Human ; Male ; Female ; Dermoscopy ; Dermatology ; Melanoma

The superficial fibramatoses are a rare group of mainly benign disorders that clinically manifest as slow progressive dermal hypertrophies. This bewildering group of dermal matrix proliferation is composed of fibrous tissue, fibroblastic cells or spindle stromal cells with varying degrees of cellularity. Skin lesions are usually solitary or localized to a specific site of predilection. This is a case of a 15-year-old Filipino boy, presenting with asymptomatic firm, skin colored to erythematous papules and nodules on his limbs and nose. The lesions slowly worsened, resulting in flexion deformity and limited range of motion of both hands.

Human ; Male ; Adolescent ; Administration, Cutaneous ; Fibroblasts ; Hypertrophy ; Nose ; Range Of Motion, Articular ; Skin ; Skin Diseases ; Stromal Cells ; ; Dupuytren Contracture

A 21 year old Filipino male presented with swelling of the second right hand digit unresponsive to antibiotics. Amputation revealed chronic inflammation and negative cultures. He developed sterile conjunctivitis and a generalized eruption of asymptomatic red papules and nodules. First skin biopsy revealed a diffuse infiltrate of epithelioid and foamy histiocytes, diagnosed as "juvenile xanthogranuloma." The second biopsy revealed large histiocytes with a "ground-glass" eosinophilic cytoplasm, multinucleated giant cells, and mixed cell infiltrate. Immunohistochemistry showed histiocytes staining with (+)S100 and (+)CD68, and (-)CD1a. Final diagnosis was "multicentric reticulohistocytosis." Despite treatment with oral prednisone, methotrexate and alendronate, lesions were progressive.
CONCLUSION: This fascinating case manifests with overlapping features of both juvenile xanthogranuloma and multicentric reticulohistiocytosis, and lead the authors to suggest considering the spectrum of diseases called the non-Langerhans cells histiocytosis when presented with a generalized nodular eruption.

Human ; Male ; Young Adult ; Antigens, Cd1 ; Biopsy ; Conjunctivitis ; Exanthema ; Giant Cells ; Histiocytes ; Histiocytosis, Non-langerhans-cell ; Inflammation ; Methotrexate

INTRODUCTION: The nails have many functions for daily life including protection of the digits against different kinds of trauma. The nail apparatus is composed of multiple kinds of keratins. Defects in keratin may produce several genodermatoses, which include Pachyonychia congenita. This is a rare genodermatosis that is either automosal dominant or sporadic. The usual involved keratins are KRT6a, KRT6b, KRT6C, Kl 6 and Kl 7. Keratin defects may manifest on the hair, mucosa, skin and nails. Different presentations of each patient depends on the involved mutated keratins, In rare cases, nail dystrophy may be the only manifestation of the keratin defect. CASE SUMMARY: A 23 -year-old female presented with a 13-year-history of nail thickening on both fingernails and toenails with no other associated symptoms. She denied oral and skin lesions. She had been unsuccessfully treated with both oral and topical antifungals by several dermatologists. No family members have any similar conditions. She admitted to having hoarseness. On physical examination, nails of both hands and feet marked subungual hyperkeratosis, yellowish to brown- gray discoloration and hypercurvature and rough surface of all 20 nails. The histopathology report revealed marked compact hyperkeratosis, hypergranulosis, papillomatosis and acanthosis. Fungal culture and PAS stain revealed no fungal elements. Patient responded well to nail avulsion and good nail regrowth was noted. She plans treatment of all nails with avulsion. CONCLUSION Thorough history, physical examination and histology may help confirm the diagnosis of Pachyonychia congenita, which at times may be mistaken for other nail problems. Treatment is based upon the clinical presentation of the patient. Prognosis for life is good but complications such as infections should be properly addressed.

INTRODUCTION: Cutaneous mastocytosis is the accumulation of mast cells in the skin. Diffuse cutaneous mastocytosis is a rare variant accounting for only 1.74% of al mastocytosis cases reported. Ninety percent of cases are seen in children presenting with multiple erythematous to yellow-tan papules and plaques with leathery texture. The pathogenesis is in the structure and activity of kit receptor expressed on mast cells, melanocytes and other cells. CASE SUMMARY: This is a female neonate born to an 18 year old mother, G1P1 via vaginal delivery at 37 weeks age of gestation. Patient presented with a generalized involvement of multiple, well defined, indurated, leathery, brown papules and confluent plaques. Darier sign was positive. Histopathological examination revealed diffuse involvement of the dermis with mast cells. Giemsa stain was positive. Patient was diagnosed both clinically and histopathologically with diffuse cutaneous mastocytosis without systemic involvement. She was treated with H1 antihistamines and topical glucocorticoids. CONCLUSION Diffuse cutaneous mastocytosis can be diagnosed both clinically and histopathologically. Treatment is mostly symptomatic. It is always prudent to inform co-managing physicians, the patient, and their families of potential mast cell degranulating stimuli and to watch out for signs and symptoms for systemic involvement.

INTRODUCTION: Dermatomyositis is a rare idiopathic inflammatory myopathy with characteristic skin manifestations and proximal muscular weakness. In 30 percent of classic dermatomyositis, skin findings precede muscle weakness. Since the initial skin lesions are not always highly characteristic of dermatomyositis, there may be a delay in diagnosis and treatment. CASE REPORT: This is a case of a 36-year-old Filipino female who initially presented with erythematous patches and plaques on the face, arms, and thighs. One week later, she developed multiple, well-defined, erythematous to violaceous, edematous, tender patches and plaques on the face, V of the neck, upper back, proximal extremities and buttocks. Seven weeks later, she developed proximal muscle weakness described as difficulty in raising her arms and difficulty in standing up from a sitting position. Histopathology was consistent with dermatomyositis. SGPT, C3, ANA, and anti-ds-DNA were normal. SGOT and creatine kinase were 5 and 15 times the normal value, respectively. She was treated with prednisone from the first week of illness and hydroxychloroquine from the fifth week of illness. Her condition greatly improved with no progression of the disease for the succeeding 3 years. CONCLUSION Even in the absence of muscle weakness, there should be a high index of suspicion for dermatomyositis in patients with confluent, erythematous patches and plaques on the face, trunk and proximal extremities. Adequate work-up and clinical monitoring will pave the way for early diagnosis and consequently early treatment and a better patient outcome.
Dermatomyositis

INTRODUCTION: Bullous pemphigoid (BP) is a chronic, relapsing autoimmune blistering disorder commonly found in adults older than 60 years of age. It is mediated by autoantibodies directed against the hemidesmosomal proteins BP180 and BP230, which trigger an inflammatory cascade leading to blister formation. BP may present with pruritus, followed by an erythematous plaque or urticaria, and subsequently by bullae formation with or without mucosal involvement. It develops sporadically but can also be triggered by ultraviolet light exposure, radiation therapy, and medications such as dipeptidyl peptidase-4 inhibitor (DPP4i). Since 2006, the increasing use of DPP4i (also known as gliptins) for their good safety profi le in treating Type II Diabetes Mellitus has led to a further increase in the incidence of bullous pemphigoid.

CASE REPORT: This is a case of a 65-year-old hypertensive and diabetic elderly Filipino female presenting DPP4i (linagliptin)-induced bullous pemphigoid with an atypical dyshidrosiform pattern, negative direct immunofluorescence (DIF), and Enzyme-linked immunosorbent assay (ELISA) that is negative for anti-BP180 antibodies but positive for anti-BP230 antibodies.

CONCLUSION: The increasing use of DPP4i for diabetes mellitus for its good safety profile may be an essential contributing factor to the increasing incidence of BP in elderly hypertensive and diabetic patients with a simultaneous increasing incidence of atypical BP presentations such as the dyshidrosiform variant. Inability to recognize these factors carries significant therapeutic implications, including prolonged multidrug immunosuppression and increased patient morbidity and mortality.

KEYWORDS: Bullous pemphigoid, gliptin, ELISA

Pemphigoid, Bullous ; Dipeptidyl-Peptidase IV Inhibitors ; Enzyme-Linked Immunosorbent Assay

INTRODUCTION Alopecia areata incognita is a rare form of alopecia areata which was first reported in 1987. The prevalence of this disease is unknown but it is more common in women. The usual presentation of alopecia areata incognita is acute, diffuse hair thinning. In most cases, it lacks the typical alopetic patches seen in alopecia areata. It may resemble telogen effluvium and androgenetic alopecia. The prognosis of this disease is favorable and recovery is rapid and spontaneous. Case: A 19- year-old Filipino female presents with a two-month history of alopecia areata incognita. She initially had a solitary round patch of hair loss on the scalp with proximally tapered hair, rapidly evolving into diffuse hair thinning. CBC, TFTS, FBS, HBA 1 c, ANA and VDRL were unremarkable. Histopathology demonstrated dense peribulbar lymphocytic infiltrate, miniaturized hair and increased catagen hair consistent with alopecia areata. There was gradual hair growth after treatment with minoxidil 5% lotion and topical betamethasone dipropionate 0.05% lotion.

Background: With the recent rise in number of HIV/AIDS patients in the Philippines, knowledge of the most common mucosal and cutaneous findings among HIV/AIDS patients can be a valuable tool of assessment. Objectives: To determine the different mucosal and cutaneous disease findings of HIV/AIDS patients; evaluate their frequency and association with the latest CD4 cell counts, and to determine patients’ demographic and medical profiles. Methods: This is a cross-sectional study done at a tertiary hospital in Makati city from January 2017 to September 2018. Walk-in patients or those referred by Infectious Disease specialists were evaluated using a standardized history and physical examina- tion form. Latest CD4 counts were also obtained. Results: A total of 93 patients were enrolled. Majority were males (98%), with a mean age of 32 +/- 7.08, employed (64%), and on HAART (87%). A large part of the group (45%) has severe immunosuppression (CD4 counts <200/mm3). The most common manifes- tations were the following: non-infective, fungal, and drug-related dermatoses, with the most common dermatoses being seb- orrheic dermatitis, xerosis, pruritic papular eruptions (PPE), superficial fungal infections, drug hypersensitivity reactions, and syphilis. PPE was noted to be significantly associated with low CD4 counts. Conclusion Due to small population size, significant associations between the other dermatoses with their CD4 counts were not seen except for PPE, which was significantly associated with CD4 counts <200/mm3. Nevertheless, a strong suspicion for any underlying HIV//AIDS infection is still warranted in the presence of these dermatoses.
HIV ; Acquired Immunodeficiency Syndrome ; CD4 Lymphocyte Count

Background: Dermoscopy, a non-invasive diagnostic tool, has been proven to improve the diagnostic accuracy of vascular tumors since it can aid in identifying vascular structures as well as morphology of vessels. Tumor depth and precise vascular structures can also be evaluated through dermoscopy. Objective: The study aimed to describe the dermoscopic features of red tumors in Filipino patients seen at the Outpatient Dermatology Department of two centers from January 2013 to July 2014. Methods: Patients with red tumors were recruited to the study. Dermoscopic features were described for each tumor, and histopathology was done. Results: A total of 44 patients were included in the study, and 45 red tumors were evaluated. The tumors were located on the face (31%), trunk (36%), and extremities (33%). The majority of the red tumors were confirmed to be vascular tumors (78%) on histopathology. Dermoscopic features that were found in the majority of vascular tumors seen were lacunae and reddish homogenous areas. For non-vascular tumors, vessels were identifiable in 90% of the tumors seen. Conclusion In this study, the use of dermoscopy in the diagnosis of red tumors proved to be a useful preliminary tool that aided in the observation of vascular pattern, albeit red lacunae, red to dark red homogenous areas, and different types of vessels. The identification of these structures may aid in arriving at a more precise diagnosis and help differentiate vascular from non-vascular tumors.
Dermoscopy