in the Philippines.

A 26-year-old man presented with rapidly enlarging nodules on the mandible and left thigh following the early recurrence of a previously excised cardiac myxoma. A biopsy of the skin lesions demonstrated a bottom-heavy distribution of atypical spindle cells in a myxoid stroma, raising suspicion of either a primary spindle cell neoplasm or cutaneous metastasis. This prompted a multidisciplinary investigation into the underlying malignancy. Histopathology and immunohistochemical staining of both the cardiac mass and skin lesions confirmed a diagnosis of cardiac MFS with cutaneous metastasis. The aggressive nature of MFS, combined with the presence of metastasis and the patient’s decision to decline further treatment, led to rapid clinical deterioration and ultimately, death.

Cutaneous metastasis from cardiac tumors is exceedingly rare and difficult to diagnose given the paucity of reported cases. This case highlights the pivotal role of dermatologists in recognizing these dermatologic manifestations, prompting further investigation into the underlying malignancy. Dermatologists must maintain a high index of suspicion when evaluating skin lesions of patients with a history of malignancy, given the significant treatment and prognostic implications.

BACKGROUND

Skin diseases and mental disorders are often correlated. However, the prevalence of this association among outpatients is not well-documented, especially in the Philippines. This study investigated the complex relationship between skin conditions and potential mental disorders, aiming to enhance patient care through a more comprehensive, integrated treatment approach.

To determine the relationship between skin diseases and probable mental disorders among outpatients seen at the dermatology department of a tertiary government hospital in the Philippines.

This descriptive, cross-sectional study included 298 participants. Socio-demographic and clinical profiles were gathered, and a validated screening tool was used to identify probable mental disorders. Analytical statistics were employed to assess the relationship between socio-demographic and clinical profiles, skin diseases, and symptoms suggestive of a mental disorder.

The study results revealed no significant association between specific skin diseases and mental disorders. However, significant correlations were noted between certain sociodemographic and clinical factors—such as employment status, residence, educational attainment, birth order, disease severity, and disease duration—and the presence of probable mental disorders.

The results emphasized the critical role of clinical and sociodemographic factors in determining mental health outcomes in dermatology settings. Incorporating mental health screenings into standard dermatological care enables healthcare providers to greatly improve patient outcomes, providing a more comprehensive and holistic treatment approach.

Background and Objective: A positive family functionality is a significant factor to a good quality of life in the elderly. This study sought to determine the factors that contribute to family dysfunction among community-dwelling older persons. Methods: A cross-sectional study was done among community-dwelling elderly ages 60 years old and above through the outpatient department of a tertiary government hospital. A researcher-assisted interview was done to gather socio-demographic factors such as age, sex, family type, and, GDS-S score, and family APGAR. Multiple linear regression analysis was done to determine the association of the said socio-demographic factors and likelihood of depression through GDS-S with family function through family APGAR. Results: Among the 309 respondents, the average age of respondents was 69 years(SD=6.53), with female predominance of 61.8%, and a higher frequency of older persons belonging to an extended family. The mean GDS-S score is 1.69(SD=1.83), with a frequency of 13.9%. A very minimal percentage of 8.06% (25, N=309) showed to exhibit family dysfunction. Regression studies revealed association of advancing age, and female sex with family dysfunction. The type of family, and GDS-S are not significantly associated with family dysfunction. Conclusion Advancing age and female sex are associated with family dysfunction. There is no specific family type that is significantly associated with family dysfunction. Likelihood of depression does not necessarily imply family dysfunction in an elderly.
Elderly

Intraosseous hemangioma is a benign, rare neoplasm that accounts to 0.5 - 1% of all benign tumors of bones.1, 2 While most hemangiomas arise from soft tissues, it is uncommon for it to arise from bones.2 The most common sites of growth are in the vertebral body and the calvarium with frontal bone making up approximately 45% of calvarial cases.2,3 However, they are also encountered in the head and neck with sites such as the skull (53%), mandible (10.7%), nasal bones (9%), and cervical spine (6%).4 In the mandible, the body is mostly affected and 65% are found in the molar and premolar region.1 They are more common in adult females with peaks at the second and fifth decades of life.1-3 Hemangioma of the mandible is difficult to diagnose due to its nonspecific clinical presentation and radiographic features. It mimics various mass lesions in the mandible such as giant cell granuloma, fibrous dysplasia, multiple myeloma, osteosarcoma, ameloblastoma and keratocysts. Therefore, a comprehensive history taking and physical examination plus examination of the imaging studies available and tissue biopsy all play important roles in arriving at the final diagnosis.5 We present the case of an aggressive mandibular hemangioma in a young boy and our management involving a failed fibular free flap reconstruction.
Sirolimus ; Sirolimus

Background::Endoscopic bariatric therapies can help address widening management gaps in obesity. Their ability to facilitate weight loss is largely tied to influences on appetite through perturbations of gastric emptying and accommodation. As these tools gain traction in obesity therapy, their physiologic underpinnings require exploration, which may enhance efficacy, tolerance, and patient-tailored care.Methods::We prospectively assessed consecutive subjects with fluid-filled intragastric balloons (IGBs) ( n = 18) placed between October 2016 and June 2017 or underwent endoscopic sleeve gastroplasty (ESG) ( n = 23) from March 2018 to June 2018. Patients underwent physiologic appraisal at 3 months with 13C-spirulina-based gastric emptying breath test to determine time to half emptying (T50), as well as maximum tolerated volume (MTV) of a standard nutrient drink test. Changes in T50 and MTV at 3 months were compared with percent total body weight loss (%TBWL) at 3 and 6 months using best-fit linear regression. Results::The change in T50 at 3 months correlated with %TBWL at 3 months for IGB ( P = 0.01) and ESG ( P = 0.01) but with greater impact on %TBWL in IGB compared to ESG ( R2 = 0.42 vs. 0.26). Change in T50 at 3 months was predictive of weight loss at 6 months for IGB ( P = 0.01) but not ESG ( P = 0.11). ESG was associated with greater decrease in MTV compared to IGB (340.25 ± 297.97 mL vs. 183.00 ± 217.13 mL, P = 0.08), indicting an enhanced effect on satiation through decreased gastric accommodation. Changes in MTV at 3 months did not correlate with %TBWL for either IGB ( P = 0.26) or ESG ( P = 0.49) but trended toward significance for predicting %TBWL at 6 months for ESG ( P = 0.06) but not IGB ( P = 0.19). Conclusion::IGB and ESG both induce weight loss but likely through distinct gastric motor function phenotypes, and gastric emptying may predict future weight loss in patients with IGB.

Introduction: Chronic kidney disease-associated pruritus (CKD-aP) remains a frequent and distressing symptom in hemodialysis patients, fur- ther compromising their quality of life. Turmeric, or Curcuma longa, is a naturally-occurring, widely available product that inhibits major inflamma- tory mechanisms associated with CKD-aP. Objectives: This study aimed to determine the efficacy and safety of turmeric 1% emollient cream versus a bland emollient in the reduction of chronic kidney disease-associated pruritus in hemodialysis patients. Methods: This study was a randomized, double-blind, controlled trial of the effect of turmeric 1% cream in the reduction of chronic kidney disease associated pruritus in hemodialysis patients compared to a bland emollient. The main outcome measure was the proportion of subjects who demonstrated response to treatment, as well as the incidence of adverse effects. Results: Intention to treat analysis on 106 patients, 53 assigned to turmeric 1% cream and 53 to bland emollient cream, was done. There was a sig- nificant difference (P=0.03) in the proportion of patients who achieved treatment success between the turmeric group (66%) and bland emollient group (45%). The mean decrease in pruritus score (VAS) of the group treated with turmeric was significantly greater than that of the bland emol- lient group (P=0.018). No adverse effects were noted in both groups. Conclusion Among hemodialysis patients diagnosed with CKD-aP, topical application of turmeric 1% cream twice daily for four weeks was supe- rior to that of bland emollient cream based on efficacy and safety outcome measures.
Curcuma ; Renal Dialysis

Telehealth has become an alternative service delivery of different healthcare professionals, including occupational therapists, upon the onset of the COVID-19 pandemic. Occupational therapists have adapted to this platform to deliver service in response to the global crisis. This conceptual framework explores the facilitators of occupational therapy evaluation provided via telehealth. It aims to provide insights to clinicians and clients in engaging tele-evaluation. It also aims to establish primary considerations to ensure a thorough evaluation process. The Tele-Evaluation Facilitators Model (TFM) describes the occupational therapy evaluation in the therapy setting. It outlines the OT evaluation process, adapting it to the telehealth setting. The process emphasizes the importance of client-caregiver interaction in creating and achieving occupational therapy goals. Moreover, surrounding the tele-evaluation process, the model highlights the facilitators of tele-evaluation, enabling a comprehensive evaluation process despite the challenges and barriers of this alternative service delivery. Across practice settings, the COVID-19 pandemic necessitated a shift in service delivery to telehealth, and occupational therapists adapted accordingly. Evaluation frameworks exist for telehealth services, but none are unique to occupational therapy evaluation. As a result, an occupational therapy framework that highlights the facilitators of telehealth evaluation will benefit occupational therapy. TFM consists of three domain areas: (1) Family Involvement, (2) Accessibility, (3) Professional Development. This framework promotes telehealth evaluation to clinicians and clients who have hesitations and difficulties in this service delivery model.
Telemedicine ; Occupational Therapy