Acrodermatitis continua of Hallopeau (ACH) is a rare, chronic, and recalcitrant inflammatory disorder classified as a localized variant of pustular psoriasis. Patients usually present with relapsing episodes of subungual pustules, nail dystrophy, and scaling. We report a case of ACH in a 32-year-old female, which developed following a nail infection and exacerbated during pregnancy, with no medication for 2 years. She presented at the clinic with severe manifestations of anonychia and multiple bone resorption on the distal phalanges. The patient was started on topical medication of combination corticosteroid and vitamin D analogue and oral methotrexate initially at l0mg/week then increased to 15mg/week due to poor response. Despite compliance to medications and avoidance of possible irritants, the patient still had relapse of pustules on the nails.

Several treatment options for ACH are available such as topical steroids, vitamin D analogue, systemic biologics, and non-biologics such as methotrexate and cyclosporine. However, systemic biologics are considered the most efficacious for ACH but financial constraints often limit their use in resource-poor settings.

BACKGROUND

With the utility of nail dermoscopy to supplement the diagnosis of onychomycosis, studies have been done in describing common findings. However, most of these were based in Europe and the Americas. Given the geographical variation of onychomycosis, a local study is needed.

The general objective of this cross-sectional study is to determine the different patterns among the clinical subtypes of laboratory diagnosed onychomycosis patients seen at the Philippine General Hospital (PGH).

Clinically suspected Filipino onychomycosis patients seen at the PGH - Department of Dermatology, and at the PGH inpatient wards were recruited. All patients underwent the following: direct KOH microscopy, fungal culture studies, and nail clipping with PAS staining.

A total of 75 samples were included; 93.33% of the samples were categorized as DLSO subtype, 5.33% as TDO, and 1.33% as PSO. The three most common onychoscopic patterns were subungual hyperkeratosis (93.33%), chromonychia (85.33%), and longitudinal striae in 81.33%. KOH was positive in 57.33% of the cases, cultures in 38.67% and PAS stain in 80%. Onychoscopic pattern was not associated with clinical type of onychomycosis and causative organism. Negative KOH result was associated with linear edges (p=0.02).

Among patients with clinical and laboratory diagnosed onychomycosis, linear edges and jagged proximal edges were associated with negative KOH microscopy and fungal CS, respectively. Hence, in situations where such examinations are negative despite a strong clinical suspicion of onychomycosis, the above onychoscopic findings can be used for empirical diagnosis.

Bullous pemphigoid (BP) is the most common autoimmune blistering disease primarily characterized by tense blisters and occasionally with urticarial plaques, affecting the skin and mucous membranes. These are caused by autoantibodies against BP180 and BP230 which target antigens on the basement membrane zone. The diagnosis relies on the integration of clinical, histopathological, immunopathological, and serological findings. The management depends on the clinical extent and severity. We present in this article a literature review and the clinical consensus guidelines of the Immunodermatology Subspecialty Core Group of the Philippine Dermatological Society in the management of BP.
Pemphigoid, Bullous

Hailey-Hailey disease (HHD) is an uncommon acantholytic disorder of the skin. This is a case of a 64-year-old Filipino female with a chronic history of painful and malodorous intertriginous plaques. Histopathologic evaluation showed overlapping features of pemphigus vulgaris and Hailey-Hailey disease. A negative direct immunofluorescence test clinched the diagnosis of Hailey-Hailey disease. The patient was advised regarding preventive measures and treated with topical antibiotics and corticosteroids with improvement of her lesions.
Pemphigus, Benign Familial ; Fluorescent Antibody Technique, Direct

Pemphigus vulgaris is an autoimmune bullous dermatosis presenting with flaccid blisters and erosions. The morphology of pemphigus reflects the more superficial intraepidermal level of split seen histologically in contrast with pemphigoid, where the level of split is deep below the epidermis. This is a case of a 58-year-old male clinically presenting with arcuate tense bullae, which are more characteristic of the pemphigoid group of disorders, which revealed an intraepidermal split and tombstoning pattern of the basal epidermis on histopathology. Direct immunofluorescence revealed intercellular IgG and C3 distribution. Although this patient presented clinically with tense bullae, the histopathology and direct immunofluorescence results were consistent with pemphigus vulgaris.
Pemphigus ; Fluorescent Antibody Technique, Direct

Introduction: Mastocytosis is a disease defined by the proliferation of mast cells in organs, most commonly the skin. It may affect any age group but is usually found in children in the first year of life. We present a case of diffuse cutaneous mastocytosis manifesting in the rare bullous form. Case: A 4-month-old Filipino male presented with multiple bullae on the head, trunk, and extremities after applying chamomile oil. Biopsy of the skin demonstrated numerous mast cells, confirming the diagnosis of bullous mastocytosis. The patient was treated with oral antihistamines and corticosteroids, which was followed by a good response. Conclusion Diagnosis of diffuse cutaneous mastocytosis may be challenging due to its rarity. Proper management requires preventive measures, symptomatic treatment, as well as communication of prognosis with the stakeholders.
Mastocytosis, Cutaneous

Environmental and occupational health are interconnected disciplines of public health that are concerned in maintaining a symbiotic relationship between the ecosystem and humans. This relationship is under threat by the continuous and alarming increase of the Earth's temperature causing climate change that impacts not just health but also the economy and the safety of the population. The First National Environmental and Occupational Health Forum was organized by the Department of Environmental and Occupational Health, College of Public Health, University of the Philippines Manila to address and discuss the complex issues that the Philippines is currently experiencing when it comes to environmental and occupational health by providing a space where stakeholders from different sectors can actively participate in mapping out challenges and opportunities. The organizer's long-term vision is to catalyze and build a network of collaboration that is geared towards the improvement of health and safety in the workplace that involves mitigating the effects of climate change. The discussions in the forum gave a comprehensive insight into the different challenges we face for being one of the most vulnerable countries to natural disasters: how this affects health, workplace, and environment. These challenges created new opportunities for the country to build resilience and formulate adaptive strategies to decrease the vulnerability of the population especially the workforce who are constantly exposed to different hazards that are exacerbated by changes in the environment.