MMP is a rare blistering disease manifesting with painful erosions or blisters on one or more mucosal surfaces. An estimate of one to two cases per million annually are diagnosed, with females more affected than males.

We present a case of a 73-year-old Filipino female with recurrent multiple mucosal lesions involving the oral mucosa and genitals, ocular symptoms of foreign-body sensation, and erosions on her scalp.

On physical exam, there were multiple well-defined white plaques on an erythematous base on the oral mucosa and the labia minora. There were multiple well-defined erythematous alopecic patches with erosions and milia on the scalp. Histopathology revealed subepidermal split, while DIF findings were consistent with the pemphigoid group. ELISA showed increased anti-BP180, the most common target antigen for MMP. The patient was managed as a case of MMP. Prednisone 25 mg/day was given, which improved her lesions and decreased her MMPDAI score from 44 (moderate) to 10 (mild). She is currently maintained on azathioprine 50 mg/tablet.

Mucous membrane pemphigoid, being rare, is often overlooked as a differential diagnosis. When presented with a patient with predominantly mucosal lesions, it is important to consider MMP to prevent consequences from delayed diagnosis.

Human ; Female ; Aged: 65-79 Yrs Old

Psoriasis may manifest as severe hyperkeratotic lesions resembling an oyster shell called ostraceous psoriasis. This type of psoriasis is extremely rare and is often associated with psoriatic arthritis. Psoriatic arthritis is a chronic inflammatory disease of the joints presenting with pain, stiffness, swelling, tenderness, and limited movements. This is a case of a 16-year-old Filipino female presenting with pruritic erythematous plaques topped with thick adherent ostraceous scales associated with bilateral knee and elbow pains. Laboratory tests and biopsy were done. Histopathology is consistent with psoriasiform dermatitis and psoriatic arthritis is established through Early Psoriatic Arthritis (EARP) Screening Questionnaire and Classification Criteria for Psoriatic Arthritis (CASPAR). Patient was started on potent topical corticosteroids and Narrow-band Ultraviolet B (NB-UVB) phototherapy with minimal improvement. Hence, Secukinumab was initiated which showed significant improvement on the skin lesions and joint pains 7 days after the first dose of Secukinumab. Ostraceous psoriasis is rarely found in pediatric population. It is commonly associated with psoriatic arthritis that should be screened during routine consult. Its characteristic firmly adherent thick scales are resistant to topical treatments. One of the therapeutic options is Secukinumab, an IL-17A selective inhibitor targeting the release of proinflammatory cytokines, chemokines and mediators of tissue damage. It demonstrates immediate effect, significant and sustained improvement in the skin lesions, minimal adverse reactions, as well as improved quality of life and physical function. It is therefore a preferred treatment for patients with moderate to severe psoriasis and psoriatic arthritis requiring rapid clearance.

Human ; Female ; Adolescent: 13-18 Yrs Old ; Arthritis, Psoriatic ; Secukinumab

Dermatofibroma (DF) is a common, benign fibrohistiocytic tumor with unknown pathogenesis. There are multiple uncommon histologic variants of DF reported in literature, one of which is hemosiderotic DF. It can variably present as a pigmented papule or nodule commonly located on the lower extremities. Hemosiderotic DF remains to be underreported in the Philippines despite the widely available dermatopathology services in the country.
Human ; dermatofibroma ; histiocytoma, benign fibrous