BACKGROUND

Hansen’s Disease, a chronic infectious disease, presents with a variety of cutaneous lesions. Being the “great mimicker” that it is, patients may often be misdiagnosed initially, hence the delay in the initiation of the multidrug therapy. Dermoscopy offers an effective, efficient, operator-friendly and non-invasive adjunctive tool in the diagnosis of Hansen’s Disease.

OBJECTIVES

The general objective of the study is to describe the common dermoscopic features according to clinical and histologic findings among all newly diagnosed Hansen’s Disease patients in a tertiary institution within the study period of 6 months.

METHODS

Purposive sampling was applied to include all newly diagnosed and biopsy-proven Hansen’s Disease patients aged 18 years to 65 years. Participants were clinically examined and dermoscopy was performed on a representative lesion. Other data were collected from chart review, acid fast smear and histopathology reports.

RESULTS

The main dermoscopic feature of Hansen’s Disease is yellowish orange areas observed in all 23 cases studied regardless of the spectrum. This feature can be attributed well to the presence of granuloma formation and inflammation. Another common feature is the presence of white globules and dots which correlates to the presence of the grenz zone, while vascular structures correlate with dilated blood vessels on histopathology.

CONCLUSION

The major dermoscopic features seen in the study may add to the clinical clues to arrive at a diagnosis of Hansen’s Disease. Although dermoscopy alone is insufficient for the confirmation of Hansen’s Disease, combining it with physical findings would provide additional basis for its clinical diagnosis.

Human ; Dermoscopy

Introduction: Epidermolysis Bullosa Acquisita (EBA) is a rare autoimmune blistering disease which presents in the skin and mucous membranes. The decrease in anchoring fibrils in the basement membrane zone causes separation of the epidermis from the dermis, resulting in its blistering presentation. The treatment plan will depend on the severity of the disease. The first-line treatment for mild EBA includes topical corticosteroids and immunomodulators such as dapsone and colchicine; while severe cases of EBA may be given intravenous immunoglobulins, systemic steroids, and immunosuppressants such as azathioprine and cyclophosphamide. Case Report: This is a case of a 50-year-old Filipino male who presented with a 2-year history of vesicles and tense bullae which evolved into papules, plaques and erosions with scarring and milia formation on the scalp and trauma-prone areas of the trunk and extremities. Clinical examination revealed multiple, well-defined, irregularly shaped erythematous papules and plaques with crusts, scales, erosions, pearl-like milia and scarring on the chest, back, upper, and lower extremities. The oral mucosa was moist with some ulcers on the tongue. Histopathologic examination using Hematoxylin and Eosin (H&E) stain revealed the absence of the epidermis with retention of dermal papillae suggestive of subepidermal clefting. Further examination with direct immunofluorescence (DIF) revealed monoclonal immunoglobulin (IgG) deposits demonstrating an intense linear fluorescent band at the dermoepidermal junction, consistent with Epidermolysis Bullosa Acquisita. Overall, the combined administration of prednisone, azathioprine, and colchicine resulted only in transient and incomplete resolution of lesions in this case of EBA. Conclusion The management of EBA is mostly supportive with the goal of minimizing complications. Combination treatments using steroids, colchicine, and azathioprine have been reported with various results. Its management remains challenging as most cases are refractory to treatment.
Epidermolysis Bullosa Acquisita ; bullous disease ; azathioprine ; colchicine ; prednisone