Salicylic acid and lactic acid, along with topical 5-fluorouracil, constitute additional therapeutic options. Oral retinoids are typically reserved for patients with more pronounced disease (1-3). Reportedly effective are both doxycycline and pulsed dye laser therapy (29). In a controlled laboratory environment, one study found that COX-2 inhibitors could potentially re-activate the misregulated ATP2A2 gene (4). To put it concisely, DD is a rare keratinization condition which might have a widespread or focused presentation. Segmental DD, though uncommon, ought to be contemplated within the differential diagnosis for dermatoses that manifest along Blaschko's lines. Treatment options span the spectrum of topical and oral medications, adjusted according to the severity of the condition.

The most prevalent sexually transmitted disease, genital herpes, is frequently associated with herpes simplex virus type 2 (HSV-2), which spreads mainly through sexual contact. This case report highlights a 28-year-old woman with an uncommon HSV presentation marked by rapid labial necrosis and rupture within less than 48 hours from the first sign of the infection. Painful necrotic ulcers on both labia minora, causing urinary retention and extreme discomfort, were reported by a 28-year-old female patient who visited our clinic (Figure 1). The patient recounted unprotected sexual intercourse a few days prior to experiencing pain, burning, and swelling of the vulva. To alleviate the intense burning and pain, a urinary catheter was immediately inserted during the act of urination. Immunomagnetic beads Lesions, ulcerated and crusted, completely covered the vagina and cervix. Multinucleated giant cells observed on the Tzanck smear and the definitive results of polymerase chain reaction (PCR) analysis for HSV infection contrasted with the negative results of syphilis, hepatitis, and HIV tests. population genetic screening Because labial necrosis progressed, accompanied by the emergence of fever two days after hospital admission, the patient was subjected to two debridement procedures performed under systemic anesthesia, simultaneously receiving systemic antibiotics and acyclovir. Both labia exhibited complete epithelialization, as observed during the follow-up visit, four weeks after the initial assessment. Multiple papules, vesicles, painful ulcers, and crusts, characteristic of primary genital herpes, arise bilaterally after a brief incubation period, healing within 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). We, as a multidisciplinary team, evaluated this patient's condition, recognizing the possibility of an association between ulcerations and unusual malignant vulvar pathology (3). The gold standard for diagnosing this condition is via lesion-derived PCR. To effectively combat primary infection, antiviral therapy must be initiated within 72 hours and administered for a period of 7 to 10 days. To remove necrotic tissue, a process known as debridement, is essential for healing. Non-healing herpetic ulcerations necessitate debridement to remove the necrotic tissue, a favorable environment for bacteria that may cause more widespread and serious infections. By removing the necrotic tissue, the rate of healing is increased and the likelihood of additional problems is reduced.

To the Editor, photoallergic skin reactions, involving a delayed-type hypersensitivity response from sensitized T-cells, are triggered by a photoallergen or a chemically similar substance to which the subject was previously exposed (1). Ultraviolet (UV) radiation-induced alterations are detected by the immune system, triggering antibody production and skin inflammation in affected areas (2). Photoallergic agents, as seen in some sunscreens, aftershave lotions, antimicrobials (particularly sulfonamides), nonsteroidal anti-inflammatory drugs (NSAIDs), diuretics, anticonvulsant medications, anticancer medications, fragrances, and other hygiene products, are documented (references 13 and 4). Erythema and edema, prominent on the left foot of a 64-year-old female patient (Figure 1), prompted her admission to the Dermatology and Venereology Department. In the weeks leading up to this, the patient experienced a fracture of the metatarsal bones, and had been medicated daily with systemic NSAIDs to manage the pain. Prior to their admission to our department, five days earlier, the patient commenced twice-daily application of 25% ketoprofen gel to her left foot, while also experiencing frequent sun exposure. The patient's enduring back pain, persisting for two decades, had necessitated regular consumption of various NSAIDs, including ibuprofen and diclofenac. The patient's medical history encompassed essential hypertension, and ramipril was a component of their regular treatment plan. The medical professional advised against further ketoprofen application, restricting sun exposure, and applying betamethasone cream twice daily for seven days. This treatment protocol ultimately led to the complete resolution of the skin lesions within a few weeks. Our patch and photopatch testing on baseline series and topical ketoprofen was completed two months later. Ketoprofen-containing gel, when applied to the irradiated side of the body, demonstrated a positive reaction exclusively to ketoprofen on that area. Photoallergic responses present as eczematous, itchy spots, potentially spreading to unexposed skin areas (4). Ketoprofen, a benzoylphenyl propionic acid-based nonsteroidal anti-inflammatory drug, is a widely used topical and systemic treatment for musculoskeletal disorders. Its benefits include analgesic and anti-inflammatory effects, and low toxicity, but its classification as a frequent photoallergen is noteworthy (15.6). Following the commencement of ketoprofen use, photosensitivity reactions, typically presenting as a photoallergic dermatitis, are characterized by acute skin inflammation. This inflammation manifests as edema, erythema, small bumps and blisters, or a skin rash reminiscent of erythema exsudativum multiforme appearing at the application site one week to one month later (7). Photodermatitis from ketoprofen, triggered by sun exposure, might persist or return for a period ranging from one to fourteen years after cessation of the medication, as detailed in 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). Patients allergic to ketoprofen's photoallergic effects should take precautions against certain medications like some NSAIDs (suprofen, tiaprofenic acid), antilipidemic agents (fenofibrate), and benzophenone-based sunscreens, due to their similar biochemical structures (69). For patients using topical NSAIDs on photoexposed skin, physicians and pharmacists have a duty to explain the possible risks.

Editor, the inflammatory condition known as pilonidal cyst disease commonly afflicts the natal clefts of the buttocks, as per reference 12. The disease shows a bias towards men, presenting a male-to-female ratio of 3 to 41. Commonly, the patient demographic encompasses individuals towards the close 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, seen in our dermatology outpatient clinic, are highlighted here, along with their dermoscopic features. In our dermatology outpatient department, four patients with solitary lesions on their buttocks underwent clinical and histopathological evaluation, resulting in a pilonidal cyst disease diagnosis. Solitary, firm, pink, nodular lesions located near the gluteal cleft were observed in every young male patient, as illustrated in Figure 1, panels a, c, and e. The dermoscopic findings from the first patient's lesion included a red, structureless area located centrally, which corresponded to ulceration. White reticular and glomerular vessels were present at the periphery of the pink homogeneous background, as seen in Figure 1, panel b. Against a homogenous pink background (Figure 1, d), the second patient showcased a central, ulcerated, yellow, structureless area, which was surrounded by multiple, linearly arranged dotted vessels at the periphery. A yellowish, structureless central area in the dermoscopic image of the third patient (Figure 1, f), was encircled by peripherally situated hairpin and glomerular vessels. Lastly, much like the third scenario, the dermoscopic examination of the fourth patient exhibited a pinkish, homogeneous background characterized by yellow and white, structureless areas, and a peripheral arrangement of hairpin and glomerular vessels (Figure 2). A summary of the demographics and clinical characteristics of the four patients is provided in Table 1. The histopathological assessment of all our cases revealed epidermal invagination, the development of sinus cavities, the presence of free hair shafts, and a chronic inflammatory reaction characterized by the presence of multinucleated giant cells. Figure 3 (a and b) showcases the histopathological slides from the first patient's case. General surgery was selected as the appropriate treatment pathway for every patient. Selleck EKI-785 Dermoscopy's role in understanding pilonidal cyst disease, as detailed in the dermatological literature, is quite limited, previously investigated in only two clinical cases. The authors' reports, analogous to our own cases, detailed a pink background, white radial lines, central ulceration, and several dotted vessels positioned peripherally (3). The dermoscopic profile of pilonidal cysts varies from that of other epithelial cysts and sinuses, presenting unique diagnostic indicators. Dermoscopic examinations of epidermal cysts have revealed a punctum and an ivory-white hue (45).