Neurofibromatosis is a systemic disorder that presents with cafe-au-lait spots, intertriginous freckling, neurofibromas, optic pathway tumors, lisch nodules, and distinct osseous lesions. We present a case of a 57-year-old Filipino female with a lifelong history of multiple bumps on the skin. Clinical, dermoscopic, and histopathologic findings confirmed our diagnosis.

A multidisciplinary approach is the cornerstone of management of Neurofibromatosis Type 1. Surgical excision can be performed on symptomatic lesions, but the recurrence can occur. In April 2020, Koselugo (selumetinib) was approved by the U.S. Food and Drug Administration (FDA) for the treatment of NF1-associated plexiform neurofibromas that are disfiguring or inoperable in children 2 years and older. The outlook for patients with NF-1 is guarded and depends on the severity of the disease, the presence of malignancy, and the extent of the deformity.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Neurofibroma ; Neurofibromatoses

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