Dyshidrotic eczema (DE) and palmoplantar psoriasis (ppPSO) are both conditions presenting with vesicopustules on the palms and soles. While they have differences, distinguishing them can be a challenge in cases complicated with allergic contact dermatitis (ACD).

A 24-year-old male clerk, presented with a one-year history of vesicopustules on the palms and soles, associated with onycholysis and subungual hyperkeratosis. He admits to frequent hand washing and using rubbing alcohol as well as wearing a new pair of rubber shoes. Patch testing (International Standard series) showed +++ Potassium dichromate 0.5%, Carba Mix 3.0%, Thuiram mix 1.0%, Textile dye 6.6% and ++ Formaldehyde 2%. Gram stain was negative and KOH from plantar area showed spores and long-septate hyphae. Dermoscopy showed a bright pink background with erosions, patchy dotted vessels atop with yellow crust, and scales. Histopathology revealed psoriasiform-spongiotic dermatitis with macrovesiculation and eosinophilic spongiosis which was consistent with subacute eczema. He was managed as a case of recalcitrant DE with secondary dermatophytosis and ACD to textile dye and rubber, but still keeping in mind the possibility of eczematized ppPSO. The patient was managed accordingly, with particular emphasis on avoiding allergens. The condition improved, and nail changes resolved with topical medications and a short course of oral corticosteroid and oral anti-fungal thus favoring our initial impression of recalcitrant DE complicated by dermatophytosis and ACD.

This highlights the diagnostic challenge in distinguishing between severe DE and ppPSO in the setting of concomitant ACD, underscoring the importance of a comprehensive evaluation.

Human ; Male ; Young Adult: 19-24 Yrs Old ; Dermatitis, Contact ; Eczema

Gorlin syndrome is a rare autosomal dominant disorder characterized by multiple basal cell carcinomas, developmental abnormalities, and a predisposition to various tumors. This case study illustrates the clinical presentation, diagnostic challenges, and multidisciplinary approach of Gorlin syndrome in an adult Filipino patient.

Our case is a 47-year-old Filipino female with a 20-year history of progressive, generalized, numerous hyperpigmented to brownish-black patches and plaques. She is a 4.5-pack-year smoker with a history of intermittent sun exposure for 10-12 hours per week and denied any childhood sunburn and no use of sun protection. Physical examination shows generalized involvement with multiple well-defined dark brown patches and plaques. Dermoscopy findings showed maple leaf-like, spoke wheel structures, blue-grey ovoid nests, and microulceration. Skin punch biopsy was consistent with Basal Cell Carcinoma, Superficial type. There is the presence of skin-colored multiple depressions or pits on palms and soles, with some areas coalescing into a plaque. Gorlin Syndrome is diagnosed clinically and our patient fulfills two major criteria: Multiple Basal Cell carcinomas and palmoplantar pits, confirming the diagnosis. The family was also counseled regarding hereditary transmission. The patient’s daughter also presented with palmar pits, multiple odontogenic keratocysts, and ophthalmologic abnormalities such as hypertelorism, which also confirms the diagnosis of Gorlin syndrome.

Raising awareness and providing easy access to healthcare resources for adult patients with GS are crucial steps for better patient outcomes.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Tumors ; Neoplasms

Kaposi sarcoma (KS) is an angioproliferative tumor affecting the blood and lymphatic vessels. The human herpesvirus 8 (HHV8) is directly implicated in the development of the disease. Non-AIDS kaposi sarcoma is a rare clinical type of KS and must be distinguished from AIDS-associated KS as it differs in clinical presentation, course, prognosis, and management.

A 73-year old male, Filipino, rice farmer, from Quezon Province, Philippines, presented with a progressive 10-year history of violaceous to hyperpigmented plaques and nodules on all extremities, with associated pruritus and difficulty in performing fine motor tasks. Histopathology showed proliferation of vascular channels and immunohistochemical stains were positive for CD31, CD34, and human herpesvirus 8 (HHV8), consistent with KS. Work-up revealed non-reactive HIV serology with an adequate CD4 count and computed tomography (CT) scan of the chest and abdomen were unremarkable. The case was classified as non-AIDS KS. He was then referred to oncology for chemotherapy with paclitaxel.

This case highlights that KS can occur in non-endemic areas and in immunocompetent individuals. Non-AIDS KS must be differentiated from other types of KS since non-AIDS KS is less aggressive, limited to the skin, and is highly responsive to therapy. It is therefore crucial to correlate clinical and histopathologic findings, utilizing immunohistochemical stains, as histology of KS can mimic benign vascular tumors, and it is crucial to achieve an early and accurate diagnosis. There are currently no treatment guidelines for KS and management aims to decrease morbidity and improve a patient’s quality of life.

Human ; Male ; Aged: 65-79 Yrs Old ; Herpesvirus 8, Human ; Sarcoma, Kaposi ; Tumors

Introduction: Primary Cutaneous Anaplastic Large Cell Lymphoma (PC-ALCL) is a rare Non-Hodgkin lymphoma (NHL) representing approximately 9% of all cutaneous lymphomas.3 It usually manifests as a slow-growing, solitary tumor which has a tendency to regress spontaneously. However, metastasis is reported in 5-10% of cases.2 Case Summary: Our case is an 81-year-old female with a four-month history of an enlarging nodule on the left upper back. The initial impression was a malignant cutaneous tumor. Histopathology revealed epidermotropic large atypical lymphocytes and diffuse infiltrates of hyperchromatic, pleomorphic mononuclear cells and lymphocytes. Immunohistochemistry showed CD3+, CD20-, CD30+, epithelial membrane antigen (EMA)- and anaplastic lymphoma kinase (ALK)- consistent with PC-ALCL. Metastatic work-up revealed pulmonary involvement. The patient underwent two cycles of multi-agent chemotherapy with marked improvement. However, patient declined further treatment and expired five months after the diagnosis. Conclusion This case emphasizes that although PC-ALCL commonly presents with an indolent course, extracutaneous spread can occur. Prompt treatment with chemotherapy increases survival significantly with a cure rate of 92%.2
Lymphoma, T-Cell ; Neoplasms

Background: Dermoscopy increases the diagnostic accuracy of clinical visual inspection by 5% to 30%. This has led to a reduction of unnecessary excision of benign skin lesions and the earlier diagnosis of malignant skin lesions. Objectives: To compare the concordance agreement of the clinical versus histopathologic diagnosis to the concordance agreement of the dermoscopic versus histopathologic diagnosis of pigmented lesions. Research Design: This is a prospective, cross-sectional study of the clinical, dermoscopic and histopathological features of pigmented skin lesions on patients seen at the Out-Patient Departments of Quirino Memorial Medical Center and Ospital ng Makati from March 2013 to June 2014. Methods: Sixty-eight subjects fulfilled the criteria and were all included in the final analysis. Classification and definitive diagnosis of the lesion as benign or malignant were determined thru clinical, dermoscopic and histopathologic features by one dermatopathologist. Kappa and concordance analyses were performed to determine the statistical and concordance agreement among the results of the three diagnostic procedures, respectively. Results: The statistical agreement between clinical versus histopathologic classification as benign or malignant was good (kappa=0.872), while the statistical agreement was high (kappa=0.872) between dermoscopic versus histopathologic classification. Concordance agreement between clinical versus histopathologic diagnosis showed fair agreement (concordance coefficient=0.2397) as compared to a high agreement (concordance coefficient=0.98) in dermoscopic versus histopathologic diagnosis. Conclusion The use of dermoscopy in pigmented lesions aids the dermatologist in giving an accurate diagnosis without invasive procedures. Knowledge of the dermoscopic features will help in the early clinical detection and management of benign and malignant pigmented skin lesions.
Dermoscopy

Background: Numerous studies have demonstrated various information about COVID-19 infection. With this, the authors intend to abridge, present, and synthesize current available information, focusing on the cutaneous manifestations of COVID-19 infection, to help guide dermatologists in understanding the dermatologic aspect of this disease. Objective: This study aims to review the different cutaneous manifestations of COVID-19 by morphology and to evaluate the lesions seen in the different age groups. Furthermore, this study aims to discuss cutaneous findings together with histologic evidence and hypothesized pathophysiology, and to review the management used in treating COVID-19-related cutaneous manifestations. Methods: OVID® and PubMed databases were used to search in detail for COVID-19-induced skin lesions across all ages and their management. Discussion: COVID-19 affects the skin, hair and nails of patients. These may be attributed to the different virologic phases as well as the immune response of the body. Histopathologic findings of these lesions vary depending on the clinical presentation. Use of corticosteroid therapy and antihistamines as treatment for some cutaneous manifestations of COVID-19 showed good response. Conclusion COVID-19 infection-associated cutaneous manifestations present with different morphologies. It is important for dermatologists to gain better understanding of this disease in order to promptly identify and suspect the possibility of this illness, as well as provide appropriate actions.
COVID-19 ; Coronavirus ; Skin