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Skin diseases 101

By DR. GRACE CAROLE BELTRAN, The Philippine STAR Published Nov 15, 2022 5:00 am

I am happy to see that Operation Damayan has continued its humanitarian activities. This was a project by the late Betty Go Belmonte in trying to reach out to our destitute kababayans and poverty-stricken communities who cannot even afford a decent meal, and give them much more access to healthcare personnel and facilities.

I remember we used to hold medical missions in different areas of Quezon City, and even extended this outreach program to the mountains to serve the Aetas. It was one great experience for all of us.

Raising awareness of skin diseases can be done through these medical missions and the media’s help. Through this article, I would like to contribute in whatever way I can to make this possible.

Shawl sign. Often misdiagnosed as an allergy, the Shawl sign is a reddish or purplish rash, presumably due to the inflammation of surface blood vessels. It may occur on the face, neck and chest, shoulders and upper back, resembling a shawl. The eyelids may look as if eye shadow has been applied. Sometimes, it appears on the elbows, knees, and ankles.

• Wolf’s disease. The word ”lupus” is the Latin word for “wolf.” It is attributed to the 13th-century physician Rogerius, who used it to describe erosive facial lesions that were reminiscent of a wolf’s bite. Lupus is a chronic autoimmune disease that can damage any part of the body (skin, joints, and/or organs inside the body). Autoimmune means your immune system cannot tell the difference between the foreign invaders and your body’s healthy tissues (“auto” means “self”) and creates auto-antibodies that attack and destroy healthy tissue. The word erythematosus (from the Greek word ”erythros,” meaning” red”) refers to the reddish color of the circular-shaped facial lesions. In some patients, it may look like allergic contact dermatitis, so they do not give it much attention.

Prayer sign. Limited joint mobility is a relatively common complication of long-standing diabetes mellitus (neglected case of diabetes). Diabetes patients also suffer from scleroderma-like skin changes (hard, thickened areas of skin, making it hard to move the joints. It also leads to flexion deformities on the fingers). Some suffer from progressive flexed contractures (bent fingers in the direction of a closed fist) and hindered joint extension (joint stretching is not possible) involving the joints of the hand. There are cases when patients are unable to to press the palmar surfaces of each of their hands together, known as the prayer sign. There are actually a lot of skin manifestations that can serve as clues to diagnose diabetes. Be wary of these signs if you have a family history.

Vitiligo is characterized by a focal or generalized distribution of depigmented macules and patches (white discoloration like Michael Jackson’s skin). Vitiligo commonly occurs in the mouth, orbits, vagina, anus, or at sites of trauma (hands, elbows, knees). The disorder is often associated with autoimmune thyroid disease, insulin-dependent diabetes mellitus, pernicious anemia, Addison’s disease, and lupus. 

Doctors can mistake it for similar skin rashes like tinea versicolor, pityriasis alba, postinflammatory hypopigmentation, and hypopigmented mycosis fungoides, leukoderma, and scars. In cases of progressing and spreading vitiligo, you need to see a dermatologist.

Extramammary Paget’s Disease. Many many years ago, I had a patient who presented with an eczema-like rash on her right groin area. The rash was very itchy and keep on recurring on the same spot. She was treated for eczema for 10 years by different dermatologists, but her symptoms remain. I eventually operated on her. The rash never returned as of this writing. Extramammary Paget’s Disease is an uncommon condition characterized by unilateral eczematous plaque of the skin. The disease is typically a persistent, eczematous plaque of the anogenital or axillary regions. It affects older adults and is often associated with an underlying adnexal (apocrine) carcinoma or underlying cancer of the genitourinary tract or distal gastrointestinal tract.

Oral hairy leukoplakia causes fuzzy, white patches that resemble folds or ridges, usually on the sides of your tongue. It’s often mistaken for oral thrush, an infection marked by creamy white patches that can be wiped away, which is also common in people with a weakened immune system. Many people mistake oral thrush for leukoplakia, but the conditions are quite different. While thrush also appears as whitish patches, it’s usually softer and can bleed more easily. Unlike thrush, leukoplakia patches cannot be wiped away.

There are four main types of leukoplakia:

Homogeneous leukoplakia presents as a mostly white patch that’s evenly colored. The patch’s surface can be smooth, wrinkled, or ridged, but it’s consistent over the entire area. Non-homogeneous leukoplakia is mainly white or a blend of white and red that’s irregularly shaped. It can be flat, nodular, or raised. This type of leukoplakia is significantly more likely to develop into cancer than the homogeneous type.

Proliferative verrucous leukoplakia (PVL) is also called florid papillomatosis, a rare condition with strong ties to the Epstein-Barr virus. It may be the most aggressive type of leukoplakia and almost all cases of PVL evolve into cancer. Unfortunately, it’s often diagnosed late and there’s a high chance of recurrence.

Oral hairy leukoplakia. Like PVL, oral hairy leukoplakia has ties to the Epstein-Barr virus. It usually presents on the tongue as white, hairy patches. Oral hairy leukoplakia is common in people with weak immune systems, like those with HIV/AIDS, but doesn’t evolve into cancer.

Acne vulgaris affects 80 percent of adolescents and young adults aged 11 to 30. The majority remits before the third decade of age, leaving the rest with an unpredictable course throughout their lives. What is important for people to know is that acne is not just an aesthetic problem. One’s hormones may be involved, like testosterone, androstenedione, DHEA, SHGB, prolactin, 17 hydroxy progesterone, luteinizing hormone, insulin and serum cortisol. This means that sometimes topicals (pamahid) may not be enough to stop it.