East Avenue Medical Center Department of Dermatology and Skin Center
by Karlo Edwin R. Balisi, MD
The East Avenue Medical Center (EAMC) Department of Dermatology successfully led a continuing medical activity on pediatric dermatology entitled “CUTIS PEDIATRICA: A Two Part Pediatric Dermatology Case Conference” last October 26 and November 9, 2020 with a total of 330 and 320 attendees respectively from across the Philippines and even neighboring ASEAN countries. The course primarily aimed to sharpen clinical and theoretical knowledge and skills of both Dermatologists and Pediatricians in managing dermatologic cases in the pediatric age group. The CME activity was held online and was spearheaded and moderated by Dr. Wilsie Salas-Walinsundin, FPDS.
Part I: Soft, Supple, and Scary
The first part of the case conference was entitled: Soft Supply and Scary: Approach to Neonatal Skin Lesions. Dr. Gemmy David, a second year Resident, presented a case series of three commonly encountered conditions in neonates at the OPD and ward such as scabies, neonatal acne, and benign neonatal cephalic pustulosis. Dr. Camille Tuazon, DPDS then gave a concise lecture on Neonatal Dermatology covering the different Common Neonatal Dermatoses and their similarities and differences. Miliaria, Erythema Toxicum Neonatorum, Transient Neonatal Pustular Melanosis, Neonatal acne, Neonatal Cephalic Pustulosis, Acropustulosis of Infancy and Scabies were the cases presented. Dr. Tuazon ended her lecture by saying that many of the neonatal dermatoses are benign and self limiting. Therefore, it is very important for dermatologists and other health care professionals to educate and reassure the parents and guardians of the nature of these skin diseases. For the other skin diseases needing treatment such as scabies, safe management options should be initiated and not delayed.
Dr. Jewel Gonzales proceeded to present the second case series of Langerhan Cell Histiocytosis (LCH) and was followed by a case of Urticaria Pigmentosa (UP) by Dr. Donnelyn Priela. The reactor for both case presentations was Dr. Gisella Adasa, FPDS. She discussed a brief history on diagnosing and the types of LCH and then focused on the different treatment regimens for the different types and stages of LCH. She also gave details as to the different approaches in diagnosing and treating patients with UP. She further elaborated on the different classic signs and clinical presentations of UP and emphasized that a high clinical suspicion backed by physical examination and diagnostics are needed to catch cases of LCH and UP.
The Open Forum explored primarily the treatment options for the cases. Questions raised included the use of newer medications for LCH lesions like Imiquimod which has been reported in some journals to have an effect after 3 months of treatment. Ketotitfen’s side effect of sedation was also discussed in light of treatment for UP. Likewise, further work-up for cases were discussed such as infectious etiology work-up for neonates and their mother when presenting with vesicles at birth and the possibility of progression of LCH lesions into a systemic disease; hence close monitoring is of prime importance.
Part II: The Growth Chart
Dr. Rouslia Alfaro, a second year Dermatology Resident, delivered the first of the case series for the second part entitled: THe Growth Chart: Skin Conditions in the Growing Child. In a presentation entitled: Creepin’ it Real: Psoriasis in the Pediatric Population, three cases of the representative papulosquamous disease in children aged 2, 11 and 18 years old were presented. It was shortly followed by a thorough case reaction of Dr. Nina A. Gabaton, FPDS. She focused on topics such as prevalence and incidence of psoriasis in the pediatric population, different screening tools and treatment options in managing these cases and the different challenges in utilizing biological treatment and phototherapy especially during this time of the pandemic. Dr. Gabaton also presented recent guidelines on how to proactively look after the overall health of children with Psoriasis. She ended her lecture by emphasizing that the best treatment option should be tailored to the patient’s unique case and personal risk factors and that the decision to treat should be a shared decision.
Dr. Precious Imam, a second year dermatology resident presented the second case series entitled: “Infantile Hemangioma: Trick or Treat” where three cases of infantile hemangioma were elucidated. It was shortly followed by an expert lecture by Dr. Mark Jean Aan Koh, Head and Senior Consultant from KK Women’s and Children’s Hospital Singapore. He started by giving an overview on the classification of vascular anomalies in children. He then focused on a simplified step-wise approach in identifying and diagnosing the different types of Infantile and Congenital Hemangiomas. Dr. Koh emphasized on making the accurate diagnosis in vascular tumor to be able to identify concomitant syndromes and to arrive at the best treatment option. He then gave a real world experience of different treatment regimens for treating vascular tumors such as oral and topical beta blockers and laser intervention among others. These were complemented by an impressive before and after treatment photos of the cases.
The interactive Q and A portion started with Dr. Mark Koh giving more of his insights on the current treatment protocol of cases previously presented and future treatment intervention plan for the said cases. Another question raised focused on the mental health problems encountered by growing children in relation to their dermatologic problems. Dr. Gabaton emphasized the importance of establishing rapport with the patient and to be able to find cues about mental and social issues in these patients to help them cope holistically with their emotional stress and mental concerns and avoid social isolation.
The closing remarks for both parts were delivered by the Chairperson of the EAMC Department of Dermatology. Dr. Ma. Angela Lavadia reiterated the importance of recognizing these diseases in the younger population and managing them accordingly so that these children can fulfill their potential as our future. SHe also thanked the attendees and esteemed reactors and emphasized on the importance of collaboration between healthcare professionals for exchange of knowledge and ultimately better patient care.
Dr. Gonzales, Dr. Priela and Dr. David during their case presentations.
Dr. Wilsie Salas-Walinsundin, FPDS during her Opening Remarks.
Dr. Camille Faye Tuazon, FPDS during her case reaction on the case entitled:
“Common Neonatal Dermatoses”
Dr. Giselle Umali-Adasa, FPDS during her case reaction on the case entitled:
“Langerhan Cell Histiocytosis” and “Urticaria Pigmentosa”
Dr. Ma. Angela M. Lavadia, Chair, Department of Dermatology during her Closing Remarks of Part I
PART 2 DOCUMENTATION
Dr. Alfaro and Dr. Imam during their case presentations.
Dr. Niña Gabaton during her case reaction to the cases entitled:
“Creepin’ it Real: Psoriasis in the Pediatric Population”
Dr. Mark Jean Aan Koh during his case reaction to the cases entitled:
“Infantile Hemangioma: Trick or Treat”
The lecturers and the case reactors during the Q and A portion
Dr. Ma. Angela M. Lavadia, FPDS, Chair, Department of Dermatology during her Closing Remarks of Part II.
Cutis Pediatrica Tech Team being successful at having a smooth event.