Vulvar intraepithelial neoplasia (VIN) is a dysplastic condition of the squamous epithelium of the vulva. There are two types of VIN: high-grade squamous intraepithelial lesion of the vulva and VIN differentiated type (dDVIN). Management includes excision, laser ablation, and topical therapy. An excisional procedure used in VIN is simple local excision and partial or total skinning vulvectomy. Despite treatment, its recurrence is high. A G5P5 (5004) woman in her 60s presented with vulvar pruritus and vulvar pain of 2 years. She was treated for cervical adenocarcinoma Stage IB1 with surgery and complete radiotherapy 27 years prior. She was diagnosed twice with vulvar dysplasia 12 and 21 years after the diagnosis of cervical malignancy, both times presenting as vulvar pruritus. She was subsequently managed with vulvectomy with bilateral groin node dissection and with wide local excision, respectively. A 3 cm × 2 cm well-circumscribed, irregular erythematous plaque at the introitus’s 11–1 o’clock region was noted on physical examination. She was managed as a case of recurrent VIN III and underwent wide local excision and distal urethrectomy with split-thickness skin graft. The final histological examination of the submitted specimen showed human papillomavirus-associated classic VIN II.

: Despite observed and theoretical effectiveness and safety in immune thrombocytopenia (ITP), partial splenic angioembolization has not yet been included in clinical practice recommendations. At present, this is the first and only recorded case of partial splenic angioembolization done for chronic ITP in our institution. This case report will add to the growing body of evidence of partial splenic angioembolization as a viable and attractive alternative in treating refractory ITP among patients who refuse or are otherwise unfit for surgery. : We present a 61-year-old female, known chronic ITP unresponsive to steroids, vincristine, rituximab, mycofenolate mofetil, avatrombopag and azathioprine. She refused splenectomy and was offered partial splenic angioembolization. She achieved a durable response at post-procedure days 67, 82, and 130 with platelet count at 50 x 109/L, 85 x 109/L, and 72 x 109/L, respectively, despite continued slow tapering of prednisone and discontinuation of TPO-RA and other immunosuppressive agents. Immune thrombocytopenia (ITP) results from decreased platelet function and increased platelet destruction. About 10% of ITP becomes refractory to treatment within a year. Even among hematologists, the management of refractory chronic ITP remains to be challenging. Splenic artery angioembolization has traditionally been used as an optimization prior to splenectomy of massively enlarged spleens. Its effectiveness in treating ITP remains uncertain. However, current practice endorses it as a rescue therapy in patients deemed unfit for splenectomy.
Human ; Female ; Middle Aged: 45-64 yrs old

Botryomycosis is a rare pyogenic disease that presents with chronic suppurative and granulomatous skin lesions, commonly caused by Staphylococcus aureus. We report a case of botryomycosis presenting similarly to mycetoma, secondary to the emerging cutaneous pathogen Staphylococcus simulans. A 46-year-old female who previously worked in a wet market presented with a 13-year history of suppurative papules on a gradually enlarging right foot, and pain on ambulation. She had no systemic symptoms or co-morbidities, and does not recall preceding trauma. Physical examination showed brawny edema of the right foot with multiple sinus tracts draining purulent discharge. The clinical diagnosis at presentation was mycetoma. Magnetic resonance imaging showed a soft tissue mass involving the right foot and ankle with osseous destruction. Biopsy revealed suppurative granulomatous dermatitis; staining with Grocott methenamine silver did not highlight fungal elements. Potassium hydroxide mount of the purulent discharge did not show grains or hyphal elements. Tissue cultures showed growth of co-trimoxazole-susceptible Staphylococcus simulans. The patient was managed as a case of botryomycosis and treated with co-trimoxazole for 12 months. There was a significant decrease in right foot circumference along with scarring and resolution of associated pain. Repeat biopsy showed no evidence of infection. This is the first reported case of botryomycosis in the Philippines as well as the first report citing Staphyloccocus simulans as a causative agent. Botryomycosis is an important differential in patients clinically presenting as mycetoma. Animal pathogens may need to be considered as etiologic agents in at-risk patients with chronic subcutaneous infections.

Diffuse cutaneous Systemic Sclerosis (dsSSc) is an uncommon subtype of Scleroderma or Systemic Sclerosis (SSc), a multisystemic autoimmune disease. Philippine reports remain limited, hence there is a need to review this condition to accurately diagnose and manage Filipino patients. We present the case of a 52-year old Filipino female with a one-year history of pruritus and generalized skin thickening presenting as multiple, well-defined, hyperpigmented patches and plaques. She also presented with systemic symptoms like fever, dysphagia, and finger tenderness, swelling, numbness, and color changes upon exposure to extreme temperatures known as Raynaud’s Phenomenon. Clinical findings, alongside dermoscopic, histopathologic, nail capillaroscopy, and diagnostic data, confirmed dsSSc diagnosis with complications like Barrett’s Esophagus and Interstitial Lung Disease. Treatment options include corticosteroids, emollients, immunosuppressants, biologics, and phototherapy. Multidisciplinary teams are essential to address systemic complications.

Neurofibromatosis is a systemic disorder that presents with cafe-au-lait spots, intertriginous freckling, neurofibromas, optic pathway tumors, lisch nodules, and distinct osseous lesions. We present a case of a 57-year-old Filipino female with a lifelong history of multiple bumps on the skin. Clinical, dermoscopic, and histopathologic findings confirmed our diagnosis.

A multidisciplinary approach is the cornerstone of management of Neurofibromatosis Type 1. Surgical excision can be performed on symptomatic lesions, but the recurrence can occur. In April 2020, Koselugo (selumetinib) was approved by the U.S. Food and Drug Administration (FDA) for the treatment of NF1-associated plexiform neurofibromas that are disfiguring or inoperable in children 2 years and older. The outlook for patients with NF-1 is guarded and depends on the severity of the disease, the presence of malignancy, and the extent of the deformity.

This case series highlights the diagnostic challenges in differentiating between scarring and nonscarring alopecia, as both patients presented with similar features yet had distinct underlying conditions.

The first patient (60 year old, female) was initially diagnosed with Frontal Fibrosing Alopecia due to the pattern of hair loss in the frontal area of the scalp. Trichoscopy shows perifollicular and interfollicular scaling, yellow crusts around the follicles, dotted vessels, yellow structureless areas with surrounding erythema. However, the patient responded well to Clobetasol Propionate 500mcg/mL Scalp Solution twice a day and Minoxidil 5% Solution twice a day for 30 days, which was not expected in patients with scarring alopecia. Further evaluation revealed that the hair loss was due to Telogen Effluvium and Seborrheic Dermatitis.

In contrast, the second patient (54 year old, female), which was managed as a case of Discoid Lupus Erythematosus of the scalp. Trichoscopy shows absence of follicular opening, white patches, perifollicular scale, white and brown dots. Despite receiving similar treatment, the patient did not experience any improvement, reinforcing the complexity of managing hair loss disorders.

A key aspect of this case series is the emphasis on Trichoscopy. It shows specific patterns associated with various types of alopecia, allowing for prompt diagnosis and treatment while reducing the need for unnecessary biopsies. It invites further discussion on the importance of accurate assessment, the role of Trichoscopy in diagnosis, and the potential for unexpected responses to treatment in Dermatology.

Bullous pemphigoid (BP) is a severe autoimmune blistering condition that characteristically presents as large tense bullae on a background of normal or erythematous skin. In atypical cases, presentation is widely variegated ranging from vesicular eruptions to erythrodermic presentations. This case highlights on a rare presentation of BP manifesting with varicella-like eruption. The recognition and early diagnosis of a unique presentation of this condition is of great importance as it may greatly influence the patient’s outcome and prognosis.

Diabetic hand syndrome, also known as diabetic cheiroarthropathy, is a disorder marked by limited joint movement and features resembling scleroderma. Scleroderma-like skin changes are frequently linked to uncontrolled diabetes, in contrast to limited scleroderma, which typically manifests with a prior history of Raynaud’s phenomenon. This underscores the fact that scleroderma-like is often underdiagnosed and can mimic both autoimmune and microvascular disorders.

In this report, we presented a case of a 58-year-old diabetic female with a 1-year history of gradual stiffening of the fingers with frequent episodes of white-blue discoloration. Physical examination revealed multiple ulcers on sausage-shaped fingers, erythematous thick plaques topped with crust on the palms with associated induration, thickening, and a positive prayer sign. Biopsy of the palms and digits shows thickened collagen bundles in the superficial to deep dermis. Alcian blue was positive. Blood chemistry showed elevated glycosylated hemoglobin and fasting glucose. Immunoassays were negative for ANA, RF, anti-dsDNA, anti-RNP, anti-SM, anti-SSA, SCL70, and anti-CENP. Treatment with potent corticosteroid twice daily was started concurrently with the initiation of insulin by the endocrinologist.

Our case highlights the importance of early recognition of scleroderma-like cutaneous manifestations, whose close relationship to diabetes mellitus affects its overall morbidity. Prompt screening for endocrinopathy will help in early treatment initiation and prevent further complications.

Vulvar syringoma is a rare presentation of a benign eccrine sweat gland tumor that is more commonly found on the face. It typically presents as small, flesh-colored papules on the labia majora. Unlike syringomas elsewhere, the vulvar variant can cause significant pruritus, often worsened by heat, sweating, menses, or pregnancy. While asymptomatic cases may not require treatment, options for pruritus and cosmetic concerns include topical medications and surgical modalities like excision or laser ablation. This case report details the successful management of intractable vulvar pruritus caused by syringoma in a 53-year-old Filipino female using electrodessication. We aim to highlight the importance of considering this often-overlooked condition in the differential diagnosis of vulvar lesions, particularly in cases of persistent pruritus.

Gorlin syndrome is a rare autosomal dominant disorder characterized by multiple basal cell carcinomas, developmental abnormalities, and a predisposition to various tumors. This case study illustrates the clinical presentation, diagnostic challenges, and multidisciplinary approach of Gorlin syndrome in an adult Filipino patient.

Our case is a 47-year-old Filipino female with a 20-year history of progressive, generalized, numerous hyperpigmented to brownish-black patches and plaques. She is a 4.5-pack-year smoker with a history of intermittent sun exposure for 10-12 hours per week and denied any childhood sunburn and no use of sun protection. Physical examination shows generalized involvement with multiple well-defined dark brown patches and plaques. Dermoscopy findings showed maple leaf-like, spoke wheel structures, blue-grey ovoid nests, and microulceration. Skin punch biopsy was consistent with Basal Cell Carcinoma, Superficial type. There is the presence of skin-colored multiple depressions or pits on palms and soles, with some areas coalescing into a plaque. Gorlin Syndrome is diagnosed clinically and our patient fulfills two major criteria: Multiple Basal Cell carcinomas and palmoplantar pits, confirming the diagnosis. The family was also counseled regarding hereditary transmission. The patient’s daughter also presented with palmar pits, multiple odontogenic keratocysts, and ophthalmologic abnormalities such as hypertelorism, which also confirms the diagnosis of Gorlin syndrome.

Raising awareness and providing easy access to healthcare resources for adult patients with GS are crucial steps for better patient outcomes.