Human immunodeficiency virus (HIV) leads to immunosuppression by depleting CD4+ T-cells. Psoriasis, a common immune-mediated inflammatory dermatosis, can paradoxically worsen or emerge as an initial presentation of HIV. The introduction of highly active antiretroviral therapy (HAART) in psoriatic patients with HIV may trigger severe psoriasis flare-ups, often linked to immune reconstitution inflammatory syndrome (IRIS).

This case involves a 31-year-old Filipino male with recurrent, resistant psoriatic plaques. Further testing revealed latent syphilis and HIV infection. The patient completed treatment for syphilis and began HAART, but developed erythrodermic psoriasis, likely due to IRIS. After an inadequate response to acitretin, guselkumab, an IL-23 inhibitor, was administered. The patient responded well, showing significant improvement after four months of treatment without adverse effects.

This case suggests that in severely immunocompromised patients with newly diagnosed HIV, adding guselkumab to conventional HAART may be a safe and effective option for controlling erythrodermic psoriasis flares triggered by immune reconstitution. However, further research is needed to assess the long-term safety and efficacy of guselkumab in HIV-associated psoriasis.

Dermatofibroma (DF) is a common, benign fibrohistiocytic tumor with unknown pathogenesis. There are multiple uncommon histologic variants of DF reported in literature, one of which is hemosiderotic DF. It can variably present as a pigmented papule or nodule commonly located on the lower extremities. Hemosiderotic DF remains to be underreported in the Philippines despite the widely available dermatopathology services in the country.
Human ; dermatofibroma ; histiocytoma, benign fibrous

A 32-year-old Filipino male managed as a case of acute myeloid leukemia presented with a 6-month history of generalized, red-brown papules. After chemotherapy, the patient was advised 30-minutes daily sun exposure as a form of natural phototherapy. On follow-up, most lesions flattened. This case demonstrates chemotherapy’s potential role in controlling the patient’s inflammatory state and using ultraviolet light therapy in the form of sunlight to manage generalized purpuric lichen nitidus.
Lichen Nitidus ; Dermoscopy ; Phototherapy

Background: Basal cell carcinoma (BCC) and trichoepithelioma (TE) are follicular adnexal neoplasms that arise from the follicular germ but with divergent biological behavior. The gold standard in the differentiation is through histopathological examination using hematoxylin and eosin (H and E) stain. There are cases, however, when the distinction is not straightforward. Objective: To assess the association and diagnostic accuracy of the immunohistochemical (IHC) expressions of CD10, Ki67, CK19, androgen receptor (AR), and PHLDA1 in distinguishing between basal cell carcinoma and trichoepithelioma. Methods: We conducted a comprehensive search on cross-sectional studies on human tissue from 2000 to 2020 in MEDLINE (PubMed), CENTRAL and EMBASE for comparative studies and reference lists. The data were summarized and analyzed using Microsoft Excel and RevMan. We used Chi-square test for independence, summary receiver operator curves (sROC), and diagnostic odds ratio (OR). Results: We included 15 articles containing 686 BCC and 367 TE in the systematic review. The pooled staining of biomarkers showed a significant difference in the staining of CK19 (p<0.05) and AR (p<0.0001), and PHLDA1 (p<0.0001). Diagnostic odds ratio was used to confirm these associations. AR was found to have the highest odds in the diagnosis of BCC (OR 27.92, 95% CI 10.69, 72.86). The pattern of staining of CD10 is significant (p<0.001) with staining of both tumor and stroma (OR 8.09, 95% CI 4.57, 13.53) and staining of tumor alone (OR 8.15, 95% CI 4.56, 14.35) (p<0.001) in the diagnosis of BCC. CD10 stromal staining, on the other hand, is significantly associated with the diagnosis of TE (OR 7.26, 95% CI 5.06, 10.44) (p<0.0001). There is no significant association between Ki67 staining (OR 1.22, 95% CI 0.48, 3.09) (p=0.67) and the diagnosis of BCC. The forest plot and sROC showed that AR had high specificity across all included studies in the diagnosis of basal cell carcinoma, while PHLDA1 demonstrated high specificity and high sensitivity in diagnosing trichoepithelioma. Conclusion The biomarkers AR and PHLDA1 are useful as an initial panel to distinguish between BCC and TE, given that both showed high sensitivity as well as significant association with BCC and TE respectively. CD10 and CK19 may also be used with AR and PHLDA1 for further confirmation.
Carcinoma, Basal Cell ; Immunohistochemistry ; Receptors, Androgen

Dedifferentiated liposarcoma is a soft tissue sarcoma of adipocytic lineage. Histopathology and immunohistochemistry are essential for diagnosis. A 51-year-old Filipino woman presented with a rapidly enlarging left gluteal tumor. Histopathology revealed a multilobulated tumor having prominent myxoid stroma with numerous stellate-shaped, atypical cells bearing atypical mitotic figures. Other lobules were composed of sheets of pleomorphic cells, with atypical mitotic figures. The tumor stained positively with alcian blue, vimentin, MDM2 and p16 stains. Other immunohistochemical (IHC) studies done (pancytokeratin, CK7, CK 20, CD 34, CEA, desmin, EMA, SMA, S100) showed negative results. After a 2 cm wide excision of the sarcoma, patient was free from local tumor recurrence for 2 months, after which she was lost to follow-up. We report this case and a brief review of the current literature on dedifferentiated liposarcoma.
Liposarcoma ; Immunohistochemistry

Introduction: Non-Langerhans cell histiocytoses (non-LCH) are a group of rare diseases with varied clinical manifestations and overlapping features seen among the subtypes. Here, we present a case of Rosai-Dorfman disease with features of necrobiotic xanthogranuloma. Case: A 45-year-old female presented with a 10-year history of an enlarging neck mass with normal overlying skin accompanied by dysphagia and multiple asymptomatic pink to yellowish-brown papules, nodules, and plaques on the face, trunk and extremities. Biopsies of a skin nodule and plaque revealed granulomatous dermal infiltrates (lymphocytes, foamy histiocytes, and Touton giant cells), emperipolesis and areas of necrosis. CD1A and Fite-Faraco staining showed negative results while CD68 and S100 positively stained the tissues of interest. Histopathology of the neck mass paralleled these findings in addition to being negative for lymphoid markers. Patient had monoclonal gammopathy and thyromegaly with enlarged cervical lymph nodes on further tests and imaging. Intralesional and systemic steroids were given which led to flattening of skin lesions and improvement in dysphagia, respectively. Conclusion Diagnosis and classification of a particular type of non-LCH may be difficult due to similarities across its subtypes. Hence, it is our belief that these diseases may occur on a spectrum. Treatment involves a multidisciplinary approach for the best possible care.
Histiocytosis ; Histiocytosis, Sinus ; Necrobiotic Xanthogranuloma

A 37-year-old Filipino man presented with a 9-month history of sagging skin progressing cephalocaudally from the chin and neck to the axillae, side of the trunk, and pelvic area. This was followed by a 2-month history of increasing serum creatinine levels associated with periorbital and bipedal edema, generalized weakness, decreased appetite, vomiting, and headache. Subsequently, skin-colored, non-tender sac-like plaques appeared on the abdomen, inguinal, and intergluteal areas. Histopathology of the latter lesions showed increased spaces between collagen bundles in the dermis. Staining with Verhoeff-van Gieson revealed focal sparse elastic fibers in the papillary dermis compared to that of the reticular dermis consistent with anetoderma. Further work-up revealed normal ANA titer and low serum C3. Kidney biopsy showed IgG deposition in the tubular basement membrane and trace C3 deposition in the glomerular mesangium, giving a diagnosis of rapid progressive glomerulonephritis. On subsequent follow-up, the sac-like plaques became lax and presented as generalized wrinkling of the skin, raising the question whether cutis laxa and anetoderma are occurring in a spectrum instead as distinct entities. Based on the current review of literature, this is the first reported case of primary anetoderma co-occurring with cutis laxa in a patient with glomerulonephritis. Deposition of immunoglobulins along the elastic fibers could have activated the complement system, mediating the destruction of the elastic fibers, resulting to cutis laxa and anetoderma. This case also considers the possibility of anetoderma and type I acquired cutis laxa occurring either in a spectrum or as distinct diseases in a single patient. Further investigations may identify an ultrastructural pattern that can help differentiate the two entities.
Anetoderma ; Cutis Laxa ; Glomerulonephritis

Verrucous carcinoma is an uncommon low-grade well-differentiated malignant neoplasm that commonly arises on acral and mucosal sites. It is often both clinically and histologically misdiagnosed because of its slow growth and low cytologic atypia, respectively. We describe the case of a 74-year-old female with a papillomatous mass arising on a muscle flap and skin graft site on the left foot that had delay in diagnosis for more than 30 years. This case highlights verrucous carcinoma as consideration for both clinical and histologic differential diagnoses in chronic non-healing fungating tumor on the foot. Though non-aggressive in its course, the tumor can cause extensive local destruction of contiguous structures, hence, timely diagnosis and excision is paramount to prevent limb amputation.
Carcinoma, Verrucous

A 65-year-old female with chronic kidney disease (CKD) presented with a six-month history of asymptomatic translucent skin-colored and yellow plaques on the face. Similar yellow papules and nodules were noted in the oral cavity and eyelid margins. Biopsies were taken from the face and oral cavity showed homogeneous eosinophilic deposits with clefts in the dermis consistent with colloid milium. The patient was treated with fractional and surgical carbon dioxide (CO2) laser with improvement after one session.
Renal Insufficiency, Chronic ; Carbon Dioxide

Acquired perforating dermatosis represents one of the perforating skin disorders showing transepidermal elimination of dermal contents. Dermoscopy showing concentric zones of a central keratotic plug, white-gray structureless area and peripheral brown pigmentation may aid in diagnosis and in sample selection for biopsy.
Diabetes Mellitus, Type 2 ; Renal Insufficiency ; Dermoscopy