Occupational skin diseases is one of the top occupational diseases, and the most common form is contact dermatitis accounting for 90%. In healthcare workers, allergens most commonly identified are preservatives, excipients in cleansers, antiseptics and rubber accelerators. Contact dermatitis has a major impact in performance at the workplace and overall quality of life. Allergen avoidance is the cornerstone of management of contact dermatitis, and this poses a challenge to those exposed in the workplace.

A 31-year-old female nurse, with no known comorbidities, presented with several-years history of on-off episodes of pruritic, scaly plaques on the hands that would occasionally have fissures with associated 8/10 pain. She sought consult with several physicians, diagnosed as non-specific eczema, and was prescribed topical steroids and antihistamines with partial improvement. Due to the recurrence of the lesions, an 83-allergen patch test was done. There was a +2 reaction to carba mix noted as erythematous, indurated papules and plaque with pinpoint crusts. A definite relevance was identified since the patient works as a nurse with regular use of rubber gloves. The patient was diagnosed with allergic contact dermatitis, and advised measures to avoid exposure to the allergen.

Carba mix contains diphenylguanidine, zinc dibutyldithiocarbamate and zinc diethyldithiocarbamate, and can be found in rubber products such as gloves. Healthcare workers, especially nurses, are constantly exposed to this allergen since gloves are part of the standard and basic personal protective equipment. This case outlines the impact of patients’ occupation to their overall health.

Human ; Female ; Adult: 25-44 Yrs Old ; Carbamix ; Dermatitis, Contact ; Eczema

BACKGROUND: To date, no multicenter studies have been conducted on the prevalence and clinical profile of AD in the Philippines. Since AD is one of the top 10 skin diseases seen in the outpatients departments of all the Philippine Dermatologic Society (PDS)- accredited institutions, conducting a multicenter study provides important epidemiological information about this disease and serve as a valuable reference for future studies.

OBJECTIVES: To determine the prevalence and clinical profile of patients with atopic dermatitis (AD) seen at the outpatient departments (OPD) of Philippine Dermatological Society (PDS) - accredited training institutions from 2007 to 2011.

METHODS: Records of patients with a diagnosis of AD seen from January 1, 2007 to December 31, 2011 were retrieved and clinical data were collected.

RESULTS: There were 744,673 dermatological consults in the 10 PDS-accredited outpatient clinics from 2007-2011. A total of 4,275 records of atopic dermatitis were reviewed for this study. The prevalence of atopic dermatitis was determined to be 0.57%. Most institutions reported a prevalence rate of less than 1% except for St. Luke's Medical Center (3.36%), and Research Institute for Tropical Medicine (7.07%). More than half of the patients (65.1%) were children between 1 to 12 years old. Twenty-four percent (24%) were infants less than one year. The average age was seven years old while the youngest was one month and the oldest was 94 years old. There were more females (56.1%) than males (42.75%). Bronchial asthma was the most prevalent co-morbid medical condition. Majority of AD patients seen in institutions were newly diagnosed. Those with previous consultations were mostly seen by dermatologists and pediatricians. Moisturizers and topical corticosteroids were the most commonly used topical preparation while antihistamines followed by oral antibiotics were the commonly prescribed oral medications. Follow-up rate was low.

CONCLUSION: The prevalence of atopic dermatitis among the 10 PDS-accredited institutions is low except for SLMC and RITM. The clinical profile of patients is consistent with published literature. However, this study revealed the patient follow-up is low. This practice needs to be addressed since optimal management of this chronic disease requires close and regular follow-up to prevent complications and irrational drug use.

Human ; Male ; Female ; Multicenter Study ; Prevalence ; Patients ; Dermatology

BACKGROUND: Nail dystrophy is relatively common condition that may be idiopathic or may have associated conditions such as twenty-nail dystrophy, psoriasis, onychomycosis and verruca vulgaris. A pathophysiologic mechanism shared by these disorders is inflammation. Treatment of nail dystrophy is difficult, because non-response of these underlying conditions to conventional treatment is commonly encountered. Pulsed dye laser (PDL) targets vascular structures, consequently diminishing inflammation and stimulating tissue remodeling, accounting for its potential benefit in the resolution of nail dystrophy.
OBJECTIVE: To describe  the clinical response of patients with nail dystrophy, due to any cause, to treatment with PDL.
METHODS: This was a retrospective chart review of 28 patients with nail dystrophy, due to any cause in whom, PDL was done at the Dermatology Center of the St. Luke's Medical Center Quezon City from 2002 to August 2013 with or without concomitant medications. Positive response was described as visualization of new normal nail growth, subjective note of improvement of nails and smoothening and thinning of nails. Quality of life, in terms of associated pain, tenderness and cosmetic  disfigurement , was also assessed.
RESULTS: A total of 21 out of 28 (75%) patients demonstrated a positive response to PDL in terms of visualized new normal nail growth with or without concomitant conventional treatment . This was generally observed after the third session of PDL, with sustained improvement among those who continued treatment. Furthermore, these patients reported improved quality of life in terms of decreased pain and better cosmetic appearance with PDL>
CONCLUSION: PDL may be a significant adjunct in the treatment of nail dystrophy, particularly in terms of enhancing response to conventional treatment modalities. It is safe, non-invasive treatment option particulary for patients who have been recalcitrant to conventional medications.

Human ; Male ; Female ; Cosmetics ; Dermatology ; Inflammation ; Lasers, Dye ; Nail Diseases ; Nails ; Nails, Malformed ; Onychomycosis ; Pain ; Psoriasis ; Quality Of Life ; Retrospective Studies ; Warts

INTRODUCTION: Cosmetic intolerance syndrome is a condition attributed to multiple exogenous and endogenous factors.m Although considered a wastebasket diagnosis by some, it has proven to be a highly challenging, if not frustrating, condition for both the dermatologist and the patient. It is believed to be quite common, but underreported.
CASE SUMMARY: A 22-year-old Filipino woman presented with a 2-year history of recurrent facial redness and itching. Flare-ups of social symptoms and signs are associated with the application of cosmetics. Exacerbations have also been perceived to occur with the intake of bread, milk chocolate, cheese and shrimp, as well as handling of coins. The patient also has comedonal acne for which she has been using various topical anti-acne medications, such as benzoyl peroxide and tretinoin. She has a history of seborrheic dermatitis, allergic contact dermatitis (ACD) due to jewelry, and chronic hand dermatitis. She has a personal and family history of atopy. Diagnostic patch test was performed using the 70-allergen series. Reading after 48 hours revealed strong reactions to fragrance mix, formaldehyde, nickel sulfate, benzoyl peroxide, and thimerosal. Given the recurrent nature of facial tightness, discomfort, erythema and pruritus, noted to increase in severity with application of various cosmetics, the documentation of the above allergies, and the concomitant presence of atopy, acne vulgaris, and seborrheic dermatitis, the diagnosis of cosmetic intolerance syndrome is made.
CONCLUSION:Increasing awareness and recognition of cosmetic intolerance syndrome is important. Controlling concurrent endogenous conditions, together with correct identification of exogenous triggers, as well as patient education on avoidance and substitution of culprit substances, are the cornerstones to successful management of this challenging condition.

Human ; Female ; Young Adult ; Acne Vulgaris ; Allergens ; Cosmetics ; Dermatitis, Allergic Contact ; Dermatitis, Seborrheic ; Erythema ; Patch Tests ; Pruritus ; Thimerosal ; Tretinoin

Bullous systemic lupus erythematosus (BSLE) is a rare subset of systemic lupus erythematosus (SLE). We present a case of a 48-year-old hypertensive Filipino man, whose initial manifestation of SLE is a vesiculo-bullous eruption, possibly triggered by intake of irbesartan+hydrochlorothiazide with negative findings on anti native double stranded (ds) DNA, anti-Sm, anti-ribonucleoprotein (RNP), antiRo/SSA and anti-La/SSB, J0-1 antibody, antibody to histone and Scl 70 antibody but with persistently elevated anti-nuclear antibody (ANA) titers. Our patient fulfilled 3 out of 4 of Megahed's BSLE criteria which include: 4 of the American Rheumatism Association (ARA) criteria, skin punch biopsy and direct immunofluorescence (DIF), confirming our diagnosis. He responded well to corticosteroid and dramatically to dapsone. BSLE should be included as a differential diagnosis in bullous disorders and may be a presenting disorder of undiagnosed systemic lupus erythematosus.

Human ; Male ; Middle Aged (a Person 45-64 Years Of Age) ; Adrenal Cortex Hormones ; Antibodies, Antinuclear ; Biopsy ; Biphenyl Compounds ; Dna ; Dapsone ; Diagnosis, Differential ; Fluorescent Antibody Technique, Direct ; Histones ; Hydrochlorothiazide ; Lupus Erythematosus, Systemic ; Rheumatic Diseases ; Ribonucleoproteins ; Tetrazoles ; United States

Patch Tests