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

Nonmelanoma skin cancers are the most common human cancers. To this group basal cell carcinoma and cutaneous squamous cell carcinoma. Squamous cell carcinoma (SCC) is the second most common skin cancer in darkly pigmented patients and majority of the SCC's develop in non-sun exposed areas. We describe a case of a 72-year old male who consulted in the outpatient department of the Research Institute for Tropical Medicine for a 2-month history of non-healing ulcer on the scalp. Histopathologic examination revealed diagnosis of invasive squamous cell carcinoma. Patient was referred for surgical excision.

Human ; Male ; Aged ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Outpatients ; Scalp ; Skin Neoplasms ; Tropical Medicine ; Ulcer

We report a case of an 11-year-old girl who presented with a gradually enlarging verrucous plaque on the left knee for 3 years. Physical examination showed a solitary, slightly erythematous, scaly, verrucous plaque on the left knee measuring about 1.5 cm x 2 cm. Biopsy revealed granulomatous dermatitis consistent with cutaneous tuberculosis. A diagnosis of tuberculosis verrucosa cutis (TBVC) was made and anti-tuberculous therapy was initiated consisting of rifampicin, isoniazid, pyrazinamide and ethambutol for 2 months followed by rifampicin and isoniazid for 4 months. Upon completion of therapy, only a slightly atrophic scar remained, supporting our diagnosis. This report highlights TBVC must be considered in patients with chronic skin lesions in countries with high prevalence of tuberculosis.

Acne Vulgaris ; Benzoyl Peroxide

Introduction: Geriatric health has become a major issue worldwide. According to the World Health Organization(WHO), between 2015 and 2050, the proportion of the world's population over 60 years will nearly double from 12% to 22%. There is paucity of literature involving the spectrum of frequencies of Filipino geriatric dermatoses. Objectives: To report on sociodemographic and clinical profiles of geriatric patients seen at the department of Dermatology of Southern Philip- pines Medical Center from January 2016 to December 2019. Methods: A retrospective descriptive study was conducted. Sociodemographic and clinical parameters were recorded and analyzed. Descriptive statistics such as frequencies and percentages were used. Results: Study population involved 470 patients with 372 out-patients and 98 in-patients. There was a preponderance of elderly patients with ages of 70-79 and a slight female predominance. Most were married, residents of Davao City, retired or unemployed and had no vices. About 711 derma- tologic dermatoses were recorded. Majority of concerns(22.08%) were classified under allergic and eczematous disorders. A greater number of cases were managed by a combination of topical and oral medications. A proportion of these patients(38.09%) had at least one known co-morbid condition; most common of which is hypertension. The top 10 most common dermatoses include (1)xerosis, (2)contact dermatitis, (3)lichen simplex chronicus, (4)dermatophytosis, (5)stasis derma- titis, (6)seborrheic dermatitis and seborrheic keratosis, (7)acrochordon, (8)psoriasis vulgaris, (9)herpes zoster and (10)verruca plana. Conclusion Geriatric dermatology is an emerging branch in the new millennium. Raising the level of awareness about these dermatoses may be crucial in proper management and improved quality of life for Filipino elderly patients.
Aged ; Aging

Subepidermal blistering disorders (SBD) are diseases associated with antibodies that attack structural proteins of the skin. Blister formation with widespread distribution is common in these diseases. Diagnosis of SBD is established through the demonstration of immunoglobulin deposits in the dermoepidermal junction by direct immunofluorescence microscopy, and through the presence of circulating autoantibodies by serology. Systemic corticosteroids and other immunosuppressive drugs are used to treat SBD. We present the case of a 16-year old female with a 6-week history of intensely pruritic, erythematous plaques with generalized blister formation on the face, trunk, upper extremities, and inner thighs. We diagnosed the patient as having a subepidermal blistering disorder. We placed her on a course of prednisone and azathioprine, which successfully treated her lesions.
Autoimmune Diseases ; Pemphigoid, Bullous ; Epidermolysis Bullosa Acquisita ; Fluorescent Antibody Technique, Direct ; Adrenal Cortex Hormones

Subepidermal blistering disorders (SBD) are diseases associated with antibodies that attack structural proteins of the skin. Blister formation with widespread distribution is common in these diseases. Diagnosis of SBD is established through the demonstration of immunoglobulin deposits in the dermoepidermal junction by direct immunofluorescence microscopy, and through the presence of circulating autoantibodies by serology. Systemic corticosteroids and other immunosuppressive drugs are used to treat SBD. We present the case of a 16-year old female with a 6-week history of intensely pruritic, erythematous plaques with generalized blister formation on the face, trunk, upper extremities, and inner thighs. We diagnosed the patient as having a subepidermal blistering disorder. We placed her on a course of prednisone and azathioprine, which successfully treated her lesions.
Autoimmune Diseases ; Pemphigoid, Bullous ; Epidermolysis Bullosa Acquisita ; Fluorescent Antibody Technique, Direct ; Adrenal Cortex Hormones

Introduction: Extramammary Paget’s disease (EMPD) is a rare cutaneous slow growing tumor seen in areas rich in apocrine glands such as the anogenital region while ectopic EMPD is defined as EMPD arising on non-apocrine areas. The pigmented variant of EMPD is a very rare finding, with only a few reported cases, and can be misdiagnosed as melanoma. Case report: We report a case of a 74-year-old woman who presented with a four-year history of pruritic, non- healing erythematous plaques located on the right axilla and left lower abdomen. Histopathology revealed acanthotic epidermis with atypical keratinocytes that was negative for anti S-100 and Melan-A and was positive for carcinoembryonic antigen (CEA), cytokeratin (CK), CK 7 and epithelial membrane antigen (EMA). Patient was managed as pigmented and ectopic variant of extramammary Paget’s disease. Several tests and imaging were done to rule out malignancy. Wide excision with axillary node dissection, bilateral inguinal node dissection, frozen section biopsy and reconstruction using right pectoralis major musculocutaneous flap, split thickness skin graft with left inguinohypogastric drain were done by reconstructive surgery. Frozen section biopsy was negative for S-100, MELAN-A and HMB-45, ruling out malignant melanoma. Patient followed up every month for 6 months after the procedure with no recurrence and lymphadenopathy. Conclusion This case emphasizes that extramammary Paget’s disease is not a preventable disease and early diagnosis is the key to a favorable diagnosis. Any unilateral eczematous lesion that does not respond to an appropriate course of topical treatment warrants a skin biopsy.
Melanoma ; Immunohistochemistry

Introduction: Cushing syndrome caused by application of topical corticosteroids is rarely reported. Systemic side effects like suppression of hypothalamic-pituitary-adrenal axis, growth retardation in children and iatrogenic Cushing syndrome can occur even in small doses of potent topical steroids.1 Case Summary: This is a case of a 3-month old female who was referred to our department due to generalized erythema with desquamation. History revealed that the patient had recurrent eczema and the mother applied an over-the-counter medication containing Ketoconazole+Clobetasol 10mg/500mcg per 7-gram cream thrice daily for ten weeks. The estimated topical steroid applied weekly was around 8.5 grams and at time of admission, the patient had been exposed to approximately 50 grams of a potent topical corticosteroid. The patient presented with fever, irritability, and had positive Nikolsky sign thus managed as a case of staphylococcal scalded skin syndrome associated with topical steroid – induced iatrogenic Cushing syndrome. Unfortunately, patient’s condition worsened and with progressive pneumonia, she expired on the 23rd hospital day. The fatal outcome was due to SSSS which was complicated by progressive pneumonia and topical steroid – induced iatrogenic Cushing syndrome. The complex interplay of these features eventually led to sepsis and death. Conclusion This case highlights the risks related to abuse of potent steroid-containing preparations and the importance of education to prevent severe and catastrophic outcomes of injudicious steroid use.
Staphylococcal Scalded Skin Syndrome

Acral lentiginous melanoma (ALM) is the rarest of the four subtypes of cutaneous melanoma.1 It accounts for only 2-8% of melanomas in caucasians.2 Only 52 cases of ALM have been recorded in the Philippine Dermatological Society Health Information System from 2011 to 2016.3 Histopathologic demonstration of cytologic atypia, presence of mitoses in the deep dermis, pagetoid spread of epidermal melanocytes and lack of maturation of nests with descent into the dermis are features diagnostic of melanoma.2 4 ALM is primarily managed through wide surgical excision. The most common sites for ALM are the soles, palms, and subungual areas.2 The rarity of ALM, the inconspicuousness of the locations of some lesions, and the difficulty in discerning ALM from benign lesions and traumatic changes usually delay the diagnosis and contribute to the poor prognosis of the disease.4 5 6 A 53-year-old male consulted us for an enlarging pigmented plaque on the sole of his left foot. The lesion started as a junctional nevus, which the patient had since birth. The nevus, originally measuring approximately 0.5 x 0.5 cm, started to increase in size one year prior to the consultation. One month before consultation, the patient noted a black nodule on the center of the lesion. A week before consultation, the lesion bled and became painful after manipulation by the patient. Dermatologic examination of the plantar aspect of the left foot revealed a 1.7 x 1.6 cm, dark brown-black, asymmetric plaque with cobblestone-like surface and a black indurated nodule on the center (Figure 1A). Dermoscopic findings of bluish white veil and irregular pigmentation with variable hypopigmented blotches are suggestive of acral melanoma (Figure 1B). Skin punch biopsy and immunohistochemical stains for S100, Melan A, HMB-45, and KI-67 confirmed the diagnosis of ALM (Figure 2, 3). We did a wide local excision of the lesion with a 2-cm margin from the tumor edge, with depth up to the suprafascial level (Figure 4A). The excisional defect was repaired with a split-thickness skin graft taken from the patient’s skin on the right thigh (Figure 6), which provided excellent aesthetic result. We also did a sentinel lymph node biopsy on the left inguinal area (Figure 5A,B). Frozen section biopsy showed solid nests of atypical melanocytes invading the surrounding fibrous stroma. Individual cells exhibit round to oval, deeply basophilic nuclei and abundant, clear to eosinophilic cytoplasm. Some areas showed prominent melanin pigmentation. Sections along lines of resection, lymphovascular channels, nerves and adipose tissues of the excised mass (Figure 4 B,C) and lymph nodes from sentinel biopsy were all devoid of malignant tumor cells. Histopathologic findings from frozen section biopsy and permanent section biopsy were both consistent with malignant melanoma with 3 mm Breslow thickness. The patient’s postoperative course, including wound healing, was uneventful (Figure 7). During the patient’s 12-month follow up period, we did not observe any signs of local or distant recurrence of the tumor.
Melanoma, Cutaneous Malignant ; Skin Transplantation