By: Iris Jao
In the midst of the current COVID-19 crisis, as the community has started to slowly adapt to the enhanced community quarantine, webcasts and online conferences have proven vital to continued learning amongst people in the medical field. The Skin and Cancer Foundation, Inc., in association with the Philippine Dermatological Society, hosted its first continuing medical education (CME) activity done entirely via webcast entitled “More than Skin Deep: The Role of Inflammation in Psoriasis” last April 29, 2020.
Dr. Purita Paz-Lao opened the session by quickly discussing the relevance of the webcast with regards to the current crisis and included a dedication to all the front liners fighting this war against COVID-19. A case of a Psoriasis patient managed with 8-methoxypsoralen bath PUVA was presented, where Dr. Corrine Sison-De Jesus shared about her experience regarding current phototherapy protocols in managing patients with psoriasis. Phototherapy is a good alternative and treatment adjunct for those wary of giving immunosuppressive medication. Narrow-band Ultraviolet B (NBUVB) was noted to be the most therapeutically effective modality, as well as being both safe and cost-effective. Dr. Sison-De Jesus stated that significant results may take some time — requiring twice to thrice weekly treatments for a duration of 2 months to see changes.
Dr. Kimberly Tantuco then reacted to a case of a pediatric patient with pustular psoriasis. She shared her insights regarding using systemic treatment especially in the pediatric population and emphasized the importance of correct dosing of systemic immunosuppressive medications including Methotrexate (0.03-0.24mg/kg/week) and Cyclosporine (2-5mg/kg/day in 2 divided doses). She also stressed the importance of making sure patients had up-to-date immunizations prior to initiating immunosuppressive therapies.
Dr. Vermen Verallo-Rowell, a well-respected dermatologist with a known interest for psoriasis, shed light on the treatment of Psoriatic patients, especially in the current time of COVID-19. Knowing that biologics have some immunosuppressive effects, she stressed the importance of including functional medicine in conjunction with usual therapies. Dr. Verallo-Rowell advocates good sleep, enough rest and exercise. She also highlights the importance of an anti-inflammatory diet, with emphasis on incorporating coconut oil in your daily diet as it has both anti-viral and anti-bacterial properties. With multiple patients showing significant improvement in their psoriasis, functional medicine proves to be a relevant and well-rounded therapeutic modality in managing Psoriasis, as it is a multifactorial disease. Dr. Verallo-Rowell also introduced the concept of having a Philippine Psoriasis Registry to help aid in the management of future Psoriasis patients.
After the case presentations, Dr. Belen Dofitas provided us with relevant information on how to practice Teledermatology during a Pandemic. Any physician that has a valid license from the Philippine Professional Regulatory Commission may practice telemedicine, provided he is physically residing in the Philippines. She introduced the different platforms of Teledermatology and tackled the principles of establishing an electronic or online consultation. Minimum requirements needed to set-up telemedicine include: (1) a communication device, (2) stable internet connection, and (3) a private, well-lit location (for video consultation). Ethical use of Teledermatology must be at the forefront, maintaining mutual trust and respect between patient and physician, ensuring confidentiality, privacy and data integrity, and most importantly obtaining proper informed consent. Common concerns including advantages and pitfalls with practicing Telemedicine were addressed. Would it be better to be paid before consult? Is video consultation more convenient than sending photos? Ultimately, the decision on which application to employ rests with the physician: Direct teledermatology provides a faster way to communicate, but revenue is not always guaranteed. Indirect or third-party teledermatology guarantees revenue, but with a percentage of that revenue going to the third-party application.
Finally, Dr. Edsel Salvana, an Infectious Disease Specialist from the UP-PGH along with Dr. Chittina De Ocampo-Santiago, PDS CME Chair, presented viewers with Guidelines on the Safe Practice of Dermatology Post-Quarantine through a Question and Answer session. He underlined the importance of administrative controls like scheduling patient flow to limit number of patients in the clinic. This also minimizes wait time for each patient. Engineering controls such as protective screens for the secretary, as well as removing high-touch items like magazines from the clinic will help control the spread of disease. Dr. Salvana reiterated the importance of wearing personal protective equipment (PPE) as the primary control and explained that both administrative and engineering controls remain secondary to control spread of disease in the clinic.
Because of today’s current situation, there are many questions about how things will change post-quarantine as a medical practitioner. The topics in the CME further cemented that, but despite the current crisis and the different obstacles bound to arise, Filipino dermatologists will continue to provide essential services to the Filipino community.