Discoid Lupus Erythematosus (DLE) is the most common form of chronic cutaneous Lupus Erythematosus (LE). Characteristic lesions cause disfigurement impacting quality of life, with 5% of progress into systemic LE (SLE). Prompt diagnosis avoids sequelae such as scarring, recurrence, and malignancy. Local therapy includes sun protection, steroids, and calcineurin inhibitors (CNIs). Antimalarials and surgical or cosmetic interventions are other options.

Dyshidrotic eczema (DE) and palmoplantar psoriasis (ppPSO) are both conditions presenting with vesicopustules on the palms and soles. While they have differences, distinguishing them can be a challenge in cases complicated with allergic contact dermatitis (ACD).

A 24-year-old male clerk, presented with a one-year history of vesicopustules on the palms and soles, associated with onycholysis and subungual hyperkeratosis. He admits to frequent hand washing and using rubbing alcohol as well as wearing a new pair of rubber shoes. Patch testing (International Standard series) showed +++ Potassium dichromate 0.5%, Carba Mix 3.0%, Thuiram mix 1.0%, Textile dye 6.6% and ++ Formaldehyde 2%. Gram stain was negative and KOH from plantar area showed spores and long-septate hyphae. Dermoscopy showed a bright pink background with erosions, patchy dotted vessels atop with yellow crust, and scales. Histopathology revealed psoriasiform-spongiotic dermatitis with macrovesiculation and eosinophilic spongiosis which was consistent with subacute eczema. He was managed as a case of recalcitrant DE with secondary dermatophytosis and ACD to textile dye and rubber, but still keeping in mind the possibility of eczematized ppPSO. The patient was managed accordingly, with particular emphasis on avoiding allergens. The condition improved, and nail changes resolved with topical medications and a short course of oral corticosteroid and oral anti-fungal thus favoring our initial impression of recalcitrant DE complicated by dermatophytosis and ACD.

This highlights the diagnostic challenge in distinguishing between severe DE and ppPSO in the setting of concomitant ACD, underscoring the importance of a comprehensive evaluation.

Alopecia areata with ophiasis has a worldwide prevalence of only 0.02%. In the last ten years, only 10 cases have been reported in the Philippines. This variant is often resistant to treatment. Novel therapeutic options are being explored, although these are frequently limited to case reports due to the rarity of the disease. Newer therapies, such as JAKSTAT inhibitors and monoclonal antibodies, show promise as effective options for ophiasis-type alopecia areata.

Bullous pemphigoid (BP) is an autoimmune blistering disorder characterized by tense vesicles and bullae, primarily affecting the elderly. It results from autoantibodies targeting hemidesmosomal proteins BP180 and BP230, leading to subepidermal blistering. BP often presents with widespread pruritic plaques and blisters on flexural surfaces, and mucosal involvement is rare. While BP typically occurs spontaneously, certain medications, such as linagliptin, have been implicated as triggers. Early diagnosis and treatment with systemic corticosteroids or immunosuppressive agents can significantly reduce morbidity.

Lupus erythematosus (LE) is an autoimmune disease that has a constellation of clinical manifestations from cutaneous to multi-organ systemic involvement. Childhood-onset SLE is an uncommon, lifelong autoimmune disease that is difficult to diagnose due to its multisystem involvement and multiplicity of clinical manifestations. In children, adolescent girls are most commonly affected with a peak incidence at about 12 years of age. Bullous Systemic Lupus Erythematosus (BSLE) is a rare manifestation of SLE with few cases described in childhood.

We report a case of a 6-year-old girl with an unrecalled history of chronic livedo re:cularis and a 3-month history of non-scarring alopecia who developed multiple minimally pruritic vesicles on the face and neck. The lesions increased in number, size, and distribution, becoming excoriated. The Nikolsky and Asboe-Hansen signs were negative. There was noted oral mucosal involvement and bilateral knee pain at rest with no joint swelling. A 3-mm skin punch biopsy of a vesicle from the upper back revealed an intraepidermal blister. Direct immunofluorescence of perilesional skin showed linear deposits of IgG (+2), C3 (+2), granular IgM (+2), Linear IgA and granular fibrinogen (+2) at the basement membrane zone, consistent with bullous systemic lupus erythematosus. ANA was positive at 1:160 (speckled pattern). We started the patient on dapsone 1.5 mg/kg/day. The patient was co-managed with Pediatric Rheumatology and oral prednisone at 2 mg/kg/day, hydroxychloroquine 50 mg once a day, mycophenolate mofetil 750 mg once a day and enalapril 5 mg once a day were prescribed. The lesions became dry and flat and healed without scarring with no new eruptions noted.

BSLE is uncommon in younger individuals. They usually present with a widespread symmetrical distribution of vesicular skin lesions and frequently favor the sun-exposed areas. We present here a rare case of BSLE in a young individual with an unusual histologic presentation. Treatment with dapsone, corticosteroids, hydroxychloroquine and mycophenolate mofetil afforded complete resolution in our case.

Proteus syndrome (PS) is a mosaic disorder characterized by asymmetric overgrowth of a variety of tissues. Diagnostic criteria established in 1999 emphasized the mosaic distribution of lesions, progressive course, and disproportionate overgrowth. We present a case of proteus syndrome in a 12-year-old Filipino male with 9 year-history of enlargement of the left foot with soft, non-tender mass on the sole with a brain-like surface. Skin punch biopsy of the mass showed cerebriform connective tissue nevi which is pathognomonic of PS.

PS is a very rare disease with prevalence of less than 1 in 1,000,000 live births. Management of PS is extremely challenging, owing to the combination of the individuality of each case, the severity of the disease, and the risks of complications from procedures. A multidisciplinary clinical approach is strongly recommended to obtain the best possible management plans for individual patients.

Kaposi Sarcoma (KS) is a vascular tumor commonly associated with HIV/AIDS. There is unusual presentation of KS in a non-HIV patient, initially diagnosed as small vessel vasculitis. Early recognition and accurate diagnosis are important for the patient’s best management.

A 68-year-old male presented with spontaneous bluish-black patches on his extremities, swelling, pain, and bullae on his toes. Initial workup, including negative ANA and ANCA markers, pointed to small vessel vasculitis, with autoimmune, hematologic, and occlusive diseases considered. Peripheral vascular occlusion was ruled out, and a biopsy showed granulomatous vasculitis. Despite corticosteroid treatment, the lesions worsened. Five months later, the patient developed violaceous papules, plaques, and nodules. A second biopsy confirmed Kaposi Sarcoma (KS) with positive CD34 and HHV-8 stains. Restaining the initial biopsy also revealed KS. Treatment with Doxorubicin was initiated, but the disease progressed, affecting the gastrointestinal system. The patient’s condition deteriorated, and he died from complications of KS.

This case underscores the importance of considering Kaposi Sarcoma in HIV-negative patients with vascular lesions. The initial diagnosis of vasculitis, confirmed by granulomatous changes, delayed the KS diagnosis. Restaining the first biopsy later confirmed the presence of KS from the onset. The extensive skin and gastrointestinal involvement made management with Doxorubicin difficult, leading to a poor outcome.

This is a case of a 74-year-old female who previously worked as a Metro Manila Aide and presented with a solitary erythematous, well-demarcated mass with hyperkeratosis on the right zygomatic area. It started as a pea-sized erythematous papule three years prior without associated symptoms. The patient self-medicated with Ketoconazole + Clobetasol Propionate cream for five months without improvement. Two months before consultation, the lesion enlarged and developed yellow hyperkeratotic crusts. A biopsy revealed invasive squamous cell carcinoma (SCC). Complete excision with adequate margins was recommended. The patient underwent Mohs Micrographic Surgery and reconstruction with a rotational flap repair. Histopathology of the excised tissue confirmed squamous cell carcinoma. No tumor necrosis or lymphovascular invasion was identified, and all resection margins were clear. Post-surgical management included wound care and medications. The case emphasizes early intervention and histopathological evaluation in managing growths especially in cases where patients have not consulted and self medicated instead.

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.