We are presenting a rare case of a 71-year-old Filipino female with the presence of two skin cancers occurring simultaneously in two different regions of the body.

Patient noted symmetrical, erythematous, pruritic, eczematous patches and plaques on her inguinal areas five years prior to consultation. The patient also had a 2-year history of multiple pigmented papules and plaques on the forehead, left jaw, right cheek, lateral canthus of the left eye, and sternal area associated with occasional bleeding.

Skin examination showed symmetrical, irregularly shaped bright red moist plaques with finger-like projections measuring 26 cm x 9 cm on the vulva, inguinal areas, and intergluteal areas. The patient also had multiple pigmented papules and plaques with rolled borders located on the right forehead, lateral canthus of the left eye, right cheek, left jaw, and sternal area with measurements ranging from 0.3 x 0.4 cm to 1.5 x 2.0 cm in size.

Histological examination of the vulvar skin biopsy is signed out as extramammary Paget’s disease with positive immunohistochemical stain for Cytokeratin 7. A skin punch biopsy on the pigmented plaque on the right forehead is signed out as basal cell carcinoma.

This is the first known case of the simultaneous occurrence of extramammary Paget’s disease and basal cell carcinoma on different regions of the body. We speculate that the two tumors in our patient may have developed independently with no causal relationship, but we are attributing the occurrence of the patient’s carcinomas to her old age, prolonged sun exposure, and immunosuppression.

BACKGROUND

Psoriasis is a chronic, incurable inflammatory disease that often frustrates patients and negatively impacts quality of life, affecting treatment satisfaction.

This study evaluated treatment satisfaction, medication adherence, and dermatological quality of life in Filipino patients with plaque-type psoriasis.

Ninety-five patients at a tertiary dermatology clinic completed surveys using the Treatment Satisfaction Questionnaire for Medications (TSQM 1.4), Morisky Medication Adherence Scale-4 (MMAS), and Psoriasis Disability Index (PDI). Disease severity was measured using the Psoriasis Area Severity Index (PASI).

Patients reported moderate to high treatment satisfaction, medium medication adherence, and minimal quality of life impairment across all treatments. Convenience satisfaction was significantly correlated with educational attainment. Satisfaction with effectiveness and convenience was strongly linked to medication adherence, while overall satisfaction was tied to disease severity. Additionally, satisfaction with side effects was significantly related to quality of life.

All three treatment modalities remain vital for managing psoriasis in low- resource settings. Emphasizing medication side effects, treatment convenience, and their impact on quality of life can foster a more patient-centered approach.

INTRODUCTION

Acne vulgaris is a common skin condition caused by various factors within the pilosebaceous unit. Propolis, a sticky, brown, and fragrant resinous material made by bees, has antibacterial and anti-inflammatory properties and can help address some of the pathogenesis of acne vulgaris.

To compare the efficacy and safety of propolis 10% cream versus benzoyl peroxide (BPO) 5% cream on mild to moderate acne vulgaris.

The study included 46 participants with mild to moderate acne or Investigator’s Global Assessment (IGA) grade 2 or 3, randomized to receive propolis 10% or BPO 5% cream twice daily for 8 weeks. Primary outcomes were IGA success rates (score of 0 or 1), 50% lesion reduction, adverse reactions, and quality of life changes measured by the DLQI.

The study found that the success rate was 15% in the propolis group and 9% in the BPO group. In clinical response, 25% of patients in the propolis group and 52.38% in the benzoyl peroxide (BPO) group showed improvement in inflammatory lesions. For non-inflammatory lesions, 5% of patients in the propolis group demonstrated improvement, compared to 28.57% in the BPO group (p=0.538). 5% of the propolis group reported itching and burning, while 9.52% of the BPO group reported scaling (p=0.1806). Both groups showed significant decreases in DLQI scores from baseline to the fourth follow-up.

Topical propolis 10% cream can be an alternative acne treatment, given its comparable effect to BPO and its excellent safety profile.

BACKGROUND

Postpartum abdominal laxity is a growing concern for women. Noninvasive options like microwave technology and fractional carbon dioxide (CO2) laser show promise, but their combined efficacy and safety require further investigation.

To compare the efficacy and safety of microwaves versus combined microwaves and fractional CO2 laser in the treatment of postpartum abdominal laxity among Filipino patients.

Thirty-two patients with Fitzpatrick skin type III-V and postpartum abdominal laxity received three microwaves sessions, with one side randomly assigned an additional fractional carbon dioxide laser session (designated as side B, while the other as side A). Global aesthetic improvement scale (GAIS) scores and patient satisfaction (PS) scores were determined at every follow-up. Baseline and completion body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) were taken, and adverse effects were recorded.

Significant improvements in GAIS and PS scores were noted for both sides across all sessions, with side B showing superior scores post-CO2 laser. These improvements were attributed to epidermal thickening and dermal collagen and elastin remodeling, the latter seen histologically in a representative patient. Adverse effects were mild and noted only with CO2 laser.

The combined use of the microwaves system and fractional CO2 laser is safe and well-tolerated and is superior to microwaves alone in the treatment of postpartum abdominal laxity.

Background: Acne vulgaris (AV) is a chronic inflammatory skin condition that is non-life-threatening but may cause significant psychological morbidity regardless of severity. An extreme case of this is depicted in body dysmorphic disorder (BDD), which is often an undiagnosed condition presenting with excessive preoccupation of perceived flaws not observable by others. With the increasing popularity of social media throughout the years, there has been budding researches exploring its psychological implications, particularly on “selfies” and its possible association with self-image and body dysmorphia. Objectives: To compare body dysmorphic symptoms and selfie behavior between patients with mild AV versus those without AV. Methods This is a single-center, cross-sectional study among patients with mild AV and those without AV seen through a teledermatology platform of a tertiary hospital from April to June 2022. Results: A total of 207 patients were included in this study – 107 patients with mild AV and 100 patients without AV. A significantly higher proportion of BDD symptoms was seen in patients with mild AV using either Body Dysmorphic Disorder Questionnaire-Dermatology Version (BDDQ-DV) (31%) and Dysmorphic Concern Questionnaire (DCQ) (14%). No significant difference was noted in terms of selfie behavior between the groups. Conclusions BDD symptoms were significantly more prevalent in patients who have mild AV despite having lesions that are negligible and clinically not apparent. This highlights the importance of dermatologists’ knowledge that BDD may cause distress and impairment and should be taken into consideration in terms of management. Interestingly, selfie behavior of patients with mild AV and without AV had no significant difference.
Acne Vulgaris ; Social Media

INTRODUCTION Impetigo Is a common, contagious, superficial skin infection most commonly presenting as erythematous crusting papules and pustules on the face and or extremities. The pathogens usually implicated in this skin disease are gram- positive organisms including Staphylococcus aureus, and less frequently, group A β-hemolytic Streptococcus pyogenes. In JRRMMC, Department of Dermatology, this disease always ranks in the top 1 O most common skin diseases annually. Treatment options for this disease include topical and oral antibiotics depending on the condition's severity. Mupirocin and Fusidic acid are considered as gold standard in the treatment of impetigo.

INTRODUCTION: Follicular mucinosis is a rare skin condition, which can present as an idiopathic benign condition or as a secondary symptom of a malignant disorder, most commonly mycosis fungoides. Since its first description in 1957, only 90 cases have been reported worldwide. This condition is characterized by erythematous infiltrated plaques with scaling, sometimes with follicular prominence on the head and neck. Definitive diagnosis is made histologically. CASE: A 32-year old male presented with a 3- year history of recurrent scaling with eruption of pruritic erythematous papules and plaques over the face, neck and chest. Different local treatments (topical corticosteroids, antifungal cream and moisturizers) were ineffective. Overall, he was healthy. Histopathological examination of the lesion showed typical histological picture of follicular mucinosis. Alcian blue stain was positive. The patient was successfully treated with narrowband UVB (NB-UVB) therapy with no recurrence of lesions after one- month follow-up. CONCLUSION Idiopathic follicular mucinosis is a benign condition with localized involvement and excellent prognosis. However, long-term follow-up and monitoring is recommended because of its association with malignancy. Follicular mucinosis is a rare dermatosis, characterized histologically by the presence of mucin deposits within the hair follicle and sebaceous glands.1 There are three clinical types determined. The first and the most common type occurs as an idiopathic benign disorder, typically seen in young patients. The second type affects people 40-70 years of age and has a more chronic course. The third type usually occurs in the elderly and presents with widespread lesions. It can arise as a secondary symptom of a malignant disorder, most commonly mycosis fungoides.

Background: Verruca vulgaris are scaly, rough papules or nodules caused by the human papilloma virus. Objective: To determine the efficacy and safety of topical zinc oxide ointment versus topical salicylic acid + lactic acid ointment as treatment among patients with verruca vulgaris. Methods: This randomized, double-blind, 6-week study involved 29 patients with verruca vulgaris in a tertiary center who received zinc oxide 20% ointment or salicylic acid 15% + lactic acid 15% ointment applied daily and occluded with LeukoplastTM tape. Evaluation was done every two weeks. Results: There was significant decrease in number of warts in the zinc oxide group (p=0.004), while it was not significant in the salicylic acid+lactic acid group (p=0.392). Comparison between the two groups was not significant (p>0.05). Both zinc oxide (P=0.000) and salicylic acid+lactic acid groups (P=0.025) had significant decrease in size of warts from baseline to 6th week of observation. No significant differences were observed between the two groups in terms of adverse events such as erythema (P>0.05), edema (P>0.05), tenderness (P>0.05), and scaling (P>0.05); however, itching was significantly higher at 4th week in the salicylic acid+lactic acid group B (16.7%). Among the zinc oxide group, 100% would recommend the treatment, while only 71.4% would recommend salicylic acid+lactic acid. The satisfaction levels of zinc oxide group were also statistically higher than salicylic acid+lactic acid group (p=0.000). Conclusion Zinc oxide 20% ointment is a safe and effective option for the treatment of verruca vulgaris especially among patients that would prefer non-traumatic measures in the removal of their warts.
Zinc Oxide ; Salicylic Acid ; Lactic Acid

Introduction: Syringocystadenoma papilliferum (SCAP) is a relatively rare benign adnexal skin tumor which can manifest in a variety of clinical forms. Nearly one-third of cases are known to develop within a pre-existing nevus sebaceus (NS). The peculiar feature of this case was the appearance of a large exophytic tumor within a congenital verrucous plaque, which raised the suspicion of a malignant transformation. This is a case of a young Filipino adult with an unusual presentation of syringocystad- enoma papilliferum in a nevus sebaceus mimicking squamous cell carcinoma. Case report: A 27-year-old Filipino female presented a persistently enlarging exophytic pedunculated cribriform tumor within a congenital verrucous plaque on the left temporal area. The tumor started to appear when she was 20 years old. One month prior to consult, it rapidly increased in size and bled on gentle manipulation. She has neither comorbidities nor any family history of a similar condition. Her physical examination was normal, with no palpable lymphadenopathies. The biopsy showed syringo- cystadenoma papilliferum on a nevus sebaceus. She underwent carbon dioxide (CO2 ) laser excision under local anesthesia. The procedure was uneventful and the patient is on regular follow-up and close monitoring for any possible malignant change or recurrence. Conclusion A case of syringocystadenoma papilliferum on a nevus sebaceus mimicking squamous cell carcinoma in a Filipino female treated with carbon dioxide laser excision was presented. The unusual presentation of SCAP can mimic malignancy and histopathologic evaluation is warranted to rule out malignant transformation for proper management.
Tubular Sweat Gland Adenomas

Introduction: Basal cell carcinoma (BCC) is the most common type of malignancy worldwide. The incidence of BCC is positively associated with increasing age; thus, centenarians, defined as those aged 100 years and above, become a vulnerable population to developing malignancy. As a person ages, risk factors such as chronic sun exposure, ionizing radiation, and immunosuppres- sion induce mutations that contribute to tumor formation. Impaired DNA repair capacity in response to carcinogens and immune function dysfunction also increases BCC risk in the elderly. Currently, studies among centenarians with high-risk basal cell car- cinoma treated with surgical interventions are limited. Case report: Presented herewith is a case of a 101-year-old female with a 15-year history of hyperpigmented, hyperkeratotic plaque over the right malar area and a one-year history of progressive pain (PS 10/10) and enlargement of the lesion, forming an ulcerated, hyperpigmented tumor. Laboratory workup showed normal findings. Histopathology was signed out as a pigmented nodulocystic basal cell carcinoma. Moh’s micrographic surgery (MMS) and cheek advancement flap were performed with good wound healing and no perioperative complications. Conclusion Despite the limited options of medical and physical management due to decreased life expectancy of centenar- ians, MMS remains the standard of therapy in high-risk BCC. MMS with reconstructive surgery is generally a safe and effective modality with no increased risk of peri- and post-operative complications.
Carcinoma, Basal Cell ; Centenarians