Scleredema is an uncommon condition of unknown etiology that is characterized by dermal mucinosis and mild sclerosis. It is a symmetrical, diffuse, non-pitting induration of the skin commonly associated with an antecedent febrile illness, diabetes mellitus or paraproteinemia.This is the case of an obese, middle-aged adult female with type 2 diabetes mellitus on oral hypoglycemic medication, who presented with an ill-defined, diffuse erythema and non-pitting induration of the skin on the posterior neck and upper back. It has been estimated that as many as 2.5%-14% of diabetic patients have scleredema. This subset of patients may be under-reported as a consequence of subtle onset and under- recognition. Even lithe prognosis of scleredemadiabeticorum is usually benign, it is important that this condition is recognized since it may have systemic involvement that can lead to complications.

Human ; Female ; Middle Aged ; Diabetes Mellitus, Type 2 ; Erythema ; Hypoglycemic Agents ; Obesity ; Paraproteinemias ; Prognosis ; Scleredema Adultorum ; Sclerosis ; Skin ; Diabetes Mellitus ; Mucinoses

BACKGROUND: Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma. Diagnosis relies on clinicopathological correlation.

OBJECTIVE: To describe the clinicodemographic characteristics of patients with MF and to identify histologic criteria that will signify adequate treatment.

METHODS: Registries from years 2004 to 2009 were searched for biopsy-proven MF. Charts were retrieved and clinicodemographic data gathered. Pre- and post-treatment biopsy slides were reviewed by a dermatopathologist blinded to the patients's treatment status. Pre-selected histologic criteria were evaluated for each slide. Pearson's chi-square and Fisher's exact test were used to analyze for statistical significance of each criteria.

RESULTS: There were 34 biopsy-proven MF from years 2004 to 2009. Male-to-female ratio was 1:1.8. Mean age at initial diagnosis was 46.7 years (13-81). Among the 16 patients with fully retrievable records, the most common presentation was that of hypopigmented patches. Age ? 60 years seemed to have significant association with relapse (P=0.02). Epidermotropism of ? 5 (P=0.03), absent to focal lymphocyte tagging (P=0.04), and dropping of haloed lymphocytes from >10 to ? 10 (P=0.01) somehow differentiated treated from untreated MF.

CONCLUSIONS: The hypopigmented variant of MF may be more common in Asian countries. Age ? 60 years old may be associated with higher risk of relapse. Grading epidermotropism, lymphocyte tagging and haloed lymphocytes may be helpful in determining adequacy of treatment of MF. However, given the small sample size of the present study, future larger studies are needed to confirm these findings.

Human ; Male ; Female ; Mycosis Fungoides ; Lymphocytes ; Lymphoma ; Biopsy

BACKGROUND: Melanoma is a malignant tumor ranked as the top cause of skin cancer death and is increasing in incidence in most races. Rarity and atypical presentation in Non-Caucasians lead to delayed diagnosis and poor survival rates in these populations. This is the first study in the Philippines to document and describe both clinical and histopathologic profile of melanoma in Filipinos. Data gathered and analyzed may be used as basis for future research on prevention and treatment of this deadly disease among Filipinos.
OBJECTIVE: To determine the epidemiology, clinical and histopathologic characteristics of melanoma patients in the Philippine General Hospital.
METHODS: Melanoma patient records and biopsies from the Department of Laboratories-Pathology Services and Section of Dermatology- Dermatopathology Unit of the Philippine General Hospital from 2004 to 2009 were reviewed.
RESULTS: Fifty-eight melanoma cases were identified. Based on the medical records retrieved, 35% were males and 23% females, while 42% had missing information. Most were in the fifth decade with a mean age of 52.8 years. The most common sites were the feet and trunk. Seven patients had recorded metastasis. The most common histopathologic characteristics noted was presence of angiolymphoid spread (70%), followed by presence of tumor-infiltrating lymphocytes (42%), ulceration (37%), high mitotic rate (35%), neurotropism (14%) and co-existing nevus (2%). Vertical growth phase was seen in 49% while 16% had a radial growth phase.
CONCLUSION: Melanoma has a lower prevalence rate in the population studied, but most presented with clinical and histopathologic features consistent with advanced stages.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Dermatology ; Lymphocytes, Tumor-infiltrating ; Melanoma ; Nevus ; Nevus, Pigmented ; Prevalence ; Skin Neoplasms

OBJECTIVES: This study aimed to evaluate the efficacy and safety of cashew nut extract (DeBCC©) cream compared with a vehicle cream in the treatment of basal cell carcinomas (BCC), mainly by comparing each group's composite clearance rate, defined by the absence of histopathologic evidence of BCC at the target lesion site.

METHODS: A randomized double-blind vehicle-controlled trial was conducted on nineteen patients, who underwent eight weekly topical treatment application sessions of either vehicle or experimental drug. Six weeks post-treatment, they underwent surgical excision of their lesions. A dermatopathologist examined these specimens. Clinical and histopathologic clearances were evaluated.

RESULTS: The clinical clearance rate (67%) of DeBCC was significantly higher compared to vehicle (p=0.003), while the composite clearance rate (33%) was not (p>0.005). The pre-test probability of clinical clearance in concordance with histopathologic clearance (15.79%) suggests that clinical resolution of a BCC lesion may not equate to histopathologic clerance.

CONCLUSION: This study showed a modest clinical clerance rate but a low composite clerance rate for DeBCC cream. Further studies with bigger sample size that are limited to less aggressive BCC subtypes are needed to strongly establish the efficacy and safety of topical cashew nut extract for BCC treatment.

Human ; Anacardium ; Nuts ; Carcinoma, Basal Cell ; Administration, Topical ; Probability ; Aminoquinolines ; Skin Neoplasms

We report a 23-year-old male with lepromatous leprosy atypically presenting with 5-year history of asymptomatic, verrucous papules, and nodules. Human Immunodeficiency Virus (HIV) testing was positive with depressed CD4 count. In HIV/leprosy co-infection, most of the documented patients were diagnosed with paucibacillary leprosy as immune reconstitution disease (IRD) from treatment-induced immunological recovery. Rarely, multibacillary lepromatous leprosy is encountered in the setting of untreated, severe immunodeficiency. Atypical clinical presentation warrants investigation for concurrent HIV infection.

Human ; Leprosy ; Leprosy, Lepromatous ; Hiv ; Coinfection

A 37-year-old Filipino man presented with a 9-month history of sagging skin progressing cephalocaudally from the chin and neck to the axillae, side of the trunk, and pelvic area. This was followed by a 2-month history of increasing serum creatinine levels associated with periorbital and bipedal edema, generalized weakness, decreased appetite, vomiting, and headache. Subsequently, skin-colored, non-tender sac-like plaques appeared on the abdomen, inguinal, and intergluteal areas. Histopathology of the latter lesions showed increased spaces between collagen bundles in the dermis. Staining with Verhoeff-van Gieson revealed focal sparse elastic fibers in the papillary dermis compared to that of the reticular dermis consistent with anetoderma. Further work-up revealed normal ANA titer and low serum C3. Kidney biopsy showed IgG deposition in the tubular basement membrane and trace C3 deposition in the glomerular mesangium, giving a diagnosis of rapid progressive glomerulonephritis. On subsequent follow-up, the sac-like plaques became lax and presented as generalized wrinkling of the skin, raising the question whether cutis laxa and anetoderma are occurring in a spectrum instead as distinct entities. Based on the current review of literature, this is the first reported case of primary anetoderma co-occurring with cutis laxa in a patient with glomerulonephritis. Deposition of immunoglobulins along the elastic fibers could have activated the complement system, mediating the destruction of the elastic fibers, resulting to cutis laxa and anetoderma. This case also considers the possibility of anetoderma and type I acquired cutis laxa occurring either in a spectrum or as distinct diseases in a single patient. Further investigations may identify an ultrastructural pattern that can help differentiate the two entities.
Anetoderma ; Cutis Laxa ; Glomerulonephritis

A 65-year-old female with chronic kidney disease (CKD) presented with a six-month history of asymptomatic translucent skin-colored and yellow plaques on the face. Similar yellow papules and nodules were noted in the oral cavity and eyelid margins. Biopsies were taken from the face and oral cavity showed homogeneous eosinophilic deposits with clefts in the dermis consistent with colloid milium. The patient was treated with fractional and surgical carbon dioxide (CO2) laser with improvement after one session.
Renal Insufficiency, Chronic ; Carbon Dioxide

Verrucous carcinoma is an uncommon low-grade well-differentiated malignant neoplasm that commonly arises on acral and mucosal sites. It is often both clinically and histologically misdiagnosed because of its slow growth and low cytologic atypia, respectively. We describe the case of a 74-year-old female with a papillomatous mass arising on a muscle flap and skin graft site on the left foot that had delay in diagnosis for more than 30 years. This case highlights verrucous carcinoma as consideration for both clinical and histologic differential diagnoses in chronic non-healing fungating tumor on the foot. Though non-aggressive in its course, the tumor can cause extensive local destruction of contiguous structures, hence, timely diagnosis and excision is paramount to prevent limb amputation.
Carcinoma, Verrucous

OBJECTIVES: To develop and validate a self-reported sunlight exposure questionnaire (SEQ) for urban adult Filipinos. METHODS: The study included adults (19–76 years old) in Metro Manila, Philippines, well-versed in the Filipino (Tagalog) language and had resided in Metro Manila for at least 1 year. Exclusion criteria included pregnancy, active skin disorders, and immunocompromised states. An expert panel created a questionnaire in Likert-scale format based on a conceptual framework and 4 existing instruments. The study proceeded in 4 phases: questionnaire item development, translation and back-translation, pretesting, and construct validity and reliability testing using factor analysis, the Cronbach alpha coefficient, and the paired t-test. RESULTS: A 25-item, self-administered, Filipino (Tagalog) SEQ answerable using a 4-point Likert scale was created. The questionnaire was administered to 260 adult participants twice at a 2-week interval, with all participants completing both the first and second rounds of testing. All questionnaire items possessed adequate content validity indices of at least 0.86. After factor analysis, 3 questionnaire domains were identified: intensity of sunlight exposure, factors affecting sunlight exposure, and sun protection practices. Internal consistency was satisfactory for both the overall questionnaire (Cronbach alpha, 0.80) and for each of the domains (Cronbach alpha, 0.74, 0.71, and 0.72, respectively). No statistically significant differences were observed in the responses between the first and second rounds of testing, indicating good test-retest reliability. CONCLUSIONS We developed a culturally-appropriate SEQ with sufficient content validity, construct validity, and reliability to assess sunlight exposure among urban adult Filipinos in Metro Manila, Philippines.