This case series highlights the diagnostic challenges in differentiating between scarring and nonscarring alopecia, as both patients presented with similar features yet had distinct underlying conditions.

The first patient (60 year old, female) was initially diagnosed with Frontal Fibrosing Alopecia due to the pattern of hair loss in the frontal area of the scalp. Trichoscopy shows perifollicular and interfollicular scaling, yellow crusts around the follicles, dotted vessels, yellow structureless areas with surrounding erythema. However, the patient responded well to Clobetasol Propionate 500mcg/mL Scalp Solution twice a day and Minoxidil 5% Solution twice a day for 30 days, which was not expected in patients with scarring alopecia. Further evaluation revealed that the hair loss was due to Telogen Effluvium and Seborrheic Dermatitis.

In contrast, the second patient (54 year old, female), which was managed as a case of Discoid Lupus Erythematosus of the scalp. Trichoscopy shows absence of follicular opening, white patches, perifollicular scale, white and brown dots. Despite receiving similar treatment, the patient did not experience any improvement, reinforcing the complexity of managing hair loss disorders.

A key aspect of this case series is the emphasis on Trichoscopy. It shows specific patterns associated with various types of alopecia, allowing for prompt diagnosis and treatment while reducing the need for unnecessary biopsies. It invites further discussion on the importance of accurate assessment, the role of Trichoscopy in diagnosis, and the potential for unexpected responses to treatment in Dermatology.

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

Lymphangioma is a rare vascular malformation, comprising about 4% of such anomalies. Its most common symptom is swelling, which often leads to cosmetic deformity. The most prevalent subtype, lymphangioma circumscriptum, seldom presents on the vulvar area, making treatment especially challenging due to potential complications and recurrence risks.

This is a case of a 10-year-old Filipino female, otherwise healthy, who presented with progressively enlarging, tender, “frog spawn”-like papules on the left vulva since birth. These papules showed partial improvement following surgical excision. Histopathological examination confirmed the diagnosis of lymphangioma. Over the past year, the patient experienced recurrence of papules, resulting in vulvar asymmetry and labial swelling. Pelvic magnetic resonance imaging (MRI), ultrasound, and fine needle aspiration biopsy, revealed multiple superficial and deep cystic masses consistent with lymphangioma. Long-pulsed Nd:YAG laser was administered to the external lesions, yielding partial improvement. Subsequently, she underwent ultrasound-guided sclerotherapy with bleomycin under local anesthesia.

This procedure, performed by interventional radiology, successfully resolved the deep cysts and swelling after two sessions, with no reported complications.

In cases of cutaneous lymphangioma, especially in anatomically sensitive regions like the vulva, imaging plays a crucial role in determining lesion depth and guiding treatment to minimize recurrences. Although no local literature is available, this case highlights the effectiveness and safety of ultrasound-guided sclerotherapy with bleomycin as a novel treatment option for lymphangioma.

Human ; Female ; Child: 6-12 Yrs Old ; Lymphangioma ; Sclerotherapy

BACKGROUND

Despite the widespread prevalence of pattern hair loss, treatment options remain limited. Platelet-rich plasma (PRP) is a promising alternative but is hindered by high costs and a lack of standardized protocols. In the Philippines, only one FDA-approved PRP kit is available, leading to interest in whether Acid Citrate Dextrose Solution A (ACD-A) tube could provide equivalent results. Additionally, international research on different anticoagulant preparations is lacking, with no studies conducted in the Philippines.

OBJECTIVE

To determine if the efficacy and safety of PRP therapy using ACD-A and Sodium Citrate (SC) PRP Kit are equivalent in the treatment of adult pattern hair loss.

METHODS

A single-blind, randomized, placebo-controlled, equivalence trial. Participants were randomly assigned to either a control group or a treatment group receiving ACD-A or SC PRP Kit preparations. Treatments were administered monthly for six sessions. Hair growth was assessed at baseline and after each session using global photography, hair classification system, and trichoscopy.

RESULTS

A total of 48 participants completed the study, divided into three groups of 16 participants each. Mean hair density scores for the ACD-A and SC KIT groups, along with 95% confidence intervals for mean differences at various timeframes, fell within the equivalence margin of ±16 hair follicles/cm2. Minimal adverse effects were observed throughout the study.

CONCLUSION

ACD-A produces results equivalent to the SC PRP Kit in terms of hair growth and patient satisfaction. Both preparations are safe, with only minor adverse effects, making ACD-A a viable alternative for PRP treatments of pattern hair loss.

Human ; Platelet-rich Plasma

BACKGROUND

Accurate diagnosis of onychomycosis is important because its treatment is long-term, costly, and sometimes with complications. KOH test is quick and cheap but has low sensitivity. Hence, the need for additional tests such as culture and/or PAS. However, these two tests are not readily available and expensive. Dermoscopy is an emerging tool for the diagnosis of nail conditions.

OBJECTIVE

This study aims to evaluate the accuracy of dermoscopy as a point-of-care tool in diagnosing distal subungual onychomycosis (DSO).

METHODS

This is a prospective, cross-sectional study of 22 clinically diagnosed DSO patients selected via convenience sampling in a tertiary hospital from November 2019 to March 2021. Participants had gross nail examination, dermoscopy, KOH and PAS tests. Measures of diagnostic accuracy for the different dermoscopic patterns were obtained, with KOH and PAS results as reference standard.

RESULTS

Fifty-one nail samples were submitted for processing with only 49 nails accepted for analysis. The most common pattern was jagged edge with spikes (65.3%). Combining all 5 dermoscopic patterns increased the sensitivity to 91.2% (95% CI: 76.3, 98.1).

CONCLUSIONS

Dermoscopy may be used as a first-step, point-of-care tool in the diagnosis of DSO. Addition of mycological and histopathological tests is still warranted for confirmation.

Dermoscopy ; Onychomycosis ; Potassium Hydroxide