: Pachydermoperiostosis (PDP) or primary hypertrophic osteoarthropathy (PHO) is a rare genetic disorder that affects mainly skin and bones. Its main clinical features are pachyderma (thickening of the skin), periostosis ~excessiv~ bone formation) and clubbing of fingernails. The d1sea~e is more common among males with a 7:1 ratio, starts during adolescence and stabilize and cease progression after 5 - 20 years. OBJECTIVE: To discuss the summary of the case, new management options, and outcomes of the management options. CASE SUMMARY (METHODS): A 28-year-old male presents with a 9-year history of wrinkling of his facial skin. Other associated symptoms were seborrhea, acne, clubbed fingers, and occasional minimal knee joint pain. Histopathology results showed thickened dermis, fibrosis of the papillary dermis and around the folliculosebaceous units, hyalinized collagen bundles involving the fibrous trabeculae of the subcutis, and prominence of sebaceous and eccrine glands. The patient was given oral isotretinoin at 0.5 mg/kg/day, underwent fractional CO~ laser f?r rhytides and large pores, and given botuhnum toxin A injection (total of 16 U) on 5 sites at the glabellar region. The patient was referred to plastic surgery for frontal rhytidectomy, and orthopedic surgery for management of joint pains. RESULTS: The patient noted 80% improvement from baseline. CONCLUSION Treatment of pachydermoperiostosis is mainly symptomatic and requires a multi-spec~alty approach. Because of its rarity, treatment options for pachydermoperiostosis have yet to_ be standardized. In this particular case, all available options in the institution were utilized which led to satisfaction of the patient of the outcome.

INTRODUCTION: Acne Vulgaris is one of the most common dermatologic diagnoses in the world. It can persist for years, result in permanent scarring, and have serious adverse effects on psychosocial development.

OBJECTIVES: This study aims to determine the relationship between whole blood zinc levels and severity of acne.

METHODS: This is a cross-sectional comparative study. Whole blood zinc levels of 30 patients with acne vulgaris divided into mild (n=10), moderate (n=10), and severe (n=10), and 10 healthy patients were measured. Acne severity was evaluated using the Global Acne Grading System (GAGS).

RESULTS: A total of 40 patients participated in this study. The mean whole blood zinc level in acne patients and non-acne patients were 5.03 ± 1.92 mcg/mL and 7.39 ± 0.79 mcg/mL, respectively. The mean zinc level of the controls was significantly higher compared to that of the acne patients (p=0.0006). Furthermore, mean whole blood zinc level of the patients with severe acne was significantly lower compared to that of the controls, mild acne and moderate acne (p<0.001). Adjusting for age and sex, there is a significant association between severity of acne vulgaris and blood zinc levels (p<0.0001). Specifically, the mean blood zinc level of the patients with moderate and severe acne were significantly lower compared to that of the control group (p=0.019 and p<0.001, respectively).

CONCLUSION: Whole blood zinc levels were inversely correlated with acne vulgaris severity in the Filipino population. Further studies are recommended to determine the role of zinc in the pathogenesis of acne and the effects of oral zinc supplementation on acne patients.