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Dr. Ma. Celina Cephyr C. Gonzalez

Last April 24, 2019, the University of the Philippines – Philippine General Hospital Section of Dermatology, in cooperation with the Philippine Dermatological Society’s (PDS) Hansen’s Disease subspecialty core group, conducted a webinar entitled, “ENHANCING LIVES: Bridging the Gap between Knowledge and Healthcare in Dermatology.” This event was part of the PDS Continuing Medical Education (CME) series. The CME was held at the Teleconferencing Room, ITC Building of UP Manila Information Management Service and was broadcasted nationwide to PDS consultants and residents. This was the first CME webinar held by the Section. Dr. Winlove P. Mojica served as the moderator for the event. Dr. Eileen Liesl A. Cubillan, Chief of Section, commenced the three-part program with her opening remarks.

UP-PGH Dermatology consultants and residents with the speakers

 

The first topic of the webinar dealt with dermatologic emergencies. Emergency cases are uncommon in dermatology. When they occur, accurate diagnosis and subsequent immediate intervention should be given to improve prognosis. Oral medications in dermatology, when used erroneously, may cause adverse drug reactions and toxicity. Hence, it is important to be familiar with the management of drug-induced toxicity in dermatologic patients, as well as to recognize when to refer to other specialty services.

Dr. Val Constantine S. Cua presented a case of acute methotrexate toxicity in a psoriasis vulgaris patient. The patient consulted a general practitioner and was prescribed methotrexate 2.5 mg/tab 3 tablets every 12 hours, three doses per week for four weeks. However, the patient misread the instructions and took 3 tablets of methotrexate daily, with a cumulative dose of 22.5 mg weekly. She eventually developed generalized erosions on the previous psoriatic plaques.

Dr. Lynn Crisanta R. Panganiban, Professor of the Department of Pharmacology and Toxicity at the UP College of Medicine and Consultant of the National Poison Management and Control Center at the UP-PGH, gave her reaction and lecture on the approach to the management of drug-induced toxicity in dermatologic patients. One of the important lessons from this case was the approach to the diagnosis of methotrexate toxicity. In psoriasis, the signs and symptoms of drug-induced toxicity are similar to that of a flare. Clues in the clinical history that point to a drug-induced toxicity versus a psoriatic flare is the amount of drug taken by the patient. The greater the amount of drug ingested, the greater the risk of toxicity. Serum methotrexate determination is important to evaluate toxicity, but oftentimes may not be cost-effective. More importantly, we should ensure that communication between doctor and patient must be clear and understandable to both parties. This will prevent medication errors that may cause mortality and morbidity in our patients.

The next part of the program focused on the management of the neuropathic foot in relation to Hansen’s Disease. Dr. Belen L. Dofitas echoed the knowledge she gained from the short course on “Lower Extremity Amputation Prevention (LEAP) – The Comprehensive Management of the Neuropathic Foot” at the National Hansen’s Disease Program, Baton Rouge, Louisiana USA (September 2018). Dr. Dofitas talked about the LEAP program elements (annual foot screen, patient education, daily self-inspection, appropriate footwear, management of simple foot problems), the pathomechanics of foot injury (pressure = force/area) and the comprehensive management of the neuropathic foot. She also discussed the challenges in the management of neuropathic foot in Hansen’s disease. Dr. Dofitas discussed a case of Hansen’s neuropathic foot, managed with control of neuritis, proper wound care and makeshift off-loading shoe inserts made up of gauze and carton. Over a course of 12 weeks, the patient’s foot ulcers dramatically improved. Due to the high cost of ideal materials for off-loading especially footwear, the value of improvising cannot be overemphasized.

Dr. Belen Dofitas delivering her lecture promoting “Healthy Feet for Life!” among Hansens patients

The last lecture was on the rehabilitation management of hand and foot deformities. Dr. Dorothy Dy Ching Bing-Agsaoay, a rehabilitation medicine consultant at the Philippine General Hospital, discussed the management of peripheral neuropathy in Hansen’s disease in the community setting. She discussed the signs and symptoms associated with nerve involvement in Hansen’s disease. She highlighted the importance of early detection of neuropathy and prompt referral to rehabilitation medicine.

Awarding of certificates (from left to right): Dr. Winlove P. Mojica, Dr. Lynn Crisanta R. Panganiban, Dr. Belen L. Dofitas, Dr. Dorothy Dy Ching Bing-Agsaoay, and Dr. Eileen Liesl A. Cubillan

To end the productive afternoon, Dr. Georgina C. Pastorfide, past PDS president and UP-PGH Section of Dermatology consultant, briefly summarized the important learning points from the different lectures. She closed the program with words of gratitude to all attendees, compliments to all organizers, and well wishes on the event.

PDS
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