Event: What’s behind the rash?: Deciphering subtle signs in Leprosy and STI.
Continuing Medical Education

Date: February 19, 2020

Venue: B Hotel, Scout Rallos St., Quezon City

Moderator: Dee Jay B. Arcega, MD, FPDS

Welcome Remarks: Ma. Angela M. Lavadia, MD, FPDS

Case Presenters:

• Katrina Rose G. Baluyot, MD;
• Donnilyn G.  Priela, MD;
• Louie Arielle Dado, MD

Lecturer: Gilbert C. Yang, MD, FPDS

Case Reactors:

• Ma. Teresita G. Gabriel, MD, FPDS;
• Emmerson S. Vista, MD, FPDS;
• Gertrude P. Chan, MD, FPDS;
• Kristine Joy Bajandi, MD, FPSMID

Total Number of Attendees: 50 (On-site) and 350 (Webinar)

The East Avenue Medical Center in cooperation with the Leprosy Subspecialty Core Group and Sexually Transmitted Infection Core Group of the Philippine Dermatological Society held their CME meeting highlighting subtle signs in leprosy and STI.

The event started with a rare case of Hansen’s disease (HD) presenting as a hypertrophic scar which led to an interesting discussion on inoculation leprosy. This is a delayed hypersensitivity reaction after inoculation of bacilli from burns, vaccination, tattooing or needle stick injuries. This mode of transmission is especially important for us, dermatologists who do diagnostic procedures for these patients, highlighting the importance of proper technique and protection. The guidelines for management of Leprosy in the Philippines is currently being developed, allowing for a unified approach towards disease control and prevention. For instance, close contacts of paucibacillary HD patients may be given 1 dose of Rifampicing, Ofloxacin and Minocyclin while close contacts of multibacillary HD patients may be given the same regimen for 3-6 months.

A lecture on history taking and physical examination in patients coming in for sexually transmitted infections followed. The audience had a refresher course on proper sex and gender terminology. “Sex” is assigned at birth based on anatomy, while “sexual orientation” related to their emotional and sexual attraction to others. The terms “Men who have sex with men” or “Women who have sex with women” relate to sexual behavior, while “Gender identity” is the sense of being a man or a woman. “Transgender” is used when the sex assigned at birth does not correspond with their gender identity, while “cisgender” is when the two aspects align. The importance of non-verbal communication was emphasized, and the participants were reminded to conduct a thorough physical examination including sensitive areas that may not be part of the chief complaint, such as the perianal area and inguinal lymph nodes. This was followed by an important lecture on HIV and dermatology, since 80-90% of patients affected by HIV present with cutaneous. Kaposi Sarcoma, being the most common HIV-associated malignancy was appropriately highlighted because of dermatologist’s important role in its recognition. We must look beyond the skin lesions, and pay attention to symptoms that may implicate visceral involvement such as gastrointestinal bleeding and persistent cough, which will warrant further workup. WHO guidelines recommend Highly active antiretroviral therapy (HAART) for mild and moderate disease and HAART with systemic chemotherapy for severe disease.

The subtle signs of leprosy and HIV were deciphered in a patient who was found to have coinfection, an unusual occurrence with only few reports globally. Although persons affected with HIV are immunocompromised, existing reports do not find their HIV disease activity to be correlated to the severity of leprosy. The immune reconstitution syndrome (IRIS) as response to antiretroviral therapy may cause lepromatous reactions which are managed with Prednisone to prevent neuritis and motor damage. A lecture from an infectious specialist highlighted the need to ensure adherence to antiretroviral therapy to prevent resistance to medications. It was emphasized that although no cure has been established for HIV, treatment is important to control the virus and prevent onward transmission and spread of the disease. Standard precautions using personal protective equipment when doing dermatologic procedures in patients affected by HIV is sufficient.

The learnings from this CME highlighted the essential role of dermatologists in the control of Leprosy and HIV, two diseases that continue to affect public health. As the authority in dermatology, we are instrumental in the fight against the stigma that plagues these infectious diseases.