Psoriasis vulgaris and vitiligo are chronic autoimmune skin conditions that affect all races and age groups. Psoriasis presents as erythematous plaques with silvery scales, while vitiligo manifests as symmetric depigmented macules. Their co-occurrence, although documented since 1955, remains relatively rare and underreported in Asian populations. We report the case of a 54-year-old Filipino male, with no known comorbidities who presented with both psoriasis and vitiligo. Skin punch biopsies confirmed the diagnoses of both conditions. During treatment, new vitiliginous lesions appeared over psoriatic plaques, suggesting Koebnerization. We review the current literature to explore possible immunologic and genetic overlaps and provide insights to their treatment.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Vitiligo

Cutaneous metastasis (CM) describes the spread of a distant primary tumor into the skin. The overall incidence of CM ranges from 5% to 10% with breast cancer having the highest rate in women. CM of breast carcinoma origin may manifest as erysipelas-like erythema on the chest, having distinct raised borders and edema due to lymphatic obstruction termed as carcinoma erysipeloides. In most cases, CM is recognized after the initial diagnosis of primary internal malignancy. However, in 0.6–1% of cases, CM served as the first presenting sign of malignancy. A 48-year-old female presented with multiple, erythematous patches, and plaques with clear-cut raised margins, some topped with violaceous pinpoint papules and nodules on the chest, abdomen, and back. No palpable breast mass was appreciated. There was noted nipple retraction and axillary lymphadenopathy. A 4-mm skin punch biopsy revealed nests of large pleomorphic cells on the papillary dermis admixed with mitotic figures and attempts of ductal formation. CK7 and CEA were positive. Results of ultrasonography and mammogram were highly suspicious of malignancy. Core needle biopsy of the breast mass revealed an invasive ductal carcinoma. In the context of an eczematous presentation on the chest area without palpable nodules or mass on breast examination, a diagnostic challenge is expected. Interestingly, our patient represents a small group of CM having cutaneous lesions as their primary manifestation. A high index of suspicion supplemented with proper clinicopathologic and radiologic correlation is crucial for the diagnosis of CM. A multidisciplinary referral is required for adequate management and overall survival rate.
Breast Neoplasms