Introduction: COVID-19 has emerged as a global problem with vaccines being established as one of the best tools in its control. Of particular interest in dermatology are risks and manifestations of cutaneous reactions from such countermeasures, with strides made in documenting and associating skin reactions with vaccines against COVID-19. This study aimed to determine the incidence of cutaneous adverse reactions in recipients of recombinant ChAdOx1-S and inactivated SARS-COV-2 vaccines among healthcare personnel and employees of UERMMMCI. Methods: A cross-sectional study was done were respondents, chosen through randomized stratified cluster sampling, were given a questionnaire to elicit cutaneous adverse effects associated with COVID-19 vaccines. Results: There were198 respondents, of which 29.3% were male and 70.7% were female, with a mean age of 26.07 years. Of these respondents, 72 (36.36%) received recombinant ChAdOx1-S and 126 (63.64%) received inactivated SARS-COV-2 vaccine. For the first dose, cutaneous reactions developed in 6 (8.33%) recipients of recombinant ChAdOx1-S, and 2 (1.59%) recipients of inactivated SARS-COV-2. For the second dose, no reactions followed vaccination with recombinant ChAdOx1-S while 4 (3.17%) reactions developed after inactivated SARS-COV-2 vaccination. Lesions were mostly confined to the injection site presenting with erythema for both vaccine types. One urticarial, widespread reaction was associated with a second dose of inactivated SARS-COV-2 vaccine. Conclusions Adverse reactions to COVID-19 vaccinations have been documented which may be attributed to respective excipients rather than vaccine antigens. Due to the rare occurrence of severe anaphylactic reactions, vaccine use is recommended as they confer protection even to those with prior infections. Documented reactions in this study were observed to be mild and self- limiting similar to larger studies.
Vaccines ; COVID-19 ; Pandemics

Essential alopecia syphilitica (AS) is a rare presentation of secondary syphilis, known to affect 3-7% of the population. To the best of our knowledge, this is the first reported case in the country. Herein we present a rare case of alopecia syphilitica in a 27-year-old MSM.

A 27-year-old male presented with a 3-week history of irregularly-shaped, moth-eaten appearing alopecia without any history or presence of mucosal ulcers and copper penny-looking macules and plaques on the palms and soles. History-taking revealed multiple casual unprotected sexual practices. Syphilis enzyme immunoassay and rapid plasma reagin titer were reactive. Biopsy was consistent with syphilitic alopecia.

Syphilis, a highly prevalent STI presents in different spectra. Patients usually present with copper penny-looking erythematous to hyperpigmented macules and plaques on palms and soles, condylomata lata, erythematous papules and plaques on the trunk, and rarely as moth-eaten alopecia. Atypical presentation might lead to a missed diagnosis and untreated disease. This may give rise to an infectious and potentially debilitating deadly disease.

AS may be mistaken as any other alopecia. Keen clinical eye, high index of suspicion, thorough history-taking with emphasis on sexual history and complete physical exam are needed to prevent missed diagnoses in these cases. Prompt treatment, close follow-up and proper counselling are essential to completely diagnose and treat.

Extramammary Paget’s disease (EMPD) is an extremely rare cutaneous malignancy that represents a slow-growing, erythematous, ulcerative or eczematous plaque in areas of the body that possess a high concentration of apocrine glands. It is frequently observed in the genital region of Caucasian females, with the perianal region representing an uncommon site of involvement. Here, we report a case of primary extramammary Paget’s disease in the perianal region of a 55-year-old male, offering new insights into this elusive and poorly understood dermatologic condition.

A 55-year-old male sought consultation for a solitary, well-defined, irregularly shaped, erythematous to violaceous, ulcerated plaque in the perianal area of one-year duration. A clinical diagnosis of primary EMPD was confirmed by histopathologic findings of Paget cells, a cytokeratin 7 positive/cytokeratin 20 negative immunophenotype, and the absence of underlying malignancy. A wide excision with negative margin control and a bilateral V-Y fasciocutaneous advancement flap were performed with good results.

Extramammary Paget’s disease is a rare but insidious dermatologic malignancy often easily disregarded as a benign inflammatory condition. It underscores the need for clinicians to maintain a high index of suspicion to provide an early, accurate diagnosis, leading to a multidisciplinary treatment approach to prevent potential complications.

BACKGROUND

Disorders of hyperpigmentation can affect the quality of life and pose a significant psychological burden for patients. However, little is known about sun protective behaviors within patient populations with hyperpigmentation disorders.

This study aimed to evaluate the knowledge, attitudes, and practices on sun exposure and protection among patients with cutaneous hyperpigmentation.

This was a single center analytical cross-sectional study which used a self-administered questionnaire on knowledge, attitudes, and practices on sun exposure and protection. Study subjects were 135 patients aged 13-59 years old who sought consult at a tertiary hospital and diagnosed with cutaneous hyperpigmentation. The level of knowledge, type of attitude, and practices on sun exposure and protection were determined. The association between the sociodemographic factors and knowledge, attitudes, and practices was determined using multivariate logistic regression model.

In this study, majority of the patients have adequate knowledge (80%), desirable attitudes (82%), and good practices (79%) towards sun exposure and protection. None of the demographic factors were found to be significantly associated with knowledge. The odds of having a desirable attitude among those in the construction sector was 803 times the odds for those in the transportation sector. Only the attribution of hyperpigmentation to the sun was a factor found to be significantly associated with good practices.

This study recommends that dermatologists caring for patients with cutaneous hyperpigmentation continue to emphasize patient education on sun exposure and protection since adequate knowledge consistently translates to good practices for this group of highly motivated patients.

: Pityriasis lichenoides (PL) is an inflammatory papulosquamous condition that exists in a continuous spectrum that consists mainly of pityriasis lichenoides et varioliformis acuta and pityriasis lichenoides chronica (PLC). The condition has been reported to erupt in response to infections, radiocontrast media, medications and vaccines. Most case reports on vaccine-related eruption involve the acute PL, hence, this report aimed to present a case presenting with lesions of the chronic variant. : A 21-year-old female presented with multiple erythematous to hyperpigmented ill defined plaques, some ulceronecrotic, topped with fine scales and excoriations on the upper and lower extremities, periumbilical area and back of 4 months duration, following rabies vaccinations. : Histopathologic findings, including interface dermatitis, parakeratosis, spongiosis, and mixed inflammatory infiltrates, confirmed the diagnosis of PLC. The patient responded well to oral corticosteroids and heliotherapy. PL is rare and requires additional research. The potential role of vaccination as an etiologic agent represented a crucial area of this investigation. Additionally, heliotherapy should be considered as a viable therapeutic alternative when phototherapy is not feasible.. Further research is needed to elucidate the pathogenesis of PL and establish evidence-based treatment protocols.
Pityriasis lichenoides chronica ; Pityriasis lichenoides ; heliotherapy ; vaccine

Introduction: Bullous pemphigoid (BP) is an acquired autoimmune subepidermal bullous disease characterized by linear depo- sition of IgG and C3 along the basement membrane. It rarely occurs in childhood, especially in adolescence, with only 14 cases identified in literature. Treatment of choice is systemic corticosteroids but other treatment options such as anti-inflammatory antibacterials and methotrexate are available. Case report: A 16-year-old Filipino girl presented with a three-month history of generalized vesicles and bullae. Nikolsky and Asboe-Hansen signs were negative. Histopathology and direct immunofluorescence were consistent with BP. ELISA to BP180 au- toantibody levels was elevated at 135 IU (normal <9 IU). Complete blood count showed leukocytosis with increase in neutrophils. Chest x-ray revealed pulmonary tuberculosis. The patient was given quadruple anti-Koch’s medication (pyrazinamide, rifampi- cin, ethambutol, isoniazid), prednisone, oral erythromycin and topical clobetasol propionate. Complete remission was attained at 10 months and is sustained at the time of writing. Conclusion To establish a definitive diagnosis and appropriate management, BP requires clinical, histopathologic, and immuno- logical correlation. Childhood BP has good prognosis and rapid treatment response, with rare relapses.
Pemphigoid, Bullous

INTRODUCTION: The occurrence of malignant tumors associated with leprosy has been observed, with lymphoma being the most commonly associated non-epithelial malignant tumor and may be due to the depressed immunologic surveillance. The converse where leprosy manifests in a lymphoma patient undergoing chemotherapy has also been mentioned in a few articles. CASE SUMMARY: A 49-year-old female was diagnosed to have peripheral T-cell lymphoma after an initial presentation of enlarged lymph nodes, generalized asymptomatic papules and plaques on the trunk, and pancytopenia. Two weeks after initiation of chemotherapy with cyclophosphamide, doxorubicin, vincristine, prednisolone (CHOP), her skin lesions progressed to become violaceous to slightly hyperpigmented. Further query revealed a year-long history of hypoesthesia of the lower extremities. Histopathologic examination revealed nodular histiolymphocytic infltrates surrounding blood vessels, adnexal structures, and nerves, consistent with lepromatous leprosy. Fite-Faraco stain was positive. Due to lymphoma-related pancytopenia, the patient was given monthly rifampicin, ofoxacin and minocycline (ROM) chemotherapy, alternatively. Erythema nodosum leprosum reaction developed for which clofazimine was given, resulting in improvement. CONCLUSION Leprosy is a great mimicker and dermatologists need to be adept at diagnosing skin conditions in immunocompromised patients, especially since disease course and manifestation may be modifed in this subset of patients. Leprosy must be considered when granulomatous lesions arise in lymphoma patients before ascribing them to the underlying disease. Management may also be challenging due to the comorbidities, which may limit treatment options. Careful history, clinical clues, histopathologic correlation, and prudent therapeutic approach are important tools in addressing these cases.

INTRODUCTION: Interdigital pilonidal sinus is an acquired condition secondary to penetration of hair fragments into the skin of the web spaces of the hands commonly observed in hairdressers, and occasionally, among pet groomers. Local literature reports or guidelines to ensure practice of protective measures for this population of workers are currently lacking. CASE SUMMARY: A 24-year old pet groomer consulted due to occasional white hair strands emerging from two openings in the third interdigital space of his dominant hand. Histopathologic examination of the sinus tract showed an acanthotic, hyperplastic epidermis with scale crust, and nodular dermal infiltrates composed of epithelioid histiocytes, plasma cells, lymphocytes, and eosinophils. Transepidermal extrusion of polarizable hair cortical material was also evident establishing the diagnosis of an interdigital pilonidal sinus. Sinusectomy and debridement with healing by secondary intention resulted in an optimal wound closure and full motion of the affected hand after one week and minimal scarring with no recurrence after seven months. CONCLUSION Surgical excision followed by proper wound care is essential to avoid recurrence. In conclusion, since interdigital pilonidal disease is a rare condition, awareness among physicians would lead to accurate diagnosis, optimal treatment, and proper patient education.
occupational diseases ; grooming ; extremities ; Pilonidal sinus

INTRODUCTION: There is a consistent increase in the interest and demand for non-invasive modalities to
improve facial skin laxity and rhytides. Monopolar radiofrequency is one of such non-invasive modalities.
This systematic review aimed to determine the efficacy and safety of monopolar radiofrequency in
improving facial rhytides and skin laxity.

METHODS: Clinical studies that assessed the efficacy of monopolar radiofrequency to address clinically
observable facial rhytides and skin laxity were included. Outcome measures included improvement
in rhytides and skin laxity as documented by patient satisfaction scores, and investigator and third-person
observer ratings based on clinical photographs and clinical scales.

RESULTS: Three studies involving 29 participants were included in this review. All studies reported 25-
50% improvement in facial rhytides and skin laxity. Participants from the three studies were satisfied
with the results. Transient erythema was reported in several patients.

CONCLUSION: Monopolar radiofrequency appears to be beneficial and safe for patients with facial
rhytides and skin laxity. However, the evidence is inconclusive due to problems in the methodological
quality of each trial and the heterogeneity of the studies included in this review.

Human ; Female ; Middle Aged ; Antifibrinolytic Agents ; Melanosis ; Orobanchaceae ; Tranexamic Acid