Dr. Josef Symon S. Concha

02/10/2025

28/09/2025

As an advanced medical dermatology specialist, I approach acne with the same depth and precision that I use in managing complex medical conditions.

While the majority of patients with acne need basic care, it takes formal training and extensive experience to tease out those who need advanced treatment options. Always seek the expertise of a board-certified dermatologist for acne and other skin/hair/nail/mucosal diseases.

18/09/2025

𝙋𝙝𝙤𝙩𝙤𝙨𝙚𝙣𝙨𝙞𝙩𝙞𝙫𝙞𝙩𝙮 𝙞𝙣 𝙇𝙪𝙥𝙪𝙨
𝘿𝙧. 𝙂𝙚𝙧𝙖𝙡𝙙𝙞𝙣𝙚 𝙕𝙖𝙢𝙤𝙧𝙖
𝘿𝙧. 𝙅𝙤𝙨𝙚𝙛 𝙎𝙮𝙢𝙤𝙣 𝘾𝙤𝙣𝙘𝙝𝙖

Lupus erythematosus is an autoimmune disease that affects the skin and other organs like joints, kidneys, and blood. The butterfly rash or the red patch on the cheeks and the bridge of the nose is the most striking presentation of lupus on the skin. Sometimes, it is also accompanied by a rash affecting the neck, chest, and arms that follows a pattern where the sun or light hits the skin. This finding is also known as the photosensitive lupus rash.

In this issue, we speak with an internist and rheumatologist to discuss the skin and systemic effects of sun, light, and heat on patients with lupus. Additionally, we also talk about some practical ways to protect the photosensitive skin.

Questions:

𝐖𝐡𝐲 𝐝𝐨𝐞𝐬 𝐭𝐡𝐞 𝐬𝐮𝐧 𝐦𝐚𝐤𝐞 𝐥𝐮𝐩𝐮𝐬 𝐨𝐧 𝐭𝐡𝐞 𝐬𝐤𝐢𝐧 𝐰𝐨𝐫𝐬𝐞?

A lupus patient's immune system reacts strongly to the ultraviolet (UV) rays of the sun. This exaggerated immune activation results in inflammation which can be seen on the skin as a red rash or felt by the patients as itching, stinging, or tingling. Some patients also react strongly to indoor lighting, especially that made of fluorescent or halogen bulbs. Heat is also a known trigger. Although the rash could appear within a day, some patients experience worsening of their skin lesions after more than a week of the initial exposure.

𝐂𝐨𝐮𝐥𝐝 𝐨𝐭𝐡𝐞𝐫 𝐨𝐫𝐠𝐚𝐧𝐬 𝐛𝐞 𝐢𝐧𝐯𝐨𝐥𝐯𝐞𝐝?

Since blood circulates from the skin to the rest of the body, cutaneous inflammation triggered by UV rays could reach the other organs. Some patients end up feeling fatigued and getting muscle and joint aches after being out in the sun for too long. There are reports of patients getting abnormal liver and kidney tests, and blood counts after too much UV exposure.

𝐇𝐨𝐰 𝐜𝐚𝐧 𝐥𝐮𝐩𝐮𝐬 𝐩𝐚𝐭𝐢𝐞𝐧𝐭𝐬 𝐩𝐫𝐨𝐭𝐞𝐜𝐭 𝐭𝐡𝐞𝐦𝐬𝐞𝐥𝐯𝐞𝐬 𝐟𝐫𝐨𝐦 𝐭𝐡𝐞 𝐬𝐮𝐧?

Strict avoidance of sun exposure by staying indoors with good ventilation and cooling is primary. Interestingly, UV rays can still enter indoors through the windows, so even this spot is off limits for extremely photosensitive patients. Indoor lighting should be UV-filtered and made of LED bulbs. If sun exposure is anticipated, sunscreen (broad-spectrum, SPF 50 or higher), hats, sunglasses, sun protection vests/shirts are a must. Vehicles might need protective anti-UV film coating, but specifications should follow local regulations to maximize driver and passenger safety. Less UV exposure could cause vitamin D deficiency, so monitoring of vitamin D levels or outright supplementation is encouraged.

𝐖𝐡𝐚𝐭 𝐚𝐫𝐞 𝐭𝐡𝐞 𝐭𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭 𝐨𝐩𝐭𝐢𝐨𝐧𝐬 𝐟𝐨𝐫 𝐭𝐡𝐢𝐬 𝐩𝐡𝐨𝐭𝐨𝐬𝐞𝐧𝐬𝐢𝐭𝐢𝐯𝐞 𝐫𝐚𝐬𝐡?

Once the rash is there, photoprotection is not usually enough. There are topical and systemic medications that calm the hyperactive immune system. Talk to your dermatologist and rheumatologist to know more about your options.

19/08/2025

𝗠𝗮𝘅𝗶𝗺𝗶𝘇𝗶𝗻𝗴 𝘁𝗵𝗲 𝗦𝗮𝗳𝗲𝘁𝘆 𝗮𝗻𝗱 𝗘𝗳𝗳𝗶𝗰𝗮𝗰𝘆 𝗼𝗳 𝗔𝗻𝘁𝗶𝗯𝗶𝗼𝘁𝗶𝗰 𝗧𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁 𝗶𝗻 𝗔𝗰𝗻𝗲

𝗝𝗼𝘀𝗲𝗳 𝗦𝘆𝗺𝗼𝗻 𝗦. 𝗖𝗼𝗻𝗰𝗵𝗮, 𝗠𝗗
𝗜𝘀𝘀𝗮 𝗥𝘂𝗳𝗶𝗻𝗮 𝗦𝗲𝗻𝗴𝗮-𝗧𝗮𝗻𝗴, 𝗠𝗗

Antibiotics target the commensal bacterium Cutibacterium acne and suppress inflammation, which are key factors in acne formation. Treatment guidelines recommend starting topical antibiotics in mild to moderate acne, whereas systemic antibiotics are initiated when the severity increases to ‘moderate’ and/or when there is extensive involvement.

A common misconception is that this drug class is only used for a week or two to control inflammation. Surprisingly, antibiotics should be used for several weeks to appreciate a significant effect. However, increasing the duration of treatment also poses risks such as antibiotic resistance and GI disturbance.

For this week's article, we collaborated with an internist and infectious disease expert on how we can harness the benefits of antibiotic treatment and mitigate some of its associated adverse events.

𝗦𝗵𝗼𝘂𝗹𝗱 𝘄𝗲 𝗳𝗲𝗮𝗿 𝗮𝗻𝘁𝗶𝗯𝗶𝗼𝘁𝗶𝗰 𝘂𝘀𝗲 𝗶𝗻 𝗮𝗰𝗻𝗲?

We should not, as long as the treatment plan is guided by a licensed doctor. In general, they are a well-tolerated class of anti-acne medications. GI disturbance is the most common side effect.

𝗪𝗵𝗮𝘁 𝗮𝗿𝗲 𝘁𝗵𝗲 𝗺𝗲𝗮𝘀𝘂𝗿𝗲𝘀 𝘁𝗼 𝗺𝗶𝗻𝗶𝗺𝗶𝘇𝗲 𝗮𝗻𝘁𝗶𝗯𝗶𝗼𝘁𝗶𝗰 𝗿𝗲𝘀𝗶𝘀𝘁𝗮𝗻𝗰𝗲?

Resistance means a particular antibiotic is no longer effective in acne, or other infectious conditions that it was meant to treat. Do not combine oral and topical antibiotics in acne. Switch to another non-antibiotic, anti-acne medication once moderately clear. Choose an antibiotic with a narrow spectrum of activity, if available and practical for the patient.

𝗪𝗵𝗮𝘁 𝗶𝘀 𝘁𝗵𝗲 𝗺𝗮𝘅𝗶𝗺𝘂𝗺 𝗱𝘂𝗿𝗮𝘁𝗶𝗼𝗻 𝘄𝗲 𝗰𝗮𝗻 𝘂𝘀𝗲 𝗼𝗻𝗲 𝗮𝗻𝘁𝗶𝗯𝗶𝗼𝘁𝗶𝗰?

Ideally, topical and oral antibiotics should be used for no longer than three months for every course. Topical clindamycin in toner form is notoriously used long-term among patients who have been lost to follow-up, so check this ingredient in the acne regimen. Regular visits with your dermatologist should prevent this scenario.

For expert care, choose a board-certified medical dermatologist who can offer evidence-based medical and procedural treatments for acne.

𝗗𝗿. 𝗜𝘀𝘀𝗮 𝗥𝘂𝗳𝗶𝗻𝗮 𝗧𝗮𝗻𝗴 is an infectious diseases specialist who was the chairman of the antimicrobial stewardship committee of the Philippine Orthopedic Center and the infection prevention committee of the PCCH. She is currently undergoing further training in Melbourne, Australia

13/08/2025

I’d like to welcome everyone to my professional page, where I feature concepts that cover dermatology and other fields in medicine. My goal is to raise awareness of medical dermatology by collaborating with other specialties in approaching conditions of the skin and the systemic issues that go along with it.

For this first issue, we tackle 𝗵𝗼𝗿𝗺𝗼𝗻𝗮𝗹 𝗮𝗰𝗻𝗲 𝗮𝗻𝗱 𝘁𝗵𝗲 𝗺𝘂𝗹𝘁𝗶𝗽𝗿𝗼𝗻𝗴𝗲𝗱 𝗮𝗽𝗽𝗿𝗼𝗮𝗰𝗵 𝘁𝗼 𝗶𝘁𝘀 𝘁𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁.

Almost all forms of acne are hormonal by nature. Androgenic or male s*x hormones stimulate the oil glands to form sebum, which triggers the cascade of acnegenesis. While the common anti-acne medications treat faulty exfoliation, bacteria, and inflammation, hormonal imbalance is quite a tricky factor to address.

Here, we speak with 𝗗𝗿. 𝗝𝗲𝗮𝗻 𝗔𝗶𝗹𝗲𝗲𝗻 𝗘𝗹𝗮𝘂𝗿𝗶𝗮-𝗠𝗮𝗻𝗮𝗹𝗮𝘀𝘁𝗮𝘀, an obstetrician-gynecologist, women’s health expert, and one of the few urogynecologic surgeons in the country, to talk about hormonal treatment in acne.

𝗛𝗼𝘄 𝗱𝗼 𝘄𝗲 𝘁𝗿𝗲𝗮𝘁 𝗵𝗼𝗿𝗺𝗼𝗻𝗮𝗹 𝗮𝗰𝗻𝗲?

There are several drug classes that may be prescribed, including oral contraceptive pills (OCPs), anti-androgens, and rarely, steroids. In general, these are combined with the usual anti-acne medications, like the retinoids and antibiotics for females with hard-to-treat, scarring, or moderate to severe acne. OCPs have the additional benefit of preventing pregnancy, so this could be a good option for s*xually active women who want to use anti-acne medications that have the potential to cause congenital birth defects.

𝗛𝗼𝘄 𝗱𝗼 𝗽𝗶𝗹𝗹𝘀 𝘁𝗿𝗲𝗮𝘁 𝗵𝗼𝗿𝗺𝗼𝗻𝗮𝗹 𝗮𝗰𝗻𝗲? 𝗜𝘀 𝗶𝘁 𝘀𝗮𝗳𝗲 𝗮𝗻𝗱 𝗲𝗳𝗳𝗲𝗰𝘁𝗶𝘃𝗲?

Oral contraceptive pills or OCPs aside from preventing pregnancy, are used for other conditions such as irregular me**es, dysmenorrhea, and acne vulgaris. Hormonal acne is related to a high level of androgen such as is seen in patients with polycystic ovarian syndrome.

However, not all OCPs are equal. Newer generations of OCPs contain drospirenone which is a progesterone with anti-androgenic and anti-mineralocorticoid activity which removes both acne and bloating in pill-users.

OCPs are generally safe for non-smokers less than 35 years old with no history of venous thrombosis (blood clots in the veins), but it is best to consult your doctor before starting on the pill.

𝗪𝗵𝗮𝘁 𝗮𝗿𝗲 𝘁𝗵𝗲 𝗼𝘁𝗵𝗲𝗿 𝗼𝗽𝘁𝗶𝗼𝗻𝘀 𝗶𝗻 𝘁𝗿𝗲𝗮𝘁𝗶𝗻𝗴 𝗵𝗼𝗿𝗺𝗼𝗻𝗮𝗹 𝗮𝗰𝗻𝗲?

Office-based procedures such as acne surgery, anti-inflammatory injections, chemical peels, light and laser-based treatments further boost the effects of hormonal acne treatment. Consult with your dermatologist to find the right treatment combination for your skin type.

𝗗𝗿. 𝗝𝗲𝗮𝗻 𝗔𝗶𝗹𝗲𝗲𝗻 𝗠𝗮𝗻𝗮𝗹𝗮𝘀𝘁𝗮𝘀 is a women’s health advocate and a practicing Obstetrician-Gynecologist who specializes in the management of pelvic organ prolapse, voiding dysfunction, urinary and f***l incontinence, and genitourinary fistulas. She is the assistant training officer of the OB-GYN residency training program at the Angeles University Foundation Medical Center. She is affiliated with the Philippine Obstetrical and Gynecological Society and the Philippine Society of Urogynecology and Reconstructive Pelvic Surgery. She can be reached via the following platforms:

https://seriousmd.com/doc/jean-aileen-manalastas

https://www.facebook.com/urogynedoctor/