Human ; Male ; Child: 6-12 Yrs Old ; Linear Iga Bullous Dermatosis ; Immunoglobulin A ; Skin Diseases

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.

Human ; Female ; Adolescent: 13-18 Yrs Old ; Adolescent ; Erythema Elevatum Diutinum ; Leukocytoclastic Vasculitis

Background: Skin metastases are rare yet crucial indicators of advanced disease. They can mimic various skin conditions, making them challenging to diagnose. Aims and Objectives: To investigate the incidence rate of biopsy-confirmed cutaneous metastasis and explore the clinical presentation, workup, and diagnostic techniques for skin metastases Materials and Methods: Local study involving comprehensive laboratory tests, pathological examination, and immunohistochemistry to identify primary tumors and confirm diagnoses. Results: Nodules were the most common manifestation of skin metastases, particularly in breast carcinoma. The chest wall and abdomen were frequent sites of involvement. Pathological examination and immunohistochemistry played a critical role in confirming diagnoses, revealing various histopathologic patterns. Immunohistochemical markers assisted in determining tumor origin but required careful interpretation. Monitoring tumor behavior over time provided insights into nature and origins. Conclusion Comprehensive workups including laboratory testing, pathology, and immunohistochemistry are essential for accurate diagnosis and management of skin metastases. Careful monitoring of tumor behavior can provide valuable information about its nature and origins.
Diagnosis

The concept of “precision medicine” has been a mainstay in discourses about the future of medicine, although it was not until the completion of the Human Genome Project that genetic associations to Mendelian diseases have risen dramatically. Since genetic variations in most (85%) monogenic or oligogenic diseases reside in exons, whole-exome sequencing (WES) serves as a pivotal tool in the identification of causative variants in genodermatoses and other diseases, leading to efficient and timely diagnosis. Here, we share our current diagnosis protocol for genodermatoses using WES as a first-tier solution. Two cases are presented to demonstrate the process of identifying germline variants and one case for a somatic variant. In the first case, a germline missense mutation in COL7A1 (exon73:c.G6127A) was identified for a patient that presented with clinical symptoms of dystrophic epidermolysis bullosa (DEB). Immunofluorescence study revealed decreased collagen VII expression in the dermal-epidermal junction. In case 2, we detected a germline missense mutation in KRT16 (exon1:c.374A>G) in a patient with palmoplantar keratoderma (PPK) and congenital pachyonychia. Sanger sequencing and segregation analysis confirmed the variant detected in WES. For case 3, a patient with linear nevus comedonicus was found to have a somatic missense mutation in NEK9 (exon4:c.500T>C), which was only detected in the lesional DNA sample. Thus, WES shows great potential as a diagnostic tool for monogenic or oligogenic genodermatoses. Since omics is a technology-driven tool, we expect that reaching precision medicine is ever closer.
Precision Medicine

The new era of molecular diagnostics has provided new insights in both routine clinical work and research in hereditary epidermolysis bullosa (EB). Several different approaches and techniques have provided significant advantages in terms of diagnostic accuracy, predict- ing prognoses, clarifying the pathogenesis, and developing new therapies. In many developing countries, however, modern laboratory techniques remain inaccessible. Therefore, a practical diagnosticmatrix has been developed to predictthe diagnosis and subtype of EB. In thisreview,we highlight themolecular and practicaltechniquesin diagnosing hereditary EB.
Epidermolysis Bullosa

Background: Turmeric demonstrated anti-inflammatory properties in laboratory and clinical studies that suggest its usefulness in psoriasis. This is the first randomized controlled trial comparing the efficacy and safety of turmeric 1% cream to clobetasol propionate 0.05% cream in the treatment of plaque-type psoriasis. Objectives: To determine the efficacy and safety of turmeric 1% cream versus that of clobetasol propionate 0.05% cream in the treatment of plaque-type psoriasis. Methods: This was a randomized, double-blind clinical trial to determine the proportion of patients with clinical remission. Secondary outcomes namely mean PASI and pruritus scores per visit, time to remission and incidence of adverse effects were also determined. Results: Fifty-nine patients were randomized into two groups: a turmeric (n=30) and a clobetasol (n=29) group. After four weeks of treatment, there was no significant difference (p=0.36) in the proportions of patients with clinical remission in the turmeric group (5/20, 25%) and the clobetasol group (8/23, 35%) (RR 1.15, 95% CI 0.78-1.70). The average time to achieve clinical remission was 4 weeks in the turmeric group and 3.38 ± 1.06 weeks in the clobetasol group (p=0.07). There was no significant difference in post-treatment mean PASI scores in turmeric (8.77 ± 5.71) and clobetasol (7.26 ± 6.04) groups (p=0.40). Post-treatment mean pruritus scores in turmeric (6.9 ± 2.83) and clobetasol (5.83 ± 3.87) groups (p=0.30) were also statistically comparable. Two patients in the clobetasol group developed folliculitis. Conclusion Turmeric 1% cream demonstrated comparable efficacy and safety with clobetasol 0.05% cream in the treatment of mild to moderate plaque-type psoriasis.
Curcuma ; Clinical Trial

Introduction: Cutaneous protothecosis usually presents as pyoderma-like lesions or infiltrating papules and plaques on the extensor side of the extremities. It can be misdiagnosed as eczema, pyoderma, or a fungal infection. Although it has been isolated from a swimming pool, sewers and rivers in the Philippines, there has been no reported case of cutaneous protothecosis in the country. Case summary: A 78-year-old Taiwanese male farmer visited the dermatology clinic due to a six-month history of a large, pruritic erythematous plaque studded with papulopustules on his left forearm. A potassium hydroxide (KOH) examination showed negative for hyphae or spores. And a skin biopsy showed morula-like bodies, which were highlighted by the Periodic acid-Schiff stain. Conclusion We report a case of cutaneous protothecosis from Taiwan so Filipino dermatologists will be aware of the clinical and histopathologic manifestations and management of cutaneous protothecosis.
Skin Diseases, Infectious ; Administration, Cutaneous

Background: The Psoriasis Registry (PsorReg) was created by the Psoriasis Foundation of the Philippines with the goal of assessing the true magnitude of psoriasis in Davao City. Objectives: To determine the demographic and clinical profiles of Filipino patients enrolled in PsorReg. Methods: Cross-sectional study among adult patients enrolled in PsorReg. Results: A total of 131 patients were included in the study. Mean age was 43.89 ± 15.8 years old. Chronic plaque psoriasis (96.2%) was the most common clinical pattern. 63.4% had nail involvement, while 35.1% had psoriatic arthritis. BMI was normal in 51.1% of patients. Common co-morbidities were hypertension (19.1%), diabetes (10.7%), and dyslipidemia (9.2%). Most common treatment were topical medications, while biologics were the least common. 42.7%, 49.6% and 37.4% had moderate psoriasis using BSA, PASI, and PGA, respectively. Majority (47.3%) reported a large effect of psoriasis on their quality of life. Conclusion This study determined the demographic and clinical profiles of adult Filipino patients registered in PsorReg in Davao City.
Psoriasis ; Registries ; Philippines ;

BACKGROUND: Systemic sclerosis (SSc) is a rare, connective tissue  disease  with  multisystem involvement.This is due to immunological processes,vascular endothelial cell injury  and extensive activation of fibrolast that commonly affects the skin and other internal organs such as the esophagus, lungs, heart, and kidneys. SSc has one of the highest mortality among  the  autoimmune  rheumatic  diseases,  hence  the  emphasis  on  the  early  recognition  and  management  to  prevent significant progression of the disease.
CASE: A 22-year-old  female  presented  with  a  one-year history of multiple hard and hypopigmented patches on the face, neck, trunk and upper extremities. Further examination revealed mask-like facies, microstomia, frenulum sclerosis, Raynaud's phenomenon, pitted scars on the digital pulp of hands  and  sclerodactyly.Baseline  blood  chemistry,chest radiograph and electrocardiography  were  all  negative  for systemic involvement. Autoantibodies were positive for dsDNA, SS-A/Ro and Scl-70. Skin biopsy revealed sclerosing dermatitis, which was consistent with SSc.
OUTCOME: The  patient  was  initially  started  with  oral prednisone 0.5 mg/kg/day and was increased to 0.75 mg/kg/day for eight weeks. Prednisone was slowly tapered to 5.0 mg/day and methotrexate 15.0 mg/week was included in  the  management for eight weeks which resulted in decreased joint pains, halted the progression of skin induration, decreased in pruritus and palmar edema.
CONCLUSION: The characteristic dermatological findings of SSc are not only important signs to dermatologists, but these serves as diagnostic clues for clinicians from other disciplines as well. In our case, the presence of the autoantibody Scl-70 indicated the potential risk of pulmonary fibrosis and pulmonary arterial hypertension that accounts with high mortality.Hence,physicians should be aware of the possible risk of organ damage,even when asymptomatic because there is a high risk of disease progression. The importance of early recognition and a multidisciplinary approach lead to the good outcome in this case.

Human ; Female ; Adult ; Autoantibodies ; Prednisone ; Methotrexate ; Cicatrix ; Microstomia ; Sclerosis ; Raynaud Disease ; Pulmonary Fibrosis ; Hypertension, Pulmonary ; Edema ; Rheumatic Diseases ; Scleroderma, Systemic ; Scleroderma, Diffuse

BACKGROUND: Ultraviolet radiation is a major modifiable risk factor for aging and skin cancer. Studies assessing knowledge, attitudes and practices towards sun exposure and protection should be conducted on high-risk groups like the triathlete community.
OBJECTIVES: To assess the knowledge, attitudes, and practices regarding sun exposure and protection among triathletes in Manila, Cebu and Davao City. To determine if these are associated with demographic characteristics, and if knowledge and attitudes are correlated with protective practices.
METHODS: This was a cross-sectional study conducted among adult triathletes evaluating their knowledge, attitudes and practices concerning sun exposure and protection, using a self-administered e-questionnaire.
RESULTS: There were 120 respondents. Almost half of the respondents had inadequate knowledge scores, while majority (83%) had desirable attitudes. Having at least a college degree significantly increased the odds ratio of having a desirable attitude (OR 6.0, 95% CI 1.36-26.45). Only 37.5% of the participants practiced good sun protection. Triathletes with Fitzpatrick III phototype had significantly increased odds ratio of having adequate sun protection practices (OR 2.22; 95% CI 1.04-4.72), while higher socioeconomic status was associated with poor protection practices (OR 0.42, 95% CI 0.19-0.90). Only 32.5% of the participants had adequate KAP scores combined.
CONCLUSION: Even though more than half of the respondents had limited knowledge scores, most of them had desirable attitudes towards sun protection. Athletes with adequate knowledge and desirable attitude were more likely to exhibit adequate practice. These findings indicate the pressing need for public health strategies on sun protection for the triathlete community.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Athletes ; Attitude ; Demography ; Odds Ratio ; Philippines ; Public Health ; Risk Factors ; Skin Neoplasms ; Social Class ; Sunburn ; Ultraviolet Rays