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Dr. Charmaine Vanessa S. Chamberlin, Dr. Jay-V James G. Barit and Dr. Mae N. Ramirez-Quizon
In the practice of dermatology, contact dermatitis is encountered on almost a daily basis. Despite its commonality, it is actually a disease that requires careful consideration and critical investigation. And as we see cases of contact dermatitis from unregulated products, our role as dermatologists grows from being just a doctor, but to being influencers and active players in the public health landscape. Hence, as part of the Philippine Dermatological Society’s Continuing Medical Education (CME) series, the University of the Philippines – Philippine General Hospital, in partnership with the Contact Dermatitis and Environmental Dermatology Subspecialty Core Group, conducted SAFE SKIN: Vigilance and Social Accountability in Contact Dermatitis. The CME was held at Dr. Enrique Garcia Auditorium of the Lung Center of the Philippines, on October 24, 2018. The sessions were moderated by Dr. Mae N. Ramirez-Quizon.
Dr. Ma. Lorna F. Frez, Chief of Section, opened the event on how it was going to be filled with learning and pearls for daily dermatological practice. A case presentation on allergic contact dermatitis to an unregistered topical whitening product by Dr. Jay-V James G. Barit started the program, revealing mercury and thimerosal as the offending allergens. Analysis of the product in question revealed levels of mercury 6400 times above the legal amount in our country.
Dr. Lonabel A. Encarnacion, chief of the environmental dermatology unit in St. Luke’s Quezon City, elucidated more on contact dermatitis to mercury and thimerosal as well as tips on management and surveillance. As numerous personal care products, cosmetic products, and traditional Chinese medications may contain mercury or thimerosal, it is recommended that mercury and thimerosal are added to the baseline series for Philippine patch testing for suspected allergic contact dermatitis to topical products.
Prompting dermatologists beyond just diagnosis and management, the documenting and reporting adverse reactions to medications was emphasized through the lecture of none other than the PDS President herself, Dr. Ma. Angela M. Lavadia. Recently, PDS has launched a task force on skin safety and one of its projects was to advocate active reporting of side effects from topical products, especially unregistered ones, among PDS members. She went through the currently reported data to PDS, the relatively painless process of online reporting through the FDA website and vigilance as a characteristic and responsibility that distinguishes a PDS dermatologist. Everyone is the PDS community is encouraged to report all adverse reactions to medications to the FDA (https://ww2.fda.gov.ph/index.php/adr-report-new) and to email a copy of this report to PDS through firstname.lastname@example.org.
Dr. Hanna Lucero-Orillaza, newly minted from her fellowships in environmental dermatology in the US and advanced medical dermatology in Canada, gave a thorough discussion on the global updates in contact dermatitis. Highlights include the Allergen of the Year for 2018, propylene glycol, found as a humectant, emollient and preservative for a lot of daily-use products. Other emerging allergens include surfactants (cocamidopropyl betaine, found in no-tear shampoo, soaps, and other skin care products), argan oil, and metal allergies due to implants. She also proposed a Philippine version of the US Contact Allergen Management Plan (CAMP) database which can help patients sift through the countless products available in the market, knowing their patch test result.
The second half of the program dealt on the science and art of patch testing, heralded by Dr. Lillian Villafuerte, chair of the Contact Dermatitis Subspecialty Core Group. At this point, seats were almost full and had 189 online attendees in the webcast, the highest so far for the year. The basics of patch testing was covered by Dr. Clarissa V. Cellona, underscoring that patch testing is the standard of care for the diagnosis of allergic contact dermatitis (ACD), and that patch testing should be performed in every case of chronic and/or recurrent eczema or lichenification whenever a possibility exists that ACD may be the cause or complication of the disease. This was followed by Dr. Encarnacion’s lecture on the interpretation and relevance of patch test results. Important in patch test reading is to determine whether the reaction is allergic or irritant; and if allergic, to determine relevance (whether present, past or unknown). Lastly Dr. Heidi Chan discussed some important do’s and don’ts after knowing the patch test result, such as knowing the allergen and its cross-reactants, teaching patient to read product labels, and so on.
A hands-on patch test workshop led by members of the core group followed, demonstrating the proper way of preparing and applying the allergens for patch testing. The fruitful afternoon was closed with words of compliments, good wishes, updates for the PDS community, and upcoming celebrations by PDS president, Dr. Angela Lavadia.