Human ; Writing ; Artificial Intelligence

BACKGROUND

Psoriasis is an increasingly prevalent chronic disease commonly treated with topical corticosteroids (TCS), although these agents are often misused. There is a need to explore the factors influencing nonadherence to TCS among patients with psoriasis in the Philippines. This study aimed to determine the knowledge, attitude, and practice (KAP) regarding TCS among Filipino patients with psoriasis.

A cross-sectional survey was conducted on 76 Filipino patients with psoriasis at a tertiary hospital using a constructed validated questionnaire.

Patient scores clustered at the upper end of the distribution, indicating a generally good level of KAP regarding TCS. Increasing age was associated with a lower level of knowledge, while female respondents had a higher level of knowledge. Higher knowledge levels were associated with better patient attitude, and better patient attitude was associated with better practice.

Predictors of correct KAP regarding TCS are less likely influenced by sociodemographic and clinical factors; rather, these three domains significantly correlate with each other. Physicians can utilize these interrelationships by educating patients regarding their topical treatment to yield more positive attitudes regarding its efficacy and minimize their fear of side effects, which can motivate them to adhere to prescribed therapy.

BACKGROUND

Skin cancer is the most common cancer in fair-skinned populations. Ultraviolet (UV) radiation exposure is the most common and important modifiable risk factor. It is the target of most prevention strategies for cutaneous malignancies. Currently, data on knowledge, attitude, and practices (KAPs) of bikers on UV index in relation to sun protection are unavailable.

The objectives of this study were to develop a validated questionnaire, determine the demographic characteristics of bikers, and describe their KAPs on UV index in relation to sun protection.

The study was conducted among bikers at the outpatient department of a tertiary hospital, through a self-administered questionnaire. Patients included were occupational and/or recreational bikers, aged 18 years old and above, belonging to both sexes, biking at least 15 min per day, who were able to understand written English or Filipino. Exclusion criteria included bikers who have skin cancer.

One hundred and twenty-eight bikers were able to answer the validated questionnaire, with mostly male respondents, college graduates, with internet or social media as the source of information for knowledge on sun exposure and sun protection. One hundred and two of them know that forecasts of UV index from weather app on the phone are free and readily available. However, only 59 of them check the UV index regularly as a guide for sun protection.

Forecasts of UV index raise the awareness and alert the public to the need for sun protection to reduce skin cancer risk and modify health promotion and primary prevention strategies.

In 1963, Rowellet al. described a syndrome combining lupus erythematosus (LE) and erythema multiforme (EM)-like lesions. In this report, we present a 15-year-old female who presented with both systemic LE and EM-like skin lesions meeting all of the major and one of the minor criteria for a diagnosis of Rowell syndrome. Her condition improved with administration of systemic and topical corticosteroids, and hydroxychloroquine. Rowell Syndrome, a rare entity, is often debated as a coincidental overlap of other conditions according to Bonciolini,et al.[1]In light of Rowell Syndrome's infrequency and the paucity of available literature, we emphasize the clinical significance of recognizing this challenging condition.

Overlap syndrome is a rare condition involving the coexistence of at least two distinct autoimmune diseases, such as systemic lupus erythematosus and systemic sclerosis. This condition has limited studies on epidemiology probably because it is often under-recognized. We present a 22-year-old Filipino female with a 10-month history of hyperpigmented patches on the malar surface and extremities, with associated photosensitivity, fatigue, pallor, arthralgia, and oral ulcers, and positive antinuclear antibody titer. She was treated with oral Prednisone in tapering doses, leading to clinical improvement. Eight months later, there was a recurrence of hyperpigmented patches on the face and extremities with skin tightening and diffuse hair loss, development of shiny skin with facial fold loss, a beak-like nasal appearance, and episodes of dyspnea and malaise. Consistent with scleroderma, the patient was started on mycophenolate mofetil (MMF) 500 mg daily, with close monitoring for disease progression and systemic involvement. Overlap syndrome remains under-recognized due to its variable presentation and rarity. Treatment is individualized based on the specific connective tissue diseases involved and the patient’s symptoms. Multidisciplinary care is crucial for timely management and to adjust treatment as needed, given the potential for life-threatening complications involving cutaneous and internal organs.

Mammary Paget’s disease (MPD) is a rare form of intraepithelial adenocarcinoma occurring in the apocrine gland-bearing areas in patients older than 50 years old. This clinical disease presents as erythematous, scaly plaque that usually affects the unilateral nipple or areola and is frequently misdiagnosed as inflammatory or infectious dermatitis. In this report, we are presented with a 54-year-old Filipino female who came in with a 3-year history of persistent pruritic erythematous moist plaque on the right nipple gradually spreading to the surrounding areola previously treated as a case of fungal infection. Mammography revealed BI-RADS 4C. Skin punch biopsy showed nuclear atypia with pale staining cytoplasm and were consistent with MPD. Immunohistochemical stains showed positive for epithelial membrane antigen and carcinoembryonic antigen. We reiterate the importance of early diagnosis for appropriate treatment to prevent unwanted sequelae.

Tufted angioma (TA) is a rare, benign, vascular neoplasm of the skin. The diagnosis of this condition is infrequent due to its rare occurrence. Only 158 cases have been described as of 2015. The treatment reported in the literature is very limited with no clear guidelines on its management. Currently, there are no reported cases in the Philippines of TA treated with aspirin. This is a case of a 1-year-old Filipino boy presenting with multiple dusky red papules and plaques on the left side of the cheek, pre- and postauricular areas, parieto-occipital areas, chest, and upper back. His lesions started at 2 months of age, noted to increase in size, number, and thickness over time. Dermoscopy revealed homogenous erythematous background with perifollicular lacunae separated by thin septa. Histopathology revealed dilated vessels in the papillary dermis with proliferation of endothelial cells in lobules, surrounded by dilated crescent-shaped vascular channels in the dermis. The patient was treated with low-dose aspirin (5 mg/kg/day) once a day for 1 month with improvement. After 4 months from treatment, no new lesions, no increase in size, nor symptoms were noted. Low-dose aspirin is an effective and safe option for monotherapy of TA in pediatric patients.

Leukocytoclastic vasculitis (LCV) is a histopathologic descriptor for a prevalent type of small-vessel vasculitis (SVV) that affects arterioles, capillaries, and postcapillary venules. Although the association between vasculitis and malignancy only accounts for <5% of vasculitis cases, it has been recognized as a true paraneoplastic syndrome in several studies. A 57-year-old Filipino male presented with erythematous, nonblanching macules on his lower extremities, which rapidly progressed to violaceous lesions on his trunk, buttocks, and lower extremities. He also reported significant weight loss, decreased appetite, and vomiting. A skin biopsy confirmed LCV. Initially treated for meningococcemia, his condition did not improve. Abdominal imaging revealed an enlarged heterogeneous liver with retroperitoneal lymphadenopathy and a parenchymal nodule. He was eventually diagnosed with vasculitis secondary to an underlying hepatic malignancy and expired later from multiorgan failure.

Unilateral rosacea is a rare type of rosacea that affects only one side of the face. Limited literature exists on this condition which resembles classic rosacea with persistent erythema, papules, or pustules but shows an unusual asymmetric pattern. The cause is unclear though localized triggers or vascular differences may be involved, complicating diagnosis due to similarities with other conditions.

This is a case of a 42-year-old male who presented with a 4-year history of few ill-defined erythematous patches topped with yellowish papules on the right side of his face and neck. On initial consult, he was noted to have a history of prolonged esun exposure. A skin punch biopsy was done and revealed basal layer hyperpigmentation, pigment incontinence and lymphohistiocytic cell aggregates in the dermis, consistent with granulomatous dermatitis. There was no Demodex infestation. Based on clinical and histopathological data, the diagnosis was unilateral rosacea. Treatment in this case included topical Azelaic Acid cream and frequent sunscreen application along with physical photoprotection, avoidance of unnecessary and prolonged sun exposure.

First reported in 1989 by Shelley et al., unilateral rosacea is underreported, making it challenging to estimate its prevalence. It affects middle-aged adults and can be confused with other unilateral skin conditions. However, no specific data or large-scale studies have been dedicated solely to unilateral cases and it may be mistaken for other unilateral skin conditions making the diagnosis challenging. Treatment generally follows the rosacea protocols like topical therapies, oral medications and lifestyle modification.

INTRODUCTION

Oral isothretinoin is the treatment of choice in moderate to severe acne vulgaris. The most common adverse effect is mild mucocutaneous symptoms and the most seious risk is related to teratogenecity. Hyperuricemia and gouty arthritis are rarely associated with isotretinoin therapy.

We report a case of a 26-year-old female patient with no known comorbidities who was started on isotretinoin therapy for acne vulgaris. The patient presented with baseline hyperuricemia with no joint pains or swelling. Two and a half weeks later after initiation of isotretinoin therapy, the patient developed pain and swelling on the left wrist, hence was started on urate-lowering medications and maintained on isotretinoin tharapy. The patient had no recurrence of joint pains and remains symptom-free for six months later.