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Botryomycosis is a rare pyogenic disease that presents with chronic suppurative and granulomatous skin lesions, commonly caused by Staphylococcus aureus . We report a case of botryomycosis presenting similarly to mycetoma, secondary to the emerging cutaneous pathogen Staphylococcus simulans. A 46-year-old female who previously worked in a wet market presented with a 13-year history of suppurative papules on a gradually enlarging right foot, and pain on ambulation. She had no systemic symptoms or co-morbidities, and does not recall preceding trauma. Physical examination showed brawny edema of the right foot with multiple sinus tracts draining purulent discharge. The clinical diagnosis at presentation was mycetoma. Magnetic resonance imaging showed a soft tissue mass involving the right foot and ankle with osseous destruction. Biopsy revealed suppurative granulomatous dermatitis; staining with Grocott methenamine silver did not highlight fungal elements. Potassium hydroxide mount of the purulent discharge did not show grains or hyphal elements. Tissue cultures showed growth of co-trimoxazole-susceptible Staphylococcus simulans . The patient was managed as a case of botryomycosis and treated with co-trimoxazole for 12 months. There was a significant decrease in right foot circumference along with scarring and resolution of associated pain. Repeat biopsy showed no evidence of infection. This is the first reported case of botryomycosis in the Philippines as well as the first report citing Staphyloccocus simulans as a causative agent. Botryomycosis is an important differential in patients clinically presenting as mycetoma. Animal pathogens may need to be considered as etiologic agents in at-risk patients with chronic subcutaneous infections., Competing Interests: Both authors declared no conflicts of interest., (© 2024 Acta Medica Philippina.)

Background: Psychodermatology is a field that focuses on the interaction of the skin and the mind. Psychodermatology patients are often challenging to manage because they often lack insight and are not amenable to psychiatric treatment or referral. Therefore, it is important that dermatologists become aware of the psychosocial impact of cutaneous disease and be knowledgeable in the fundamentals of psychodermatologic diagnosis and therapy. However, studies done in several countries report a general lack of perceived knowledge, awareness, and confidence in the management of psychodermatology disorders among dermatologists., Objective: This study aims to determine the knowledge, attitudes, and practices of Filipino dermatologists towards psychodermatology using a self-administered questionnaire., Methods: This is a mixed methods study using qualitative and quantitative measures. A self-administered questionnaire was validated and disseminated among the dermatologists in the country. Descriptive analysis was done., Results: Of the 153 participating dermatologists, majority (70.59%) reported psychodermatologic patients comprised <10% of their practice. While more than half (56.2%) have a clear understanding of psychodermatology and are comfortable (57.52%) in approaching patients with these conditions, only 58 (37.91%) participants are able to demonstrate adequate knowledge on psychodermatology. Patients with primary psychiatric disorders are less frequently encountered than dermatologic disorders with psychiatric component or secondary psychiatric disorders. Most commonly prescribed medications are anti-histamines. Other psychotropic medications are rarely or never prescribed by the participants. All participants agree that psychodermatology is important in the practice of dermatology; 127 (62.1%) have attended at least one Continuing Medical Education (CME) on psychodermatology and 114 (74.51%) expressed willingness to attend CME training in psychodermatology. One hundred nine (71.24%) participants think that the best practice approach is a multidisciplinary approach to psychodermatology. The top recommendations for better healthcare delivery in psychodermatology were better access to mental health specialists (86.27%), more training opportunities and better training during residency (75.16%), and increase collaboration with psychiatrists (71.9%). The knowledge score was found to be associated with the duration of dermatology practice and attendance in CME proceedings but was not associated with the perceived adequacy of knowledge gained during training. Longer duration of practice may be associated with the knowledge score owing to the greater exposure to cases and more access to training opportunities., Conclusions: There are many challenges to providing psychodermatologic care in the Philippines but the positive attitude towards psychodermatology, coupled with increased access to education and training opportunities, and the multidisciplinary approach to these cases may improve the quality of dermatologic care that we provide., Competing Interests: All authors declared no conflicts of interest., (© 2024 Acta Medica Philippina.)

Background: Superficial mycoses are one of the most common skin conditions encountered in the outpatient clinics, causing significant morbidity amongst patients. Since these are highly prevalent diseases of the skin, the general practitioner should be able to manage uncomplicated cases, with no need for evaluation by a specialist., Objectives: The study aimed to determine the knowledge, attitudes, and practices of Filipino medical interns on the management of superficial cutaneous mycoses using a self-administered questionnaire. This may help identify possible gaps in knowledge, as well as obstacles these future clinicians may encounter when managing superficial mycoses. This in turn may assist in the development or improvement of dermatology training among medical students and continuing medical education programs amongst non-dermatologist physicians., Methods: This is a descriptive cross-sectional study among medical interns of the Philippine General Hospital to investigate their knowledge, attitudes, and practices regarding the management of superficial mycoses. Eligible participants were asked to complete an online self-administered survey questionnaire which assessed their capacity to recognize and manage uncomplicated superficial mycoses, and determined their attitudes regarding dermatology training in medical school., Results: The study included 170 medical interns, with majority having only 1-4 weeks of cumulative duration of dermatology training in medical school. Many of the participants (67.1%) had inadequate overall knowledge scores, but this was not significantly associated with their cumulative duration of dermatology training, as well as with their frequency of encounters with superficial mycosis patients. Most deem dermatology training (92.4%) and learning about the management of superficial mycoses (91.2%) during medical school very important. Majority are interested in attending more courses or training in the subject. Recommendations to improve medical school training on superficial mycoses include more practical approach in dermatology modules, integration of dermatology electives in medical school, and longer duration of dermatology modules/rotations during medical school., Conclusion: While knowledge scores of medical interns were not significantly associated with the duration of their dermatology training during medical school as well as their encounters with patients with superficial mycoses, it is shown that they have low confidence scores regarding management of superficial mycoses. They deem that learning more about this disease and dermatology in general is vital to their medical education and are desirous of more training in this subject. Recommendations to improve medical school training on superficial mycoses include dermatology modules, rotations or electives in medical school. Additionally, better training during medical school, and formulation of clinical practice guidelines specific to cutaneous mycoses were recommended to improve healthcare delivery for patients with such diseases., Competing Interests: All authors declared no conflicts of interest., (© 2024 Acta Medica Philippina.)

Background: Pityriasis versicolor is a common fungal infection of the superficial skin layer caused by Malassezia furfur , a normal commensal in the skin. Keratolytic agents are popular, cheap, and readily available over-the-counter treatments for pityriasis versicolor. Conventional antifungal agents are more expensive, requiring prescription, and may induce resistant strains. However, evidence of their comparative safety and efficacy is still lacking., Objectives: To assess the efficacy and safety of synthetic antifungals compared to keratolytic agents in the topical treatment of pityriasis versicolor through a systematic review., Methods: We searched the following databases: MEDLINE (from 1966) through PubMed, CENTRAL (Issue 9 of 12, September 2021), EMBASE (from 1974), LILACS (from 1987); Herdin (from 1970), www.clinicaltrials.gov, www.isrctn.com, www.trialregister.nl. We contacted researchers in the field, hand searched relevant conference abstracts, and the Journal of the Philippine Dermatological Society 1992-2019. We included all randomized controlled trials involving patients with diagnosed active pityriasis versicolor where topical antifungal was compared with a topical keratolytic for treatment. Two review authors independently applied eligibility criteria, assessed risk of bias using the Cochrane collaboration tool, and extracted data from included studies. We used RevMan 5.3 to pool dichotomous outcomes using risk ratios (RR) and continuous outcomes using the mean difference (MD), using random-effects meta-analysis. We tested for statistical heterogeneity using both the Chi² test and the I² test. We presented results using forest plots with 95% confidence intervals. We planned to create a funnel plot to determine publication bias but were unable to due to few studies. A Summary of Findings table was created using GRADE profile software for the primary outcomes., Results: We included 8 RCTs with a total of 617 participants that compared azole preparations (ketoconazole, bifonazole and econazole) versus keratolytic agents (selenium sulfide, adapalene, salicylic-benzoic acid). Pooled data showed that azoles did not significantly differ from keratolytic agents for clinical cure (RR 0.99, 0.88, 1.12; 4 RCTs, N=274, I 2 =55%; very low-quality evidence), and adverse events (0.59 [0.17, 2.06]; very low-quality evidence) based on 6 RCTs (N=536). There were two patients given a keratolytic agent (selenium sulfide shampoo) who had acute dermatitis and discontinued treatment., Conclusion: It is uncertain whether topical azoles are as effective as keratolytic agents in clinical clearance and occurrence of adverse events in patients with pityriasis versicolor. A wider search of grey literature and local studies are warranted. Larger RCTs with low risk of bias are recommended., Competing Interests: All authors declare that there is no conflict of interest., (© 2024 Acta Medica Philippina.)