INTRODUCTION: Secondary syphilis is a sexually transmitted infection characterized by localized or diffuse mucocutaneous lesions, often with generalized lymphadenopathy with laboratory evidence consistent with syphilis. Condolyma latum is one of the many forms of secondary syphilis and is noted to occur commonly on moist intertriginous areas of the body such as the axilla, web spaces of the toes, genital and perianal regions.
CASE REPORT: An 18 year-old man presented with a four-month history of few erythematous pruritic plaques on the penile shaft and multiple moist plaques involving the scalp, face, anterior neck, nape, axilla,anterior abdomen, upper and lower extremities, and scrotum. There are few erythematous scaly patches noted on the palms and soles. Serologic testing confirmed a diagnosis of syphilis and the patient tested negative for human immunodeficiency virus infection. The patient was given a single dose of intramuscular benzathine penicillin G 2.4 million units, with noted flattening of all lesions upon follow-up three months later.
CONCLUSION: Condylomata lata, although most commonly found on moist intriginous areas of the axilla, web spaces of the toes, genital and perianal regions, can also involve less commonly affected areas such as the scalp, face, anterior abdomen, and the extremities. A high index of suspicion therefore is warranted to differentiate it from other cutaneous diseases and to prevent progression of the disease by initiating appropriate antibacterial therapy.

Human ; Male ; Adolescent ; Anti-bacterial Agents ; Axilla ; Hiv Infections ; Lower Extremity ; Lymphadenopathy ; Scrotum ; Sexually Transmitted Diseases ; Syphilis ; Syphilis, Cutaneous

Cytomegalovirus (CMV) rarely manifests as cutaneous lesions in immunocompromised patients. Only 25 cases have been reported since 1991. It causes latent infection among exposed individuals but reactivation may occur in immunocompromised patients causing encephalitis, pneumonitis, colitis, retinitis and congenital fetal infection. Cutaneous manifestations of CMV infection usually present with various skin lesions such as ulcers, erosions, erythematous morbilliform rash, vesicles and bullae. We report a case of cutaneous CMV infection in an HIV-AIDS patient presenting as a persistent ulcerated plaque on the nose. The lesion slowly evolved into a plaque which partially destroyed the right alar rim. Skin punch biopsy showed perivascular giant cells with large eosinophilic inclusions resembling an owl's eye consistent with CMV infection. He was subsequently diagnosed with CMV retinitis because of blurring of vision and findings of retinal necrosis on fundoscopy. Oral valganciclovir 1800mg/day was given for 21 days. Significant thinning and drying of the plaque with no further progression of ulceration of the alar rim were noted.

Human ; Male ; Adult ; Acquired Immunodeficiency Syndrome ; Blister ; Colitis ; Cytomegalovirus ; Cytomegalovirus Retinitis ; Encephalitis ; Exanthema ; Ganciclovir ; Immunocompromised Host ; Pneumonia ; Strigiformes ; Succinates ; Ulcer

We report a case of penicilliosis in a Filipino man with HIV-AIDS who presented with skin-colored and erythematous to hyperpigmented, umbilicated papules and nodules on the face, trunk, and extremities associated with fever, lymphadenopathy, and anemia. The diagnosis was made through skin biopsy and fungal culture, which showed characteristic paintbrush-like hyphae and conidiophores. The patient was treated with intravenous amphotericin B at 0.6 mg/kg/day for 14 days followed by oral itraconazole 200 mg twice daily for 10 weeks resulting to flattening of lesions with hyperpigmentation, and prevention of appearance of new lesions. Resolution of fever, lymphadenopathy and improvement of anemia were also noted. He was placed on maintenance regimen with itraconazole 200 mg once daily to prevent relapse. Early diagnosis and appropriate management is important because mortality of disseminated disease is high if diagnosis and treatment are delayed.

Human ; Male ; Adult ; Acquired Immunodeficiency Syndrome ; Amphotericin B ; Anemia ; Biopsy ; Early Diagnosis ; Hyperpigmentation ; Hyphae ; Itraconazole ; Lymphadenopathy ; Recurrence ; Skin ; Torso

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

BACKGROUND: Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF) are now considered as major health problems in the Philippines. N,N,-dietyl-3-toluamide (DEET) is recognized as the most effective against Aedes aegypti. However, the concern about its use have underscored the need to find a safer alternative repellent.
OBJECTIVES: This study aims to determine and compare the repellent activity of tea tree (Melaleuca alternifolia) oil against Aedes aegypti with 7% DEET using a double-blind controlled experimental trial
METHODOLOGY: Twenty healthy subjects were allocated systematically by alternate assignment into three treatment groups (Control vs. Tea Tree oil, control vs. 7 percent DEET, Tea Tree oil vs DEET). All subjects were exposed to Aedes aegypti for 5 minutes every hour for 8 hours and the number of mosquitoes biting/landing were recorded and compared for each treatment group
RESULTS: Fifty percent tea tree oil has a repellent activity against Aedes aegypti and its efficacy is comparable to 7% DEET. Both treatments were equally effective in repelling mosquitoes for 7 hours. No cutaneous reactions to both repellents were noted
CONCLUSION: The efficacy of tea tree oil is comparable to 7% DEET and is recommended as an alternative natural mosquito repellent.

Human ; Aedes ; Deet ; Dengue ; Healthy Volunteers ; Insect Repellents ; Melaleuca ; Severe Dengue ; Tea ; Tea Tree Oil ; Trees

Seabather's eruption (SBE) is characterized by pruritic erythematous papules on the covered areas of the body that appear within 24 hours after exposure to seawater. SBE is known to be caused by the planula of a thimble jellyfish (Linuche unguiculata) or a sea anemone (Edward siellalineata). We report cases of two adult male triathletes who developed pruritic erythematous papules on the chest and back after a swim training along the coastal waters of Samal island, Davao City. Examination of samples of the seawater revealed multiple planulae or larval forms of cnidarians. The histopathologic examination revealed moderately dense superficial and deep perivascular and periadnexal inflammatory infiltrates consisting predominantly of lymphocytes, few eosinophils and neutrophils. Treatment with a short course of systemic corticosteroids proved beneficial in both patients. A review of published literature regarding this interesting aquatic sports dermatosis was also conducted.

Human ; Male ; Adult ; Adrenal Cortex Hormones ; Eosinophils ; Lymphocytes ; Neutrophils ; Scyphozoa ; Sea Anemones ; Seawater ; Skin Diseases

Mycosis fungoides presenting with hypopigmented lesions is an uncommon variant, which is usually described among dark-skinned patients. We report a case of hypopigmented mycosis fungoides in an eight-year-old girl who has responded favorably to narrowband-ultraviolet B therapy. The disease mimics several benign inflammatory skin conditions, hence, a high clinical suspicion is warranted in patients presenting with widespread hypopigmentation.

Human ; Female ; Child ; Albinism, Oculocutaneous ; Hypopigmentation ; Mycosis Fungoides ; Skin ; Lymphoma

Introduction: Rosacea is a chronic relapsing inflammatory facial dermatosis often characterized by flare-ups and remissions exclusively affecting the centrofacial skin. Case report: This is a case of multiple symmetric intensely erythematous papules, pustules, and plaques over both cheeks in a 47-year-old Filipino female. Dermoscopy showed brown-yellowish structureless areas, straight vessels in a polygonal pattern, dilated follicles, follicular plugs, ill-defined white rosettes, and non-specific scales. Skin punch biopsy showed spongiosis of the epidermis and demodex folliculorum within the follicular infundibulum. The dermis revealed telangiectasia of blood vessels and dense inflammatory infiltrates. Hypertrophy of sebaceous lobules was also seen. The patient was initially treated with oral lymecycline 300mg twice a day for 2 weeks without improvement. Due to the persistence of centrofacial erythema, papules and pustules, the patient was given prednisone 10mg once a day for 1 month and low dose isotretinoin 10mg once a day for 8 months which resulted in significant decrease in erythema and number of existing lesions. To further decrease the inflammation con- tributed by demodex mites, permethrin 5% cream twice a day for 1 month was applied. Long-pulsed Neodymium-doped yttrium aluminum garnet (Nd:YAG) 1064 nm laser for a total of 10 sessions together with Isotretinoin 10 mg every other day effectively maintained remission for 1 year and 5 months. Gentle skin care measures, sunscreen, metronidazole 0.75% cream once a day, and desonide 0.05% cream twice a day for 1 week in cases of acute flares were maintained during the treatment course. Conclusion An armamentarium of topical and oral antibiotics, corticosteroids, isotretinoin and non-ablative long-pulsed Nd:YAG 1064 nm laser showed significant improvement in the inflammatory papules, pustules, and centrofacial erythema of rosa- cea and proves to be beneficial in the maintenance of its long-term remission.
Rosacea ; Isotretinoin ; Lymecycline

INTRODUCTION: Pigmented contact dermatitis (PCD) is characterized by non-eczematous pigmentation associated with contact sensitizers, usually without any active or preceding pruritus and erythema. PCD was first described by Riehl, who identified patients with brown to gray facial pigmentation concentrated on the face most commonly associated with sensitizing chemical such as cosmetics, fragrances, and textiles. CASE REPORT: This is a case of a 48-year-old female Filipino who presents with blue-grey to brown patches on the forehead of 1-year duration with no significant pathologic history. Clinical examination, dermoscopy and histology were consistent with a variant of pigmented contact dermatitis known as Riehl melanosis. Since anamnesis was unremarkable, patch testing was done to identify the contact allergen triggering the symptom. Results obtained a positive reaction to nickel, potassium dichromate, and textile dye. CONCLUSION:Treatment includes the elimination of trigger factors, hence the importance of patch testing in the investigation of its cause. Alongside adequate photoprotection, a combination treatment of 1,064 nm Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, 20% tricholoacetic acid (TCA) peel and oral retinoids, were found safe and effective in the management of facial melanosis. Three-dimensional imaging and dermoscopy were utilized to obtain a more standard and objective pre- and post-treatment comparison.
Lasers, Solid-State ; Patch Tests ; Melanosis ; Skin Abnormalities ; Dermatitis, Contact

Introduction: Hansen’s disease (HD) is a chronic granulomatous disease principally affecting the skin and peripheral nervous system caused by Mycobacterium leprae. The incubation period varies from months to more than 30 years. The tuberculoid form of HD usually presents with a single hypoesthetic patch and skin biopsy shows epithelioid granulomas with absence of bacilli on Fite-Faraco stain. In contradistinction, lepromatous leprosy usually presents with numerous papules, plaques and nodules with induration of the ears and nose. Biopsy shows foamy granulomas with presence of acid-fast bacilli on Fite-Faraco stain. Case summary: We present a case of a 13-year old female who presented with a 3-year history of a single hypoesthetic patch on the left knee. The initial clinical diagnosis was tuberculoid leprosy. However, histopathology revealed a Grenz zone, and a nodular granulomatous infiltrate consisting of epitheloid and foamy histiocytes with scattered lymphocytes. Fite-Faraco stain showed a bacillary index (BI) of 3+. Slit-skin smear revealed a BI of 4+. She was then started on multidrug therapy. Conclusion This case highlights the importance of slit-skin smear and biopsy as routine procedures in all new cases of suspected HD. These procedures will help differentiate multibacillary from paucibacillary forms of the disease which will influence decisions for treatment and prognostication. This case emphasizes that lepromatous leprosy may present with single lesions and may be misdiagnosed as paucibacillary leprosy if skin-slit smear and biopsy have not been done. This case further suggests that there are factors yet undetermined which play significant roles in determining the host response to M. leprae which are believed to influence morphology, configuration, number and distribution of skin lesions.
Leprosy ; Leprosy, Multibacillary