Salicylic and lactic acids, along with topical 5-fluorouracil, represent alternative treatment options, with oral retinoids reserved for more advanced cases (1-3). Pulsed dye laser and doxycycline are reported to have shown effectiveness, per reference (29). Experimental research demonstrated that the use of COX-2 inhibitors could potentially reestablish the dysregulated ATP2A2 gene expression pattern (4). To summarize, DD, a rare disorder of keratinization, may appear broadly or in a confined area. In the differential diagnosis of dermatoses exhibiting Blaschko's lines, segmental DD should be included, despite its infrequent occurrence. Treatment options encompass a spectrum of topical and oral therapies, contingent upon the severity of the disease process.

Genital herpes, the most prevalent sexually transmitted disease, is typically caused by herpes simplex virus type 2 (HSV-2), a virus generally transmitted through sexual relations. A 28-year-old woman's case illustrates a distinct presentation of HSV, demonstrating the rapid progression to labial necrosis and rupture within a period of less than 48 hours from the first symptom. This case report details a 28-year-old female patient's presentation at our clinic, marked by agonizing necrotic ulcers on both labia minora, alongside urinary retention and intense discomfort (Figure 1). The patient stated that unprotected sexual intercourse occurred a few days before the vulvar pain, burning, and swelling. Because of intense burning and pain while urinating, a urinary catheter was inserted immediately. endocrine genetics Lesions, ulcerated and crusted, completely covered the vagina and cervix. A Tzanck smear demonstrated multinucleated giant cells, coupled with a conclusive polymerase chain reaction (PCR) diagnosis of HSV infection, in contrast to negative results for syphilis, hepatitis, and HIV. check details 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. The follow-up examination, conducted four weeks later, confirmed complete epithelialization of both labia. A short incubation period precedes the appearance of multiple, bilaterally situated papules, vesicles, painful ulcers, and crusts in primary genital herpes, which eventually heal within 15 to 21 days (2). Genital disease presentations that differ from the typical ones involve either unusual locations or unusual forms, including exophytic (verrucoid or nodular) superficially ulcerated lesions, often seen in HIV-positive patients; accompanying symptoms are also considered atypical, such as fissures, localized repetitive redness, non-healing ulcers, and burning sensations in the vulva, especially when lichen sclerosus is present (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 the condition involves PCR analysis of the lesion's material. Antiviral therapy for primary infections should begin within three days and continue for a duration of 7 to 10 days. A vital procedure for the body to heal wounds is debridement, the removal of nonviable tissue. 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, sensitization to a photoallergen or a cross-reactive chemical leads to a classic delayed-type hypersensitivity reaction, specifically involving T-cells, manifesting as a photoallergic skin response (1). Recognizing the modifications prompted by ultraviolet (UV) radiation, the immune system orchestrates antibody production and inflammation in the exposed skin (2). Sun protection products, after-shave preparations, anti-infective agents (especially sulfonamides), pain relievers (NSAIDs), water pills (diuretics), anti-seizure drugs, cancer-fighting medications, perfumes, and other personal care articles may contain substances that cause photoallergic reactions, as noted in references 13 and 4. With erythema and underlying edema on her left foot (as shown in Figure 1), a 64-year-old female patient sought admission to the Department of Dermatology and Venereology. Weeks prior, the patient sustained a metatarsal bone fracture, which led to a daily systemic NSAID treatment to manage the resulting pain. A fortnight before being admitted to our department, the patient commenced twice-daily applications of 25% ketoprofen gel on her left foot, coupled with frequent sun exposure. For twenty years, the individual grappled with chronic back pain, which prompted the regular intake of different NSAIDs, including ibuprofen and diclofenac. In addition to other ailments, the patient also suffered from essential hypertension, while regularly taking ramipril medication. To resolve the skin lesions, she was prescribed a regimen encompassing discontinuation of ketoprofen, avoidance of sunlight, and the twice-daily application of betamethasone cream for seven days. This treatment resulted in complete healing within several weeks. Following a two-month interval, we conducted patch and photopatch tests on baseline series and topical ketoprofen. Only the irradiated side of the body, upon which ketoprofen-containing gel was applied, exhibited a positive reaction to ketoprofen. A photoallergic reaction shows eczematous and itchy patches, which might extend to other regions of skin not directly subjected to solar exposure (4). Systemic and topical applications of ketoprofen, a benzoylphenyl propionic acid-based nonsteroidal anti-inflammatory drug, are effective in treating musculoskeletal conditions, owing to its analgesic, anti-inflammatory effects, and low toxicity. However, its status as a frequent photoallergen should be noted (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). Ketoprofen's photodermatitis, depending on how frequently and intensely the skin is exposed to sunlight, can continue or resurface within a period stretching from one to fourteen years post-discontinuation, according to reference 68. Furthermore, ketoprofen is discovered on clothing, footwear, and dressings, and several instances of relapsing photoallergic reactions have been observed after the repurposing of contaminated items exposed to ultraviolet radiation (reference 56). Because of their similar biochemical structures, those affected by ketoprofen photoallergy should avoid taking certain drugs, including some NSAIDs like suprofen and tiaprofenic acid, antilipidemic agents such as fenofibrate, and sunscreens based on benzophenones (citation 69). Physicians and pharmacists should explicitly communicate to patients the risks associated with topical NSAIDs applied to areas of skin exposed to light.

Dear Editor, Pilonidal cyst disease, a prevalent, acquired, and inflammatory condition, frequently affects the natal cleft of the buttocks, as documented in reference 12. Men are disproportionately affected by the disease, exhibiting a male-to-female ratio of 3 to 41. The majority of patients are young, situated close to the end of their twenties. Lesions initially lack symptoms, but the appearance of complications, such as abscess formation, is associated with pain and the expulsion of pus (1). When the signs of pilonidal cyst disease are absent, patients often visit dermatology outpatient clinics for diagnosis and treatment. Four cases of pilonidal cyst disease, having been treated in our dermatology outpatient clinic, are presented here, with a focus on their dermoscopic characteristics. Clinical and histopathological examinations led to the diagnosis of pilonidal cyst disease in four patients who had presented to our dermatology outpatient department for evaluation of a single lesion on their buttocks. Figure 1, panels a, c, and e, illustrates solitary, firm, pink, nodular lesions near the gluteal cleft in all the young male patients. The dermoscopic findings from the first patient's lesion included a red, structureless area located centrally, which corresponded to ulceration. Pink homogenous background (Figure 1, panel b) displayed peripheral reticular and glomerular vessels, characterized by white lines. A yellow, structureless, ulcerated central area in the second patient was bordered by numerous, linearly arrayed, dotted vessels along the periphery, upon a homogenous pink background (Figure 1, d). A dermoscopic examination of the third patient's lesion revealed a central, yellowish, structureless area, exhibiting peripherally arranged hairpin and glomerular vessels (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. Histological examinations of all our cases demonstrated the consistent finding of epidermal invaginations, sinus formations, and the presence of free hair shafts alongside chronic inflammation featuring multinucleated giant cells. Figure 3(a-b) displays the histopathological slides of the initial case. Treatment for all patients was prescribed by the general surgery team. ML intermediate Dermoscopic understanding of pilonidal cyst disease is underrepresented within the dermatological literature, with a previous focus on 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. In the case of epidermal cysts, a punctum and an ivory-white color are often observed in dermoscopic examinations (45).