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Code Red: Redefining Emergency Dermatology

Continuing Medical Education

by Janina Eliza T. Poa, M.D.

The Department of Dermatology of the St. Luke’s Medical Center, in partnership with the Laser Subspecialty Core Group of the Philippine Dermatological Society, recently conducted a Continuing Medical Education (CME) which focuses on an uncommon but troublesome problem – dermatologic emergencies. Aptly entitled, “Code Red: Redefining Emergency Dermatology,” the event was held at the St. Luke’s Medical Center Global City Henry Sy Sr. Auditorium last August 24, 2016.

This activity was moderated by Dr. Mia Angela C. Verzosa. The program started with an echo on the recently held 2016 Asian Dermatologic Laser and Surgery (ADLAS) Conference by the head of the PDS Laser Subspecialty Core Group, Dr. Ma. Pilar L. Leuenberger. This was followed by Dr. Lei Anne Michelle Hernandez who presented her cross-sectional study with Dr. Lourdes Anna Nebrida-Idea, on cases of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) in St. Luke’s Medical Center.

Two dermatologic emergency cases were discussed. The first case presented by Dr. Krizia Camille Ty (2nd year resident) dealt with generalized pustular psoriasis and its management. Dr. Deanna Ramiscal gave a reaction to the case and presented the recent evidence of managing cases with this condition. The next case, presented by Dr. Kathryn Anne Cembrano (1st year resident), was a case of toxic epidermal necrolysis in a 27 year old patient managed with IV corticosteroids. The reactor was Dr. Michelle Joy De Vera, a pediatric allergologist/immunologist who shared her experience and updates regarding other treatment options for SJS/TEN including intravenous immunoglobulin (IVIG) and Infliximab.

The forum served as a wonderful opportunity to be updated on the latest evidence for managing dermatologic emergencies and a good avenue for sharing one’s clinical experience and expertise

Treatment options for generalized pustular psoriasis (GPP) depend on the extent of involvement, severity of presentation and patient’s underlying risk factors.

First line therapies for GPP include Acitretin and Methotrexate for chronic stable disease while Cyclosporine and Infliximab are preferred for severe acute attacks.

Systemic steroids may be given in severe attacks but must be used together with the other recommended therapies for GPP in short courses and tapered accordingly.

The cornerstone of treatment for epidermal necrolysis remains to be early recognition and prompt withdrawal of the offending drug.

Beyond supportive care, there are no established therapies for SJS/TEN; however, there has been some evidence for the use of immunosuppressive or immunomodulating therapies such as IVIG at a dose of 1g/kg/day for 3 consecutive days in the early phase of the disease.