November 2018 Supplemental Issue
Official Publication of the Philippine Dermatological Society
Research Forum Experimental Category
A randomized, double-blind, controlled trial on the antibacterial efficacy and safety of Moringa oleifera leaves Bar Soap and Moringa oleifera seed bar soap compared to Triclosan Against Staphylococcus aureus and Staphylococcus epidermidis
Staphylococcus aureus and Staphylococcus epidermidis are common pathogens that cause skin and soft tissue infections. Triclosan soaps are usually used to prevent contamination.
Effects of using a gentle cleanser versus water alone in Filipino patients with mild to moderate acne vulgaris: an observer-blinded, randomized controlled trial
Acne vulgaris is one of the skin disorders for which patients most frequently consult a dermatologist worldwide. Adjunct skin care products are assuming an increasingly important role because they may impact the function of acne-prone skin.
The efficacy and safety of 75% garlic (Allium sativum) lipid extract versus curettage in the treatment of molluscum contagiosum: A randomized controlled trial
Molluscum contagiosum is a viral infection, caused by the Poxviridae family, that frequently affects children. The most common destructive treatment used in our setting is curettage. However, due to the pain and discomfort that patients may experience during the procedure, an alternative treatment option is necessary.
A Randomized, Double Blind, Placebo-Controlled Clinical Trial of the effects of Vitamin D supplementation among diagnosed Atopic Dermatitis patients
Atopic Dermatitis is an emerging public health concern. Recently, several studies have explored the role of Vitamin D in atopic dermatitis. To date, there is no local study using Vitamin D supplementation as an adjunct in the treatment of atopic dermatitis.
A randomized controlled study on the efficacy and safety of zinc oxide 20% ointment versus salicylic acid 15% + lactic acid 15% ointment in the treatment of patients with verruca vulgaris
Verruca vulgaris are scaly, rough papules or nodules caused by the human papilloma virus.
A pilot study on the effect of acupuncture on facial skin rejuvenation: a clinical and histologic evaluation
Previous studies on cosmetic acupuncture have shown promising results in decreasing skin wrinkling. However, histologic measurements documenting these changes have not yet been done.
Effectiveness of the Eczema Action Plan (EAP) in improving the Eczema Area and Severity Index (EASI) scores among pediatric patients with atopic dermatitis: a pragmatic randomized controlled trial
Atopic dermatitis is a chronically relapsing skin disease that occurs most commonly during early infancy and childhood. There are no reported studies on interventions done to increase treatment adherence among patients with atopic dermatitis in the local setting.
Efficacy and Safety of 10% Povidone–Iodine Solution for the Treatment of Molluscum Contagiosum: A double blind, Placebo-Controlled, Randomized Clinical Trial
Molluscum contagiosum is a common viral disease of childhood presenting as small, firm, dome-shaped umbilicated papules. Treatment options include destructive therapies, immunomodulators, and antivirals.
The efficacy and safety of 6% gabapentin topical formulation in the treatment of pruritus in adult Filipino hemodialysis patients: a randomized, double-blind, placebo-controlled study
Novel agents with good safety profiles are needed in the management of chronic kidney disease – associated pruritus (CKD-AP). This study aims to assess the efficacy and safety of topical gabapentin in the treatment of CKD-AP.
Efficacy of Sunflower seed oil versus control in reducing post-inflammatory hyperpigmentation of the axillae in adult Filipinos: a randomized controlled double-blinded crossover trial
Dark-skinned women have higher risk for post-inflammatory hyperpigmentation.
Axillary skin is considered as one of the sensitive areas prone to skin damage and
pigmentation. Treatment for axillary hyperpigmentation has remained challenging as no
standard treatment is available.
Research Forum Non-Experimental Category
Impact of allergen avoidance on the quality of life among patch test positive patients with allergic contact dermatitis in a tertiary hospital in the Philippines
Allergic contact dermatitis (ACD) is known to impair quality of life (QoL). Thus, appropriate allergen identification and avoidance are vital to its management.
Quality of life of Bullous Pemphigoid patients and its association with disease severity: A 3-year single hospital study
Bullous Pemphigoid (BP) is a rare disease characterized by autoantibodies directed against BP180 and BP230. For BP patients, disease severity may have an impact on quality of life (QOL).
Psoriasis affects 0.1-3% of the world’s population. It is a chronic multifactorial disease with a genetic basis and various triggering factors. In the Philippines, extrapolated data from 2004 reveals a 2% prevalence.
Relationship of Whole Blood Zinc Levels to Acne Severity Among Filipinos 18-25 years old: A Cross-sectional Comparative Study
Acne Vulgaris is one of the most common dermatologic diagnoses in the world. It can persist for years, result in permanent scarring, and have serious adverse effects on psychosocial development.
Self-medication Practices using Topical Agents: A Cross-sectional Study among Patients at the Dermatology Out-patient Clinic of St. Luke’s Medical Center-Quezon City
Self-medication is a common practice in developing countries like the Philippines but often underreported. In particular, there are limited studies regarding the practice of topical self-medication in the Filipino local community.
The association of functional activity limitation and quality of life of leprosy cases in a tertiary hospital: a cross-sectional study
Few studies have been done on the association of functional activity limitations (FALs) and quality of life (QoL) among those with leprosy.
Culture-proven skin and soft tissue infections among patients admitted at a tertiary hospital from 2013 to 2017: a five-year review
Skin and soft tissue infections (SSTIs) are commonly encountered in local practice. Their incidence has increased because of emergence of antibiotic resistance making their treatment more challenging.
Knowledge, Attitudes and Practices of Barangay Health Workers in Marawi City regarding Hansen’s Disease
Hansen’s Disease is a chronic granulomatous infection which primarily affects the skin and peripheral nerves. The disease is endemic in Marawi City, however recent years have seen a sharp decline in reported incidence.
Prevalence of mucosal and cutaneous disorders among HIV/AIDS adult Filipino patients 18-60 years old seen in a tertiary hospital in Makati city
There has been a recent rise in the number of HIV/AIDS patients in the Philippines. In addition, mucosal and cutaneous diseases among HIV/AIDS patients can help assess the disease severity and prognosis.
PDS Poster Contest
Merkel cell carcinoma (MCC) is an aggressive dermal tumor of neuroendocrine origin. It is a rare, highly malignant primary skin tumor, with approximately 2,000 cases reported. This malignancy poses a challenge to clinicians due to its rarity and poor prognosis.
Behcet’s disease has been described to be both an autoimmune and an autoinflammarotory disorder. Recurrent oral aphthous ulcers characterize this disease, usually with the involvement of other organ systems including dermatologic manifestations. Due to its ability to involve blood vessels, vasculitis is the usual finding.
A rare case of Blastic Plasmacytoid Dendritic Cell Neoplasm in a 43-year old Filipino male: a case report
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and highly aggressive hematodermic malignancy that usually occurs in elderly individuals and manifests with skin lesions followed by involvement of lymph nodes, bone marrow, and peripheral blood. There is a high risk for leukemic dissemination, hence, a poor prognosis.
Sezary syndrome is an extremely rare leukemic cutaneous T cell lymphoma, with annual incidence of 0.3 to 1 per 100,000, characterized by triad of erythroderma, lymphadenopathy, and circulating Sézary cells in the peripheral blood.
Epidermolysis Bullosa, Generalized-Severe (EBS-gen sev) is a rare genodermatosis, resulting from multiple gene mutations, characterized by marked mechanical skin fragility. It presents at birth with disseminated friction-induced blistering. Erosions heal without scarring and lesions tend to improve with age.
Confluent and reticulated papillomatosis (CARP), also known as Gougerout-Carteaud Syndrome, is a rare disease affecting young adults. It is often characterized by asymptomatic hyperpigmented papules coalescing into confluent patches and plaques centrally and exhibiting a reticular pattern peripherally.
Syringocystadenoma papilliferum in nevus sebaceus mimicking squamous cell carcinoma in a Filipino female: a case report
Syringocystadenoma papilliferum (SCAP) is a relatively rare benign tumor, which can manifest in a variety of clinical forms. Nearly one-third of cases are known to arise within a pre-existing nevus sebaceus but the exact incidence and probability of malignancy is unknown.
“The Great Pox of the Fungal World” Mucocutaneous histoplasmosis in a 57-year old HIV-negative Filipino male: A case report
Histoplasmosis is more widespread than once thought and its expanding global risk extends to Southeast Asia. Literature search reveals about a dozen reported cases of histoplasmosis among Filipinos. Protean clinical spectrum ranges from self-limited infection to progressive dissemination.
Erythema induratum of Bazin (EI) is a chronic recurrent panniculitis with vasculitis typically manifesting as erythematous, tender, nodules with occasional ulceration and scarring on the posterior calves as a hypersensitivity reaction to Mycobacterium tuberculosis (MTB). EI represents 35.8% of all cutaneous MTB infections in a recent retrospective study. Familial, non-MTB related cases of EI have been infrequently reported.
Scleroderma is an autoimmune disease usually affecting women from 30s to 50s due to inflammation, changes in vasculature, and connective tissue-producing cells. Environment and chemical factors could be triggers, however, fetal microchimerism can also initiate scleroderma.
Colloid milium is a rare disorder characterized by appearance of skin-colored to yellow papules mostly in sun-exposed skin. The exact pathogenesis of this disease is not yet known but ultraviolet exposure has been implicated. There have been reports of concurrence with beta thalassemia, vitamin C deficiency and trichinosis however no disease association has been definitely established.
Adverse Drug Reactions
Methotrexate Toxicity Presenting with Cutaneous Ulcers in a 51-Year Old Female Treated with Low-Dose Methotrexate: A Case Report
Methotrexate is highly effective for psoriasis vulgaris and is often used as long-term management. Well known for its side effects of myelosuppression and liver toxicity, methotrexate also induces skin ulceration, which often heralds other markers of toxicity.
Dapsone hypersensitivity syndrome (DHS) is an allergic reaction caused by dapsone, one of the components in the WHO leprosy multidrug therapy (MDT), which usually occurs in the fourth-eighth week of the treatment.
Toxic Epidermal Necrolysis (TEN) is acute mucocutaneous reaction characterized with extensive necrosis of epidermis. It is the highest grade of SJS-TEN clinical spectrum, involving necrosis of >30% of body surface area.
Generalized bullous fixed drug eruption from vincristine and cyclophosphamide in a patient undergoing chemotherapy for gestational trophoblastic neoplasia
Generalized bullous fixed drug eruption (GBFDE) is a rare presentation of fixed drug eruption. Fixed drug eruption can present with bullae but can present in a widespread distribution as GBFDE.
A Case of Steven Johnson Syndrome-Toxic Epidermal Necrolysis Overlap with Systemic Lupus Erythematosus
We report a case of Steven Johnson Syndrome-Toxic Epidermal Necrolysis (SJS-TEN) overlap in a patient with systemic lupus erythematosus (SLE). Identified drugs were amoxicillin-clavulanic acid and ibuprofen however, connective tissue diseases such as SLE contributed to this as well.
Cotrimoxazole-induced generalized bullous fixed drug eruption mimicking stevens-johnson syndrome: a case report
Generalized bullous fixed drug eruption (GBFDE) is characterized by generalized erythema and appearance of multifocal ill-defined hyperpigmentation, and flaccid bullae which easily rupture and exhibit epidermal detachment. It may be clinically indistinguishable from stevens-johnson syndrome (SJS), especially on initial presentation.
A case study of Stevens Johnson Syndrome-Toxic Epidermal Necrolysis Overlap in a 51 year old Filipino female patient treated with Intravenous Immunoglobulin and Corticosteroids.
Stevens Johnson Syndrome-Toxic Epidermal Necrolysis Overlap is an acute life-threatening mucocutaneous reaction characterized by extensive necrosis and detachment of the epidermis, usually with drugs as the most important etiologic factor.
Drug Reaction with Eosinophilia and Systemic Symptom (DRESS Syndrome) Atypical with Acute Kidney Injury
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a serious cutaneous and systemic drug reaction with multiple organ complications and a mortality rate of up to 10%. Its frequency has been estimated at 1 in 1000 to 10.000 drug exposures.
Severe Striae and Steroid Acne as Side Effects Caused by Long-term Systemic Corticosteroid Treatment
Systemic corticosteroids are often used in various fields of medicine, including dermatology. The anti-inflammatory and immunosuppressive properties of corticosteroids make this agent the first-line option in many disorders such as autoimmune and bullous diseases. However, there are also potential side effects and dermatologists who prescribe corticosteroids have to be aware of them.
Metformin is the drug of choice in patients with type 2 diabetes. Metformin side effects are ranging from gastrointestinal symptoms to very rare are skin problem.
IgA anti-tissue transglutaminase and IgA antiendomysial antibody negative dermatitis herpetiformis in a Filipino patient: A Case Report
Dermatitis Herpetiformis (DH) is a chronic, relapsing cutaneous disease with associated gluten sensitive enteropathy (GSE). DH is characterized by an symmetric, intensely pruritic papulovesicular herpetiform eruption involving extensor surfaces of the body.
Pemphigus vulgaris (PV) is a chronic, autoimmune bullous disease with a potentially fatal outcome. It typically presents with flaccid blisters and erosions on both the skin and mucous membranes due to loss of coherence among keratinocytes. It is an uncommon disease with an incidence rate estimated at 0.5 to 3.2 per 100,000 per year.
Paraneoplastic pemphigus is an autoimmune blistering disease commonly associated with lymphoproliferative disorder and rarely with a carcinoma. It is characterized by the presence of intractable, painful stomatitis and polymorphous skin eruption.
Pemphigus foliaceus is an autoimmune blistering disease of the skin which causes a characteristic inflammatory attack at the subcorneal layer of epidermis, which results in skin lesions that are scaly or crusted erosions with an erythematous base distributed along the seborrheic areas of the body.
CBDC is a rare autoimmune bullous disorder presenting with tense bullae with some lesions showing ‘cluster of jewel” or “string of pearls” appearance. Histopathology shows subepidermal bulla with predominant neutrophilic infiltrate.
Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disease of the skin and mucous membranes. Despite this, much is unknown about the initial triggers of the disease.
Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease, typically occuring in the elderly. It is due to autoantibodies against basement membrane antigens BP230 and BP180.
Linear IgA dermatosis is an autoimmune subepidermal blistering disease presented as tense bullae with a string-of-pearls appearance located most commonly in the trunk. It occurs bimodally with a slight predominance of females. This disease is caused by an antibody deposition leading to complement activation and neutrophil chemotaxis which eventuates in loss of adhesion at the dermo-epidermal junction and formation of a blister.
Dermatitis Herpetiformis is a subepidermal blistering disease that can be confirmed by histologic, immunologic, and gastrointestinal criteria. It occurs most commonly in individuals of Northern European descent and is in uncommon in Asians. Incidence rates are between 0.4 to 3.5 per 100,000 people per year worldwide and is associated with the HLA DQ2 and HLA DQ8 haploptype.
Linear IgA bullous dermatosis is a chronic, acquired autoimmune blistering disease characterized by nonspecific lesions that may be found in other diseases belonging to the same category.
Pemphigus vulgaris is an autoimmune blistering disease predominantly seen in patients between 40-60 years with an incidence between 0.076 and 1.6 per 100,000-person years. Most cases of pemphigus vulgaris are seen in adults but also occur in adolescents in 1.4-3.7% of cases. The majority of pemphigus of childhood onset is of vulgaris type with onset at 12 years with no gender predilection and called juvenile pemphigus vulgaris. We present a 14-year-old female who presented with mucocutaneous lesions of pemphigus vulgaris with modest improvement on oral corticosteroids.
Closure of Post-Excision Defect of Basal Cell Carcinoma With Full Thickness Skin Graft Method: 3 Case Reports
Basal cell carcinoma (BCC) is the most common skin cancer which is derived from unkeratinized cells in the basal epidermal layer. BCC occurring on the head and neck accounts for 80% of all cases while 30% occurs on the nose. The lesion grows slowly is locally invasive and destructive. The combination of operative therapy and histologic confirmation is the standard approach in the management of BCC. In addition, aesthetic aspect has to be taken account.
Basal cell carcinoma (BCC) is the most common skin malignancy that arises from unkeratinized basal cells in the epidermis. It occurs mostly on the head and neck (80%) and nose (30%). The lesion is locally invasive, destructive, and has a slow growth. Moh’s micrographic surgery is the standard option in treating BCC.
Incontinentia Pigmenti (Block-Sulzberger Syndrome) is a multi-system disorder whose name refers to the histopathologic finding of dermal melanophages in the third stage. An incidence of 0.6- 0.7/1,000,000 live births have been established with only 42 cumulative cases reported in the PDSHIS from 2011 to 2018.
Pachydermoperiostosis or primary hypertrophic osteoarthropathy is a rare, genetic syndrome with familial and idiopathic forms characterized by progressive joint effusion associated with pachydermia, periostosal proliferation of the long bones, and finger clubbing. This condition presents with distinctive thickening and furrowing of the skin of the scalp, forehead and cheeks, enlargement of the distal parts of the extremities, excessive sweating, and severe seborrhea of the scalp and face.
Darier’s Disease is a rare autosomal dominant genetic disorder characterized by predominantly scaly or keratotic papules distributed on the seborrheic areas of the body, with nail splitting, palmar pits and a malodorous scent. It is a chronic disease with a prevalence of 1-4 out of 100,000 people. Abnormality in the gene ATP2A2 that codes for the Sarcoendoplasmic Reticulum Calcium ATP-ase pump is implicated in the disease.
Tuberous sclerosis complex is a rare, multi-system genetic disease that causes benign tumors to grow in the brain and on other vital organs such as the kidneys, heart, eyes, lungs, and skin. In familial cases, TSC is autosomal dominant. However, most cases actually occur as sporadic cases due to new, mutations in a tumor suppressor gene, either TSC1 or TSC2. Characteristic skin lesions include angiofibroma, facial fibrous plaques, shagreen patch, hypomelanotic macules and ungal fibromas. Many TSC patients show evidence of the disorder in the first year of life. However, clinical features can be subtle initially, and many signs and symptoms take years to develop.
We report a case of multiple neurofibromas with hypertrichosis in an 11-year-old male. Classic cutaneous neurofibromas, café-au-lait macules, axillary freckling, Lisch nodules and scoliosis were also present fulfilling a diagnosis of Neurofibromatosis type 1. Hypertrichosis overlying a neurofibroma is rarely reported and the mechanism remains to be elucidated.
We report a case of bilateral segmental neurofibromatosis in a 47-year old female with classic cutaneous neurofibromas and café-au-lait macules. There were no ophthalmologic, neurologic or skeletal abnormalities.
Alopecia areata incognito responsive to azathioprine presenting in a patient with uncontrolled iatrogenic hypothyroidism
Alopecia areata incognito is a rare variant of alopecia areata presenting as diffuse hair thinning, hence its other name diffuse alopecia areata. It usually mimics acute telogen effluvium but has the characteristic trichoscopic findings of alopecia areata.
Androgenetic alopecia (AGA), also known as pattern hair loss, is the most common type of hair loss in men and women. This review aims to evaluate the efficacy and safety of a potential treatment option, topical adenosine, for androgenetic alopecia in male and female adults versus placebo and other comparators.
Acne Keloidalis Nuchae (AKN) is a chronic disorder involving inflammation and
scarring of hair follicles with subsequent development of keloid-like papules and plaques
commonly affecting the occipital scalp. Tufted Hair Folliculitis (THF) is a rare and progressive
inflammatory condition of the scalp characterized by peculiar tufting of hair. Several authors
suggest THF is a secondary phenomenon occurring in inflammatory scalp disorders, including
Dissecting Cellulitis, Acne Keloidalis Nuchae, and Folliculitis Decalvans.
Efficacy of azathioprine for alopecia areata: a systematic review of observational and interventional studies
Alopecia areata is postulated to be an autoimmune hair disorder characterized by patches of hair loss. Corticosteroids have been utilized to treat the said disorder, but efficacy has proven to be subpar when applied to severe and extensive variants such as alopecia areata totalis, alopecia areata universalis, and ophiasis. Prolonged steroid therapy leads to side effects such as skin atrophy, weight gain, Cushing syndrome, immunosuppression, and hypothalamic-pituitary-adrenal axis suppression, while discontinuation of the treatment leads to high relapse rate. There is a need for alternative treatment modalities with better safety profile and sustained treatment response to address this dilemma.
Epidermolytic Hyperkeratosis with Significant Improvement in Quality of Life after Treatment with Acitretin
Epidermolytic hyperkeratosis (EH) is a rare and severe form of ichthyosis with occurrence in 1 of 300,000 persons. EH is an autosomal dominant condition caused by mutations in keratin 1 and keratin 10. Few published literature owing to the rarity of the condition has limited the treatment options for EH. Traditional management with emollients are unsatisfactory in relieving the concerns of the patients, including the odor attributed to bacterial colonization, skin thickness and hyperpigmentation. EH is a severely debilitating disorder impairing the personal, social and economic activities of patients affected, further adding to the cost of management.
Harlequin Ichthyosis (HI) is a rare type of Autosomal Recessive Congenital Ichthyosis associated with poor survival. Clinically the diagnosis can be made for their distinct appearance characterized by diffuse epidermal hyperkeratinization and defective desquamation.
A rare case of Confluent and Reticulated Papillomatosis of Gougerot and Carteaud in a 23-year old male treated with Doxycycline
Confluent and Reticulated Papillomatosis is a rare disease seen in young adults characterized by persistent brown scaly papules that are confluent in the center and reticulated in the periphery distributed mainly on the neck, upper trunk and axillae. It is an acquired Ichthyosiform dermatosis. Misdiagnosis is frequent for it resembles lesions like that of Tinea Versicolor. Different treatment approaches have been use such as keratolytics and antibiotics. But Minocycline is still the first-line of treatment supporting that the condition is caused by an infection or inflammation.
Hypoesthesia and cutaneous eruptions in a patient with T-cell lymphoma: Telltale signs of leprosy, an unrelenting ancient disease
The occurrence of malignant tumors associated with leprosy has been observed,
with lymphoma being the most commonly associated nonepithelial 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.
Leprosy is a chronic infectious disease caused by Mycobacterium leprae primarily affecting the skin, mucous membranes and peripheral nerves. Pregnancy causes a relative decrease in cellular immunity resulting in first appearance of the disease, reactivation, or relapse in treated patients. Alteration in cell mediated and humoral immunity may trigger leprosy reactions. We report a case of a primigravid in her second trimester of pregnancy diagnosed with lepromatous leprosy in type 2 reaction treated with multidrug regimen and prednisone.
Crusted scabies, also known as Norwegian scabies, is a rare and highly contagious clinical variant of scabies infection caused by ectoparasite Sarcoptes scabiei var. hominis. This form of scabies mostly occur in elderly patients with malnutrition, sensory neuropathy, mental retardation, and immunosuppression. In <0.5% of reported cases, crusted scabies may present as erythroderma with erythema and scales on more than 90% of the body surface.
Leprosy is caused by Mycobacteriom leprae which attacks the peripheral nerves, the skin, the upper respiratory tract mucosa, the other organs except central nervous system. Multibacillary leprosy is characterized by the finding of acid-fast bacili on skin slit smear examination, thickening of more than one nerve, and the presence of more than five lesions. Treatment of leprosy with MDT-WHO decreases the incidence of leprosy. However, long treatment period, resistance, adverse events, and relapse events encouraged the discovery of new treatment regimens. One of the recommended therapeutic regimens of WHO is single-dose ROM (Rifampicin 600 mg, Ofloxacin 400 mg, Monocyclin 100mg) for single PB leprosy. However, some studies have shown the effectiveness of ROM in both PB leprosy and MB.
Tuberculosis verrucosa cutis is one variant of cutaneous tuberculosis caused by exogenous inoculation of M. tuberculosis at sites of minor wounds or trauma. Lesions usually occur at the upper and lower extremities and buttocks. They initially present as a solitary small asymptomatic papule which slowly expands peripherally leading to hyperkeratotic verrucous plaque with an irregular border. Regional lymph nodes are rarely affected. TVC also does not present with an “apple jelly appearance” on diascopy.
Leprosy is chronicle infectious disease on humans caused by Mycobacterium leprae that mainly attack the peripheral nerve vessels and skin. Leprosy with the highest frequency attacks people within the range of age 25-35 years old. There is no distinction susceptibility among male and female. Bacteria caused this leprosy, Mycobacterium leprae, is obligate aerob intracellular bacteria which cannot be bred in vitro, shaped in 3 – 8 μm x 0,5 μm positive-gram basil. It is acid and alcohol resistant.
There are about 10%-25% of population with herpes zoster got infected by Herpes Zoster Ophthalmicus (HZO) and 50% of this case got infected on the eyes as well. The clinical manifestation such as erythema lesions, maculopapular, vesicles gregarious and distributed pain in the branch of trigeminus nerve area. A comprehensive treatment will be able to prevent complication and morbidity.
Histoid leprosy (HL) in a rare variant of lepromatous leprosy (LL) which has distinct clinical, immunological, and bacteriologic findings. It presents as subcutaneous domeshaped, smooth, shiny papules or nodules arising from apparently normal skin. It was initially described in patients who were inadequately treated with dapsone monotherapy. However, de novo cases have been occasionally found.
Candidiasis is an infection caused by yeast of the genus Candida, which can attack the skin, mucous membranes, nails, gastrointestinal tract, even involving some parts of the body. The most common fungi found are C. albicans, but can also be caused by other species Candida, such as C. famata. Candidiasis Cutis is found most commonly in the intertriginous area and in immunocompromised patients such as Diabetes Mellitus.
Filariasis is caused by nematodes (roundworms) that inhabit the lymphatics and subcutaneous tissues. Infections are transmitted by mosquito vectors and humans are definitive hosts. It can be asymptomatic or associated with acute and/or chronic clinical manifestations, including adenolymphangitis, filarial fevers, hydrocele, chronic lymphatic disease, and tropical pulmonary eosinophilia.
Phaeohyphomycosis belongs to a heterogenous group of infections caused by dematiaceous fungi. Its course tends to be chronic, requiring prolonged anti-fungal therapy. Here we present the first case of phaeohyphomycosis caused by Veronaea botryosa with malignant degeneration.
Erythema nodusum leprosum (ENL) is a leprosy reaction mediated by type III hypersensitivity reaction. It is characterized by painful erythematous nodules preceded by prodromal symptoms and may occur before, during, or after treatment.
Leprosy remains a public health problem in developing countries. However, the underlying immune mechanism is still poorly understood. In the early non-specific immune protective mechanism, monocyte acts as phagocytes and holds the most significant role. A recent study suggested that IL-10 on APC is might inhibit the expression of MHC-II and co-stimulatory molecules; hence reducing the production of T cells stimulator cytokines.
Tuberculosis is major health problem in the Philippines with an incidence of 323 per 100,000. It is caused by Mycobacterium tuberculosis (MTB), which mostly affect the lungs. Cutaneous TB comprises only <2% of TB cases, with high incidence in developing countries. Erythema Induratum of Bazin (EIB) is a tuberculid presenting with inflammatory panniculitis on lower legs.
Rhinophyma is a slowly progressive enlargement of the nose with irregular thickening of the skin and nodular deformation. This reflects the hypertrophy of the sebaceous glands in nasal skin. It occurs almost exclusively in middle-aged to elderly Caucasian men with a male predominance of 5:1. Exact pathogenesis remains unknown.
Lymphatic malformations (LMs) are due to hyperplasia of the lymphatics. Lesions appear just after birth and expand with the growth of the patient. Although many cases are asymptomatic, cosmetic concerns and complications such as fluid leakage and secondary infection causes patient discomfort and embarrassment. Surgical excision is often considered first-line treatment. But after destructive measures, lymphangioma has a tendency toward recurrence. Thus, more palliative treatment options have been tried.
Bowen’s disease (BD) is generally regarded as a premalignant dermatosis. If untreated, 3% to 5% of patients may develop invasive carcinoma, which is capable of metastasizing and may even cause death. Clinically, the lesions of BD present as a scaly, slightly elevated, erythematous plaque with surface fissures and foci of pigmentation.
Penile calciphylaxis in an end-stage-renal disease patient under conservative management: a case report
Calcific uremic arteriolopathy commonly known as calciphylaxis is a rare, life-threatening, vasculopathy affecting approximately 4% of patients with end stage renal disease. Involvement of the penis is considered an unusual phenomenon indicating a higher rate mortality at 69% within 6 months. Management of the condition remains controversial. Here, we report a case of a 40-year-old male, diagnosed with end-stage renal disease since 2016, who presented with firm, necrotic, plaques on his glans penis.
Clinically amyopathic dermatomyositis (CADM) presents with the characteristic cutaneous findings of dermatomyositis (DM) but without any clinical evidence of muscle weakness. There is an established association of malignancy in adult-onset DM, although patients with CADM may have a decreased risk of having an associated malignancy compared to classic adult onset DM.
The occurrence of generalized discoid lupus erythematosus (DLE) and myelopathy has not been reported to date. DLE in the context of systemic lupus erythematosus (SLE) is considered to have a more benign prognosis. Among the subsets of cutaneous lupus erythematosus (CLE), DLE is the least likely to progress to SLE. Less than 5% of DLE cases progress to SLE. We report a 19-year-old woman who presented with generalized DLE and myelopathy.
Calcemic uremic arteriolopathy (CUA), or usually known as calciphylaxis, is an uncommon, highly morbid disorder presenting with skin ischemia and necrosis. It predominantly occurs, but not exclusively, in patients with end-stage renal disease (ESRD).
Acquired perforating dermatosis (APD) belongs to the class of perforating dermatoses, disorders that represent transepidermal elimination of dermal connective tissue. It is common among patients with underlying diabetes mellitus or chronic kidney disease.
Milia en plaque at a new site in the adult population successfully treated with a multimodal approach: a case report and review of literature
Milia en plaque (MEP) is a rare disorder distinguished clinically by numerous confluent milia on an erythematous base. No more than sixty cases have been reported in literature, majority of which are located on the post-auricular area. Although benign, it poses a cosmetic predicament among patients.
The value of dermoscopy in generalized granuloma annulare: from time of diagnosis to successful treatment with acitretin and narrowband UV-B phototherapy
Dermoscopy is traditionally used for diagnosis of cutaneous tumors and malignancies, but it has gained importance in the diagnosis of inflammatory skin diseases such as granuloma annulare (GA). Diagnosis and management of the disease is challenging due to its intractable and recurrent nature. There are few reports on the treatment of granuloma annulare with combination of acitretin and narrowband UV-B phototherapy.
Content analysis of herbal research studies in the Journal of the Philippine Dermatological Society (1992-2017)
Herbal medicine is commonly used in dermatology in the Philippines. There is a need to assess the content of locally published herbal research.
Five percent potassium hydroxide solution for the treatment of anogenital warts: a systematic review and meta-analysis of randomized controlled trials
Potassium hydroxide (KOH) is a strong alkali that is effective, safe, and well tolerated in the treatment of different dermatoviruses. No systematic review has been done reporting its efficacy as a treatment for anogenital warts.
Oral Aphthosis/Behcet's Disease
Behçet’s disease is a chronic multisystem disease that is characterized by vasculitis. Recurrent oral aphthous ulcers, genital ulcers, skin and ocular lesions, and arthritis are the most frequent clinical manifestations. Pathergy may or may not be present. Due to its distinct clinical presentation, knowledge and clinical expertise are needed in order to promptly establish the diagnosis and address the disease. We report two cases of Behcet’s Disease in 2 Filipinos on the basis of history, clinical presentation, and supported by skin punch biopsy findings.
Primary idiopathic complex aphthosis: diagnosis and successful treatment with colchicine and montelukast in a 44-year old Filipino female
Recurrent aphthous stomatitis (RAS) is a common oral ailment characterized by frequent attacks of painful oral ulcers that heal spontaneously. Severe form of RAS is known as complex aphthosis (CA) which is an unfamiliar term for many. Characterized by almost always constant presence of ≥3 painful aphthae alone, with or without genital aphthosis AND exclusion of Behcet disease (BD). CA may be a reactive condition; thus, diagnosis is based on exclusion.
Vitiligo and psoriasis are common dermatoses with autoimmune pathomechanisms. There are numerous case reports on the coexistence of these two conditions but only a few have reported the colocalization of lesions. Moreover, to our knowledge, only one case of concurrent segmental vitiligo and plaque type psoriasis has been documented. Several theories have been put forward however the exact pathogenesis of the association between these two remain unknown.
Pityriasis lichenoides et varioliformis acuta is characterized by spontaneously resolving, temporally overlapping crops of papules last for weeks and may develop crusts, vesicles, pustules, or ulcers.
Lichen Striatus is a rare, idiopathic, papular eruption that may spontaneously resolve within one to two years. Eruption is characterized by sudden onset, flat-topped papules in a linear or Blaschkoid distribution.
Psoriasis vulgaris is a chronic autoimmune disease in the skin. It could be triggered by infection, trauma either in the wound (koebner phenomenon) or in the other areas, and drugs.
Psoriasis is an inflammatory skin disease with complex etiology which is an interaction between genetic and environment factors.
Psoriasis is an inflammatory skin disease with complex interplay between genetic and environment factors. Psoriasis in children is very rare, it needs more attention and good handling because it may affect the quality of life of children both physically and psychologically. Increasing epidemiological evidence suggests that patients with psoriasis may be more obese compared with the general population. The exact mechanism underlying the association between psoriasis and obesity is uncertain. However it was theorized that adipocyte elaboration of pro-inflammatory cytokines may exacerbate psoriasis.
Pityriasis Lichenoides Chronica (PLC) is a chronic, non-communicable, skin disease that affects all racial and ethnic groups in all geographic regions. It is more common in children and young adults with a male predominance of 1.5:1 to 3:1.
Cutaneous Mastocytosis is characterized by a pathological increase and activation of mast cells in various tissues, particularly in the skin. It is the most common type of mastocytosis occurring in children. Bullous mastocytosis is a very rare variant with onset usually in the first year of life. It has a reserved prognosis with risk of systemic involvement, shock, and sudden death.
Chronic bullous disease of childhood (CBDC) is a rare autoimmune blistering disease, non-hereditary, and is characterized by immunoglobulin A (IgA) deposits at the basement membrane zone. It has been considered the pediatric variant of adult linear IgA disease.
Epidermolysis Bullosa (EB) is a rare genodermatosis characterized by fragility of the skin and mucous membranes, manifested by blistering with little or no trauma. There are three subtypes: EB Simplex, Junctional EB, and Dystrophic EB. Each type of EB has its own specific genetic defect.
Erythema induratum is an inflammatory panniculitis. It commonly presents with ulcerated nodules and deep plaques on the lower legs and is frequently associated with Mycobacterium tuberculosis infection.
Tuberculosis Verrucosa Cutis (TVC) occurs in previously sensitized individuals due to exogenous reinfection with Mycobacterium tuberculosis or Mycobacterium bovis. The sites of predilection for TVC in children are the lower extremities.
Langerhans Cell Histiocytosis with Hemophagocytic Syndrome in a 1 year and 8 month old female: a case report
Langerhans cell histiocytosis(LCH) is a rare clonal disorder of pathologic dendritic cells commonly seen in children ages 1-3 years old. It may affect nearly every organ system, the skin being the second most frequently involved.
Psoriasis vulgaris is a chronic, non-communicable, disabling and disfiguring inflammatory disorder. It can occur at any age; however, 30–50 % of adults with psoriasis develop the disease before 20 years of age.
Norwegian or crusted scabies is a rare and highly contagious form of skin parasitosis caused by Sarcoptes scabiei var. hominis. Individuals mainly affected are considered to be immunocompromised such as those on prolonged glucocorticosteroid therapy, with AIDS or organ transplant patients.
Chronic mucocutaneous candidiasis (CMCC), manifested by patients with T-cell deficiencies, is characterized by recurrent, progressive infections of the skin, nails and mucous membranes. It may be part of a syndrome, APECED, when co-existent with multiple endocrinopathies.
Fatal case of staphylococcal scalded skin syndrome associated with topical-steroid-induced iatrogenic cushing syndrome due to potent topical steroid (LS BL cream) application: A rare case report in a 3-month-old female
In pediatric patients, the mortality rate of staphylococcal scalded skin syndrome (SSSS) is very low. However, SSSS can become critical and potentially fatal with underlying sepsis, superinfection, dehydration and electrolyte imbalance due to denuded skin.
Schimmelpenning syndrome encompasses a broad spectrum of abnormalities that include the cardiovascular, skeletal, ophthalmologic and urogenital systems. Nevus sebaceous is a hallmark finding and ophthalmologic findings are seen in 59% of the cases and include colobomas and choristomas.
Chronic Non-Healing Wounds in Children: What Lies Beneath? A Case of Pediatric Pyoderma Gangrenosum in a 14 year-old Male: A Diagnostic and Treatment Challenge
Pyoderma gangrenosum (PG) is a rare neutrophilic disease. Its etiology remains unknown. Incidence is estimated at 3-10 patients per million per year. It is rarely seen in the pediatric population. A painful rapidly enlarging ulcer with a violaceous, undermined, and well-defined border containing granulation tissue, blood and purulent exudate is the hallmark of classical or ulcerative PG. A delay or miss in diagnosis of PG is not uncommon especially for pediatric patients due to its rare occurrence.
Varicella is a self-limited infection but may be associated with life-threatening complications. Staphylococcal scalded skin syndrome (SSSS) is one of its rare complications.
Neonatal Acne in a 3-week old female infant treated with zinc coceth sulfate foaming wash: a case report
Neonatal acne is a common disorder occurring in infants less than 4 weeks old. It is mostly a self-limited condition, but treatment can be undertaken for unremitting cases or to hasten improvement.
Exfoliative dermatitis (ED) is rare in children. Drugs, genodermatoses, and psoriasis are the usual triggers.
A case of von Zumbusch psoriasis and Cushing syndrome induced by prednisone and clobetasol ointment in a pediatric patient
Oral and topical glucocorticoids are widely used in dermatology. They are effective but their side effects are serious, ranging from skin atrophy to life-threatening conditions such as Cushing syndrome and sepsis.
Darier’s disease is a rare autosomal dominant disease which can affect both sexes and all ethnic groups. Literature search has revealed limited reports of Darier’s disease among pregnant women.
Impetigo herpetiformis is a rare pustular disorder that affects pregnant women. It is also otherwise termed as “pustular psoriasis of pregnancy”, owing to the fact that the pustules are sterile and are not associated with a viral etiology. The classic lesions are erythematous patches or plaques studded with subcorneal pustules spreading centrifugally. A cardinal feature of this disorder is the rapid resolution of lesions after delivery. The complications of this disease include placental insufficiency, stillbirth or neonatal death.
Annular pustular psoriasis is a rare variant of pustular psoriasis characterized by annular erythematous plaques with pustular margins. To date, there have been no reports of annular pustular psoriasis in pregnancy.
Primary Cutaneous CD 30-Positive Anaplastic Large Cell Lymphoma presenting as ulcerated nodules in a 50-year old woman
Anaplastic large-cell lymphoma (ALCL) is a CD30-positive T-cell lymphoma, a rare subtype of Cutaneous T-cell lymphoma (CTCL). It is classified into primary cutaneous ALCL and systemic ALCL subtypes. Primary cutaneous CD30-positive T-cell lymphoma account for 25% of all cutaneous T-cell lymphomas (CTCL).
Mimicry at its Finest: A case of folliculotropic mycosis fungoides with secondary xanthomatization in a Filipino male
Folliculotropic mycosis fungoides (MF) is an uncommon and aggressive variant of MF. It usually takes months to years before this condition is diagnosed because of its nonspecific presentation. Secondary xanthomatization, on the other hand, has been reported to arise from different inflammatory skin diseases including mycosis fungoides.
Cutaneous anaplastic large cell lymphoma (CALCL) has an estimated incidence of 0.1 to 0.2 per 100,000. This condition usually occurs as localized lesions in adults with extremities, head and buttocks as most common presenting sites. It is characterized by large tumor cells, majority which express the CD30 antigen.
Mycosis fungoides is the most common among the cutaneous T-cell lymphomas. It typically starts either as a patch or plaque and may evolve into a tumor which may spontaneously ulcerate. We present a case of mycosis fungoides mimicking squamous cell carcinoma in a 38-year old female.
A 17-year old Filipino successfully treated with narrowband UVB for lymphomatoid papulosis and limited cutaneous systemic sclerosis
Lymphomatoid papulosis (LyP) is a recurrent, self-healing papulonodular skin eruption, belonging to the group of cutaneous CD30+ lymphoproliferative disorders. It is rare worldwide and in the Philippines with only 11 cases recorded from 2011- 2018. Here we describe a case of LyP who was later diagnosed with limited cutaneous systemic sclerosis (lcSSc), an autoimmune inflammatory condition where the skin becomes hard and thickened and the internal organs develop fibrosis and vascular abnormalities. Only 10 cases of this have been recorded from 2011-2018 in the PDS His.
NB-UVB phototherapy for a 70-year-old Filipino male with concomitant nonsegmental vitiligo and mycosis fungoides in patch-plaque stage, a case report
Mycosis Fungoides is a peripheral T-cell lymphoma caused by skin-homing CD4+ T cells which may progress to involve the lymph nodes and viscera. It is uncommon among East Asians. Vitiligo is a chronic pigmentary disorder due to progressive autoimmune mediated melanocytic destruction. NB-UVB phototherapy is an effective treatment modality for both MF and vitiligo. However, the two conditions coexisting makes it complicated to determine effective dose of NB-UVB.
Tattooing has been practiced through the centuries as a form of artistic expression and cosmetic application. Currently, the tattoo industry is one of the most rapidly growing industries. However, it remains unregulated hence, the incidence of tattoo reactions is likewise expected to continue to rise. Reactions can be attributed to untrained tattoo artists, contaminated inks, and unhygienic practices. Direct causal relationship is hard to prove as a multitude of factors are often present simultaneously. Infections have always been the primary concern of the public.
Primary Cutaneous Anaplastic Large Cell Lymphoma in a 73-year-old Filipino Male: A Diagnostic Conundrum
Primary cutaneous anaplastic large cell lymphoma (PLACL) is a rare form of cutaneous lymphoma under the classification of CD30 positive lymphoproliferative disorders which presents histologically as large atypical lymphocytes with pleomorphic and anaplastic cytology that localizes to the dermis. Although recurrent, PCALCL usually carries a good prognosis, with 5-year survival rates ranging from 85% to 95%.
Lymphagioma circumscriptum (LC), also known as microcystic lymphatic malformation, is thought to arise from muscular lymphatic cisterns that failed to segment during embryonic development. Clinically, this pathology manifests as red, pink, or black scattered aggregates of small, thin-walled, translucent vesicles, giving it the classic appearance of “frog-spawn on the skin.” Some lesions exhibit overlying hyperkeratosis, resulting in a verrucous appearance. Histologic examination of superficial lesions reveals solitary or grouped cystically dilated lymph vessels located within the papillary dermis. Management remains a challenge while surgical excision is regarded as the most definitive treatment with lowest rates of recurrence, but has the highest risk of complications. Other treatments reported in literature include electrodessication, Laser, Imiquimod cream, percutaneous drainage, and sclerotherapy.
It comes in threes: A case of syringocystadenoma papilliferum associated with tubular apocrine adenoma and verruca in the axilla of a Filipino female
Syringocystoadenoma papilliferum (SCAP) is a benign adnexal tumor usually located in head and neck. The occurrence of SCAP in the axilla is uncommon. The occurrence of SCAP coexisting with two other histopathological types of tumors in one cutaneous lesion is unusual. We presented the case of a syringocystoadema papilliferum associated with tubular apocrine adenoma (TAA) and verruca.
Clear cell acanthoma is an uncommon benign epidermal tumor usually seen in the 60-80 year old age group and presenting in the lower legs. In the Philippines there has by far been one reported case of the disease (Philippine Dermatologic Society-Health Information System). We present a case of clear cell acanthoma in a Filipino female.
Pigmented trichoblastoma in a Filipino patient: a report of clinicopathologic and dermoscopic features*
Trichoblastoma is an uncommon benign neoplasm largely composed of follicular germinative cells. Pigmented trichoblastoma or a melanotrichoblastoma is a rare variant with only few reported cases in the literature.
Seborrheic keratosis is a benign epidermal tumor commonly seen in the sun-exposed skin of adults. Current treatment modalities are invasive, which include electrodessication, cryotherapy, or surgery. Alternative options such as topical therapy may be beneficial to patients who have contraindications to standard treatment, or to those who prefer a non-invasive approach. However, evidence supporting the use of topical agents is lacking.
Leiomyoma is a benign cutaneous neoplasm of smooth muscle. The pathogenesis has yet to be determined. Most leiomyomas are acquired but can be hereditary.
Paget disease of the breast is considered to be a ductal carcinoma in situ from the lactiferous duct extending to the nipple epidermis, without invading the basement membrane in majority of cases. Only a few cases of the invasive type of mammary Paget disease have been documented in literature.
Basal cell carcinoma (BCC) is the most common skin malignancy seen in sun-exposed areas. Pigmented nodular basal cell carcinoma (PBCC) is a clinical and histologic variant of BCC. Aside from displaying features seen in nodular BCC, it also contains increased brown or black pigment, the presence of which makes it necessary to rule out melanoma. Congenital melanocytic nevi (CMN), on the other hand, are common skin lesions that carry a risk of malignant transformation, especially melanoma.
Clinical, Dermoscopic and Histopathological Features of Pigmented Basal Cell Carcinoma in Filipinos: A Series of 20 Cases
Basal Cell Carcinoma (BCC) is the most frequent skin malignancy of all cases of non-melanoma skin cancer. Diagnosis is through clinical and histopathologic confirmation. While biopsy is the gold standard, dermoscopy is valuable in the immediate recognition of the pigmented type of BCC in brown, Filipino skin.
Keratoacanthoma is a rapidly growing hyperkeratotic tumor usually associated with sun exposure. The most common of which is the solitary keratoacanthoma. We present a case of a solitary Keratoacanthoma on the dorsal aspect of the right foot.
Dermatoses affecting the genitals may be of infectious, inflammatory, or neoplastic cause, and can be simply confined to the genitalia or a manifestation of a more widespread condition. Patients with cutaneous diseases of the external genitalia often initially present to their primary care provider which may be a dermatologist.
Angiosarcoma is a rare aggressive malignant tumor of endothelial cell origin, with a predilection for the skin and superficial soft tissues (50% affecting the head and neck). Early diagnosis is imperative to facilitate proper management and increase overall survival rate, given its high rate of metastasis.
Basal cell nevus syndrome is a rare autosomal dominant disorder with a prevalence ranging from 1 in 60,000 to 1 in 120,000. It is associated with a panoply of abnormalities including developmental anomalies and postnatal tumors such as basal cell carcinoma.
Congenital melanocytic nevi are benign proliferations of cutaneous melanocytes clinically apparent at birth or within the first postnatal weeks. As diameter increases, the potential for malignant transformation follows usually around the periphery of a flat Congenital melanocytic nevi.