INTRODUCTION: Dermatomyositis is a rare idiopathic inflammatory myopathy with characteristic skin manifestations and proximal muscular weakness. In 30 percent of classic dermatomyositis, skin findings precede muscle weakness. Since the initial skin lesions are not always highly characteristic of dermatomyositis, there may be a delay in diagnosis and treatment. CASE REPORT: This is a case of a 36-year-old Filipino female who initially presented with erythematous patches and plaques on the face, arms, and thighs. One week later, she developed multiple, well-defined, erythematous to violaceous, edematous, tender patches and plaques on the face, V of the neck, upper back, proximal extremities and buttocks. Seven weeks later, she developed proximal muscle weakness described as difficulty in raising her arms and difficulty in standing up from a sitting position. Histopathology was consistent with dermatomyositis. SGPT, C3, ANA, and anti-ds-DNA were normal. SGOT and creatine kinase were 5 and 15 times the normal value, respectively. She was treated with prednisone from the first week of illness and hydroxychloroquine from the fifth week of illness. Her condition greatly improved with no progression of the disease for the succeeding 3 years. CONCLUSION Even in the absence of muscle weakness, there should be a high index of suspicion for dermatomyositis in patients with confluent, erythematous patches and plaques on the face, trunk and proximal extremities. Adequate work-up and clinical monitoring will pave the way for early diagnosis and consequently early treatment and a better patient outcome.
Dermatomyositis

INTRODUCTION Alopecia areata incognita is a rare form of alopecia areata which was first reported in 1987. The prevalence of this disease is unknown but it is more common in women. The usual presentation of alopecia areata incognita is acute, diffuse hair thinning. In most cases, it lacks the typical alopetic patches seen in alopecia areata. It may resemble telogen effluvium and androgenetic alopecia. The prognosis of this disease is favorable and recovery is rapid and spontaneous. Case: A 19- year-old Filipino female presents with a two-month history of alopecia areata incognita. She initially had a solitary round patch of hair loss on the scalp with proximally tapered hair, rapidly evolving into diffuse hair thinning. CBC, TFTS, FBS, HBA 1 c, ANA and VDRL were unremarkable. Histopathology demonstrated dense peribulbar lymphocytic infiltrate, miniaturized hair and increased catagen hair consistent with alopecia areata. There was gradual hair growth after treatment with minoxidil 5% lotion and topical betamethasone dipropionate 0.05% lotion.

Background: Dermoscopy, a non-invasive diagnostic tool, has been proven to improve the diagnostic accuracy of vascular tumors since it can aid in identifying vascular structures as well as morphology of vessels. Tumor depth and precise vascular structures can also be evaluated through dermoscopy. Objective: The study aimed to describe the dermoscopic features of red tumors in Filipino patients seen at the Outpatient Dermatology Department of two centers from January 2013 to July 2014. Methods: Patients with red tumors were recruited to the study. Dermoscopic features were described for each tumor, and histopathology was done. Results: A total of 44 patients were included in the study, and 45 red tumors were evaluated. The tumors were located on the face (31%), trunk (36%), and extremities (33%). The majority of the red tumors were confirmed to be vascular tumors (78%) on histopathology. Dermoscopic features that were found in the majority of vascular tumors seen were lacunae and reddish homogenous areas. For non-vascular tumors, vessels were identifiable in 90% of the tumors seen. Conclusion In this study, the use of dermoscopy in the diagnosis of red tumors proved to be a useful preliminary tool that aided in the observation of vascular pattern, albeit red lacunae, red to dark red homogenous areas, and different types of vessels. The identification of these structures may aid in arriving at a more precise diagnosis and help differentiate vascular from non-vascular tumors.
Dermoscopy

Background: Dermoscopy increases the diagnostic accuracy of clinical visual inspection by 5% to 30%. This has led to a reduction of unnecessary excision of benign skin lesions and the earlier diagnosis of malignant skin lesions. Objectives: To compare the concordance agreement of the clinical versus histopathologic diagnosis to the concordance agreement of the dermoscopic versus histopathologic diagnosis of pigmented lesions. Research Design: This is a prospective, cross-sectional study of the clinical, dermoscopic and histopathological features of pigmented skin lesions on patients seen at the Out-Patient Departments of Quirino Memorial Medical Center and Ospital ng Makati from March 2013 to June 2014. Methods: Sixty-eight subjects fulfilled the criteria and were all included in the final analysis. Classification and definitive diagnosis of the lesion as benign or malignant were determined thru clinical, dermoscopic and histopathologic features by one dermatopathologist. Kappa and concordance analyses were performed to determine the statistical and concordance agreement among the results of the three diagnostic procedures, respectively. Results: The statistical agreement between clinical versus histopathologic classification as benign or malignant was good (kappa=0.872), while the statistical agreement was high (kappa=0.872) between dermoscopic versus histopathologic classification. Concordance agreement between clinical versus histopathologic diagnosis showed fair agreement (concordance coefficient=0.2397) as compared to a high agreement (concordance coefficient=0.98) in dermoscopic versus histopathologic diagnosis. Conclusion The use of dermoscopy in pigmented lesions aids the dermatologist in giving an accurate diagnosis without invasive procedures. Knowledge of the dermoscopic features will help in the early clinical detection and management of benign and malignant pigmented skin lesions.
Dermoscopy