Human ; Female ; Aged ; Mycosis Fungoides ; Skin Neoplasms ; Skin ; Dermatitis, Exfoliative ; Cheek ; Emollients

BACKGROUND: Extramammary Paget's disease (EMPD) is a rare intraepidermal adenocarcinoma seen in areas with high density of apocrine glands such as the vulva, perianal area, scrotal and penile regions. Clinically the lesions appear to be well-defined erythematous or white plaques accompanied by pruritus; often misdiagnosed as inflammatory or infectious conditions i.e. psoriasis, candidiasis or dermatitis. At present, there is no retrospective study on the prevalence of EMPD in the Philippines.
OBJECTIVE: This study aimed to conduct a ten-year retrospective review of histologically diagnosed extramammary Paget's disease in the Philippine General Hospital from 1997 to 2006, and confirm the diagnoses by carcinoembryonic antigen immunostain (CEA).
METHODS: Histopathology logbooks and organ files of the PGH Section of Dermatology and PGH Department of Pathology from January 1997 to December 2006 were searched. Records and specimen paraffin blocks of EMPD patients were retrieved for review and CEA immunostain, respectively.
RESULTS: Nine EMPD patients were seen in a ten-year period, eight were positive for CEA, and one had no paraffin block available for review. The vulva was the most common site (89 percent) followed by the perianal area (11 percent), and all patients were females, aged 47 to 86 years old. The most common complaint was pruritus, often misdiagnosed as fungal infection, contact dermatitis, vulvar carcinoma or malignant melanoma; with one week to seven years before a final diagnosis of EMPD was made. Lesions were mostly erythematous, indurated plaques ranging from 0.48 cm to 299 cm with a mean of 120.67 cm . Malignancy was noted in one patient who had breast cancer prior to appearance of vulvar lesions. Surgical removal of the lesion was the main mode of-treatment. Vulvectomy, wide excision or local excision has been done with surgical flaps or grafts depending on the size of the lesion.
CONCLUSION: From 1997 to 2006 the Philippine General Hospital had nine histopathologically diagnosed EMPD, eight of which in the vulvar area and eight had CEA positive staining. Recurrence of lesions and appearance of concomitant malignancy could not be assessed due to the poor follow up of patients and incomplete records.

Human ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Candidiasis ; Carcinoembryonic Antigen ; Dermatitis, Contact ; Melanoma ; Mycoses ; Neoplasm Recurrence, Local ; Paget Disease, Extramammary ; Psoriasis ; Surgical Flaps

INTRODUCTION: Kaposi sarcoma (KS) is a multicentric, vasoproliferative tumor. Human herpes virus 8 has been demonstrated to have a direct role in its development. Classic Kaposi sarcoma is seen in HIV-negative, elderly men, often of Jewish or Mediterranean lineage.
CASE REPORT: A 78-year-old, HIV-negative man presented with a 4-year history of multiple nodules and plaques on both lower extremities. Histologic findings were consistent with nodular Kaposi sarcoma. Immunohistochemistry studies showed CD34+ cells. Tumor cells stained positive for HHV-8 latent nuclear antigen. As palliative treatment, the patient underwent external beam radiotherapy.
CONCLUSION: Classic Kaposi sarcoma tends to run an indolent course. Progression of skin lesions however, can lead to immense discomfort and disfigurement. As there is no definitive treatment algorithm for KS, management decisions should be made judiciously to choose the most effective treatment that will cause the least morbidity.

Human ; Male ; Aged ; Antigens, Nuclear ; Disease Progression ; Hiv Infections ; Herpesvirus 8, Human ; Lower Extremity ; Palliative Care ; Sarcoma, Kaposi ; Skin Diseases ; Skin Neoplasms ; Treatment Outcome

BACKGROUND: Extramammary Paget's disease (EMPD) is a rare intraepidermal adenocarcinoma seen in areas with high density of apocrine glands such as the vulva, perianal area, scrotal and penile regions. Clinically the lesions appear to be well-defined erythematous or white plaques accompanied by pruritus; often misdiagnosed as inflammatory or infectious conditions i.e. psoriasis, candidiasis or dermatitis. At present, there is no retrospective study on the prevalence of EMPD in the Philippines.
OBJECTIVE: This study aimed to conduct a ten-year retrospective review of histologically diagnosed extramammary Paget's disease in the Philippine General Hospital from 1997 to 2006, and confirm the diagnoses by carcinoembryonic antigen immunostain (CEA).
METHODS: Histopathology logbooks and organ files of the PGH Section of Dermatology and PGH Department of Pathology from January 1997 to December 2006 were searched. Records and specimen paraffin blocks of EMPD patients were retrieved for review and CEA immunostain, respectively.
RESULTS: Nine EMPD patients were seen in a ten-year period, eight were positive for CEA, and one had no paraffin block available for review. The vulva was the most common site (89 percent) followed by the perianal area (11 percent), and all patients were females, aged 47 to 86 years old. The most common complaint was pruritus, often misdiagnosed as fungal infection, contact dermatitis, vulvar carcinoma or malignant melanoma; with one week to seven years before a final diagnosis of EMPD was made. Lesions were mostly erythematous, indurated plaques ranging from 0.48 cm to 299 cm with a mean of 120.67 cm . Malignancy was noted in one patient who had breast cancer prior to appearance of vulvar lesions. Surgical removal of the lesion was the main mode of-treatment. Vulvectomy, wide excision or local excision has been done with surgical flaps or grafts depending on the size of the lesion.
CONCLUSION: From 1997 to 2006 the Philippine General Hospital had nine histopathologically diagnosed EMPD, eight of which in the vulvar area and eight had CEA positive staining. Recurrence of lesions and appearance of concomitant malignancy could not be assessed due to the poor follow up of patients and incomplete records.

Human ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Candidiasis ; Carcinoembryonic Antigen ; Dermatitis, Contact ; Melanoma ; Mycoses ; Neoplasm Recurrence, Local ; Paget Disease, Extramammary ; Psoriasis ; Surgical Flaps

BACKGROUND: Verrucae or warts, are benign epithelial growths caused by human papillomavirus (HPV) infection of the skin. They are unsightly and may affect a patient's quality of life, causing social embarrassment, discomfort, pain, and interference in certain activities.
OBJECTIVE: To evaluate the efficacy and safety of imiquimod 5 percent cream for sixteen weeks in the treatment of verruca vulgaris and verruca plana in an open-label trial involving healthy immunocompetent Filipino patients of the Dermatology out-patient clinic of the Philippine General Hospital.
METHODS: Imiquimod 5 percent cream was self-administered by patients with verruca vulgaris or verruca plana on their lesions, nightly for 16 weeks. Follow-up was done every two weeks to determine any change in size over time. Side effects were recorded.
RESULTS: Complete clearance was seen in 31.8% of verruca vulgaris cases, with improvement seen in 59 percent of cases. Shorter duration of lesions was associated with clearance. Complete clearance was seen in only 1 out of 8 patients with verruca plana treated. Minor side effects were reported.
CONCLUSION: Topical imiquimod 5 percent cream is a safe, well-tolerated, painless, convenient, patient-applied route which may be a preferred alternative treatment for verruca vulgaris.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Aminoquinolines ; Dermatology ; Hospitals, General ; Outpatients ; Pain ; Papillomavirus Infections ; Philippines ; Skin ; Warts

This is a case of an 11-year-old male who presented with multiple neurofibromas with hypertrichosis. Classic cutaneous neurofibromas, café-au-lait macules, axillary freckling, Lisch nodules, and scoliosis were also present fulfilling a diagnosis of Neurofibromatosis type 1. This is the first report of multiple neurofibromas with hypertrichosis in the Philippines. Hypertrichosis overlying a neurofibroma is rarely reported and the mechanism remains to be elucidated.

Human ; Neurofibromatosis 1 ; Hypertrichosis ; Neurofibroma

We report the first published case of multiple eruptive myxoid dermatofibroma (MEMDF) in a male with chronic hepatitis B infection presenting with eruptive lesions showing marked deposits of dermal mucin. Alcian blue and immunohistochemistry confirmed the diagnosis of myxoid dermatofibroma. Further work-up showed asymptomatic chronic hepatitis B infection without cirrhosis.This case highlights an extremely rare histologic variant and the importance of screening for altered immunity in patients with eruptive dermatofibromas.

Human ; Female ; Middle Aged ; Histiocytoma, Benign Fibrous ; Mucins ; Alcian Blue ; Hepatitis B, Chronic ; Immunohistochemistry ; Muc1 Protein, Human ; Mucin-1 ; Liver Cirrhosis ; Exanthema

Introduction: Morphea, is a rare autoimmune disease presenting with fibrotic changes in the dermis and subcutis. It is a benign condition associated with significant atrophy and sclerosis leading to disfigurement, flexure contractures, and impaired function. Ultraviolet A1 and photochemotherapy are highly effective treatment options but are not readily available in the country. Narrowband ultraviolet B (NBUVB), on the other hand, is readily available, affordable, and safe to use. Case summary: Three patients diagnosed with different variants of morphea (bilateral generalize morphea, unilateral generalized morphea, and circumscribed morphea). underwent 30 sessions of NBUVB. Treatment response was assessed using tightness and itch Visual Analogue Scale (VAS), Modified Skin Score (MSS), photographic comparison, ultrasonographic measurement, and histopathologic analysis. NBUVB treatment resulted to 14-60% decrease in the tightness and itch VAS. MSS was also reduced by 35-50%. The size, pigmentation, and erythema of the lesions also decreased. Ultrasonography showed an improvement in the thickness of lesions after treatment. Histopathologic study showed less packed collagen with increase in inter-bundle spaces. Conclusion Response to treatment was influenced by the age of the lesion and anatomical location. More chronic lesions tend to have less response. Lesions on the face exhibited the greatest improvement while lesions on the lower extremities had the least improvement. This is the first case series study in the country that uses NBUVB as treatment for morphea. The improvement of the sclerotic and atrophic lesions treated with narrowband UVB treatment may be an acceptable substitute for UVA1 and PUVA.
Scleroderma, Localized ; Phototherapy

Bullous eruptions are rare cutaneous manifestations of systemic lupus erythematosus. We report a case of an 8-year old Filipino girl with vesiculobullous systemic lupus erythematosus (SLE) and membranous lupus nephritis on kidney biopsy who presented with clinical nephrotic features of generalized edema, proteinuria, hypoalbuminemia and hyperlipidemia. The 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE were met. Immunohistopathologic examination of the skin lesion revealed a sub-epidermal split with neutrophilic infiltrates along the dermo-epidermal junction, moderate perivascular, periadnexal and interstitial infiltrates composed of predominantly neutrophils with neutrophilic dusts, lymphocytes, plasma cells, rare eosinophils and increased dermal mucin. Direct immunofluorescence showed strong continuous linear IgG deposits along the basement membrane and weak linear IgM and IgA deposition along the basement membrane zone (BMZ). To our knowledge, this is the first report of vesiculobullous SLE in a Filipino child. This case is a rare form of cutaneous lupus in children. Bullous SLE (BSLE) should be considered in the differential diagnosis of children presenting with generalized bullous eruptions.

Human ; Female ; Lupus Erythematosus, Systemic ; Child