Further treatment options include salicylic and lactic acid, as well as topical 5-fluorouracil, while oral retinoids are employed in cases of more advanced disease (1-3). The combination of doxycycline and pulsed dye laser has also yielded positive outcomes, as documented in reference (29). In vitro research involving COX-2 inhibitors showcased a possible restoration of the dysregulated ATP2A2 gene expression (4). In brief, DD exhibits a rare keratinization disorder, showing a generalized or localized form. Despite its rarity, segmental DD should be factored into the differential diagnosis when Blaschko's lines are observed in dermatoses. Depending on the degree of the disease, diverse topical and oral treatment options are available.

Genital herpes, a highly prevalent sexually transmitted disease, is generally caused by herpes simplex virus type 2 (HSV-2) which is typically transmitted through sexual activity. A 28-year-old female presented with a unique instance of herpes simplex virus (HSV) infection, characterized by rapid necrosis and labial rupture within 48 hours of symptom onset. A 28-year-old female patient, experiencing distressing painful necrotic ulcers on both labia minora, presented at our clinic with urinary retention and extreme discomfort (Figure 1). The patient recounted unprotected sexual intercourse a few days prior to experiencing pain, burning, and swelling of the vulva. In response to the acute burning and pain accompanying urination, a urinary catheter was inserted without delay. medicine students The cervix and vagina bore ulcerated and crusted lesions. The Tzanck smear's findings, multinucleated giant cells, combined with conclusive polymerase chain reaction (PCR) results for HSV infection, contrasted sharply with negative results for syphilis, hepatitis, and HIV. cancer-immunity cycle In light of the progression of labial necrosis and the patient's febrile state occurring two days after admission, two debridement procedures under systemic anesthesia were undertaken, alongside systemic antibiotics and acyclovir. Re-evaluation of both labia, four weeks after the initial visit, demonstrated complete epithelialization. Bilaterally, primary genital herpes manifests as multiple papules, vesicles, painful ulcers, and crusts appearing after a brief incubation period, and resolving over 15 to 21 days (2). Atypical presentations of genital disease include unusual placements or forms, such as exophytic (verrucous or nodular) and superficially ulcerated lesions, frequently observed in individuals with HIV infection; fissures, localized recurrent inflammation, non-healing ulcers, and a burning sensation in the vulva are also considered unusual presentations, particularly in patients with lichen sclerosus (1). A multidisciplinary team meeting was held to discuss this patient, specifically concerning the possibility of ulcerations being associated with rare malignant vulvar pathologies (3). The gold standard for diagnosing this condition is via lesion-derived PCR. In the case of a primary infection, antiviral therapy should begin promptly within 72 hours, and the treatment should last for seven to ten days. Debridement, the process of eliminating nonviable tissue, is a critical step in wound care. A herpetic ulceration that does not heal independently signals the need for debridement, as this process creates necrotic tissue, a substrate for bacteria that can cause secondary infections. By removing the necrotic tissue, the rate of healing is increased and the likelihood of additional problems is reduced.

Dear Editor, in response to a previously encountered photoallergen or a cross-reactive chemical, the skin's T-cell-mediated delayed-type hypersensitivity reaction, a hallmark of photoallergic reactions, is triggered (1). Inflammation of the skin in exposed areas, a consequence of the immune system's antibody production in response to the changes caused by ultraviolet (UV) radiation (2). Some sunscreens, aftershave lotions, antimicrobials (including sulfonamides), non-steroidal anti-inflammatory drugs (NSAIDs), diuretics, anticonvulsants, chemotherapy drugs, fragrances, and other personal hygiene products contain ingredients that can cause photoallergic reactions (references 13 and 4). Admitted to the Department of Dermatology and Venereology was a 64-year-old female patient who presented with erythema and underlining edema affecting her left foot (Figure 1). Prior to this recent event, the patient sustained a fracture of the metatarsal bones, obligating them to take systemic NSAIDs daily to alleviate the pain. The patient's routine included twice-daily applications of 25% ketoprofen gel to the left foot, commencing five days prior to being admitted to our department; and frequent exposure to sunlight. For the last twenty years, chronic back pain had consistently affected the patient, requiring the frequent use of varied NSAIDs, including ibuprofen and diclofenac. Essential hypertension was one of the conditions afflicting the patient, who was continuously prescribed ramipril. She was recommended to stop using ketoprofen, stay out of direct sunlight, and apply betamethasone cream twice a day for a period of seven days, resulting in the complete healing of the skin lesions over several weeks. Following a two-month interval, we conducted patch and photopatch tests on baseline series and topical ketoprofen. The ketoprofen-containing gel application, specifically on the irradiated side of the body, led to a positive reaction to ketoprofen only there. Photoallergic reactions, marked by eczematous, itchy eruptions, sometimes extend to areas of skin not directly exposed to sunlight (4). Ketoprofen, a nonsteroidal anti-inflammatory drug, a derivative of benzoylphenyl propionic acid, exhibits both topical and systemic utility in treating musculoskeletal conditions. Its analgesic and anti-inflammatory properties, coupled with its low toxicity, contribute to its frequent use; it's, however, a commonly identified photoallergen (15.6). A delayed reaction to ketoprofen is frequently photosensitivity, manifested as photoallergic dermatitis characterized by acute skin inflammation. This inflammation presents as edema, erythema, small bumps and blisters, or skin lesions resembling erythema exsudativum multiforme at the application site one week to one month after initiating treatment (7). Reference 68 notes that the continuation or recurrence of ketoprofen photodermatitis, directly linked to the frequency and strength of sun exposure, can extend up to fourteen years after treatment discontinuation, varying from one year. Furthermore, ketoprofen residues are found on clothing, footwear, and bandages, and instances of photoallergic reactions returning have been documented following the re-use of ketoprofen-tainted items exposed to ultraviolet light (reference 56). Patients with ketoprofen photoallergy should avoid certain drugs, including some nonsteroidal anti-inflammatory drugs (NSAIDs) like suprofen and tiaprofenic acid, as well as antilipidemic agents such as fenofibrate, and sunscreens containing benzophenones, due to their comparable biochemical structures (69). To ensure patient safety, physicians and pharmacists must fully explain the potential risks when patients utilize topical NSAIDs on sunlight-exposed skin.

In a letter to the Editor, pilonidal cyst disease, an acquired and inflammatory condition, commonly affects the natal clefts of the buttocks (as seen in reference 12). Concerning this disease, men are affected at a much higher rate, with a male-to-female ratio of 3:41. The patients' age range is concentrated near the latter part of their twenties. Initially, lesions are without symptoms, but the development of complications, such as the formation of an abscess, is associated with pain and the expulsion of secretions (1). Pilonidal cyst sufferers frequently seek care at dermatology outpatient facilities, especially if the affliction lacks initial outward indications. We document, in this report, the dermoscopic findings in four pilonidal cyst disease cases seen at our dermatology outpatient clinic. A solitary lesion on the buttocks, prompting evaluation at our dermatology outpatient department, led to a diagnosis of pilonidal cyst disease in four patients, confirmed by both clinical and histopathological assessments. Near the gluteal cleft, all young male patients presented with solitary, firm, pink, nodular lesions, as shown in Figure 1, parts a, c, and e. The dermoscopic view of the first patient's lesion presented a red, structureless area in the lesion's center, implying ulceration. In addition, white lines defining reticular and glomerular vessels were visible at the edges of the uniform pink backdrop (Figure 1, panel b). The second patient displayed a central, ulcerated, yellow, structureless area, surrounded by multiple, linearly arranged dotted vessels on the periphery, against a homogenous pink background (Figure 1, d). The third patient's dermoscopy demonstrated a central, yellowish, structureless region, with the arrangement of hairpin and glomerular vessels occurring peripherally (Figure 1, f). Similar to the third case, the dermoscopic examination of the fourth patient showcased a pink, uniform background with scattered yellow and white, structureless regions, and a peripheral distribution of hairpin and glomerular vessels (Figure 2). Table 1 presents a summary of the four patients' demographics and clinical features. All cases' histopathology showed epidermal invaginations, sinus formation, free hair shafts, chronic inflammation marked by multinuclear giant cells. Figure 3(a-b) displays the histopathological slides of the initial case. Each patient received a general surgery referral to facilitate their treatment. this website Pilonidal cyst disease's dermoscopic presentation, as documented in dermatological literature, is currently sparse, having previously been analyzed in just two cases. A pink background, radial white lines, central ulceration, and multiple peripherally arranged dotted vessels were reported by the authors, comparable to our findings (3). The dermoscopic profile of pilonidal cysts varies from that of other epithelial cysts and sinuses, presenting unique diagnostic indicators. Dermoscopic features of epidermal cysts commonly include a punctum and an ivory-white color (45).