Acrodermatitis continua of Hallopeau (ACH) is a chronic, rare pustular form of psoriasis that affects the distal extremities, particularly the fingers and toes. Although pustules are characteristic, they may not always be clinically apparent, especially in the earlier stages. This condition is often resistant to treatment; therefore, early and accurate diagnosis is essential for proper management and preventing complications.

A 34-year-old male farmer presented with a one-year history of pruritic erythematous scaly plaques involving both palms, thumbs and thumbnails. Pertinent history showed that the lesions appeared after contact with rubber gloves and fertilizers. Irritant versus allergic contact dermatitis were considered, but a negative patch test result ruled out the allergic component. He was treated with topical corticosteroids and was advised to wear cotton gloves under rubber gloves while working which provided relief. However, the plaques recurred now with appearance of pustules on both hands. A skin punch biopsy was done revealing psoriasiform dermatitis with subcorneal pustules, consistent with ACH. The patient was started on methotrexate 7.5 mg/week and topical clobetasol, alternating with calcipotriol with improvement of the palmar plaques and pustules.

ACH is often misdiagnosed due to its pus-filled lesions which may mimic infection or secondarily infected contact dermatitis or dyshidrotic eczema. In this case, the initial presentation mimicked a contact dermatitis, and it was only after patch testing and skin biopsy, that a definitive diagnosis was made.

Human ; Male ; Adult: 25-44 Yrs Old ; Acrodermatitis ; Dermatitis, Contact ; Psoriasis

Cutaneous metastases are uncommon dermatologic manifestations, occurring in 0.7–0.9% of cancer patients. They typically originate from malignancies of the breast, lung, or gastrointestinal tract, with only a few reported cases arising from malignant cardiac tumors. Herein, we present a rare case of cutaneous metastasis from a primary cardiac myxofibrosarcoma (MFS). Based on available literature, this is the first documented case in the Philippines.

A 26-year-old man presented with rapidly enlarging nodules on the mandible and left thigh following the early recurrence of a previously excised cardiac myxoma. A biopsy of the skin lesions demonstrated a bottom-heavy distribution of atypical spindle cells in a myxoid stroma, raising suspicion of either a primary spindle cell neoplasm or cutaneous metastasis. This prompted a multidisciplinary investigation into the underlying malignancy. Histopathology and immunohistochemical staining of both the cardiac mass and skin lesions confirmed a diagnosis of cardiac MFS with cutaneous metastasis. The aggressive nature of MFS, combined with the presence of metastasis and the patient’s decision to decline further treatment, led to rapid clinical deterioration and ultimately, death.

Cutaneous metastasis from cardiac tumors is exceedingly rare and difficult to diagnose given the paucity of reported cases. This case highlights the pivotal role of dermatologists in recognizing these dermatologic manifestations, prompting further investigation into the underlying malignancy. Dermatologists must maintain a high index of suspicion when evaluating skin lesions of patients with a history of malignancy, given the significant treatment and prognostic implications.

Human ; Male ; Adult: 25-44 Yrs Old ; Heart Neoplasms ; Sarcoma