Topical 5-fluorouracil, salicylic acid, and lactic acid are further treatment options, whereas oral retinoids are considered for patients with more severe conditions (1-3). Doxycycline and pulsed dye laser treatments have also demonstrated efficacy, as reported (29). In a controlled laboratory environment, one study found that COX-2 inhibitors could potentially re-activate the misregulated ATP2A2 gene (4). Overall, DD, a rare keratinization disorder, displays itself in either a widespread or a localized manner. Segmental DD, though uncommon, ought to be contemplated within the differential diagnosis for dermatoses that manifest along Blaschko's lines. The severity of the disease dictates the appropriate choice of topical and oral treatments.

Herpes simplex virus type 2 (HSV-2), a common cause of genital herpes, is usually transmitted sexually. We document a case involving a 28-year-old woman, who experienced an unusual presentation of HSV, culminating in rapid labial necrosis and rupture less than 48 hours after the initial manifestation of symptoms. 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). Unprotected sexual contact, according to the patient, occurred a few days before the commencement of vulvar pain, burning, and swelling. A urinary catheter was immediately inserted due to the excruciating burning and pain felt whilst urinating. Cells & Microorganisms Ulcerated and crusted lesions were evident on both the vagina and cervix. 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. biological barrier permeation Following the progression of labial necrosis and the onset of fever two days post-admission, a double debridement procedure under systemic anesthesia was executed, coupled with concurrent systemic antibiotic and acyclovir administration. Subsequent examination, four weeks later, revealed complete epithelialization of both labia. Primary genital herpes is clinically evident by the development of multiple, bilaterally situated papules, vesicles, painful ulcers, and crusts, which disappear after an incubation period of 15 to 21 days (2). Clinically uncommon manifestations of genital conditions encompass unusual anatomical sites or atypical morphological characteristics, including exophytic (verrucous or nodular) and superficially ulcerated lesions, most often affecting individuals with HIV; fissures, localized recurring erythema, non-healing ulcers, and burning vulvar sensations are also considered atypical, especially 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). A PCR test performed on the lesion is the accepted gold standard for diagnosis. For the management of primary infections, antiviral therapy should be initiated within seventy-two hours and maintained for a period ranging from seven to ten days. Debridement, the process of eliminating nonviable tissue, is a critical step in wound care. Unresponsive herpetic ulcerations call for debridement due to the accumulation of necrotic tissue. This tissue provides a hospitable environment for bacteria, increasing the risk of spreading infections. The elimination of dead tissue expedites the healing process and decreases the chance of further complications arising.

Dear Editor, a subject's prior sensitization to a photoallergen or a chemically similar agent provokes a T-cell-mediated, delayed-type hypersensitivity response, the hallmark of photoallergic skin reactions (1). Ultraviolet (UV) radiation-induced alterations are detected by the immune system, triggering antibody production and skin inflammation in affected areas (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. The Department of Dermatology and Venereology received a 64-year-old female patient with erythema and underlying edema on her left foot, as illustrated in 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 twenty years, the individual grappled with chronic back pain, which prompted the regular intake of different NSAIDs, including ibuprofen and diclofenac. Essential hypertension was one of the conditions afflicting the patient, who was continuously prescribed ramipril. Ketoprofen application was advised against, alongside sun exposure. The prescribed regimen also included applying betamethasone cream twice daily for a duration of seven days, which led to a complete resolution of the skin lesions within a few weeks. Our patch and photopatch testing of baseline series and topical ketoprofen was conducted two months later. Only the irradiated portion of the body treated with ketoprofen-containing gel displayed a positive response to the presence of ketoprofen. A photoallergic reaction shows eczematous and itchy patches, which might extend to other regions of skin not directly subjected to solar exposure (4). Musculoskeletal diseases are commonly treated with ketoprofen, a nonsteroidal anti-inflammatory drug consisting of benzoylphenyl propionic acid, which displays both topical and systemic applicability. Its analgesic and anti-inflammatory properties, combined with its low toxicity, are advantageous; despite this, it is a frequent photoallergen (15.6). Photosensitivity reactions, often triggered by ketoprofen, typically manifest as photoallergic dermatitis. This acute dermatitis presents with edema, erythema, papulovesicles, blisters, or lesions resembling erythema exsudativum multiforme at the application site, appearing one week to one month following the commencement of use (7). Sun-sensitive ketoprofen-induced photodermatitis can either persist or reappear within a timeframe of 1-14 years following the cessation of the medication, as mentioned 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). Pharmacists and physicians should inform patients about the potential risks involved in using topical NSAIDs on photoexposed skin.

Dear Editor, reference 12 details the frequent occurrence of pilonidal cyst disease, an acquired and inflammatory condition that primarily affects the natal clefts of the buttocks. A notable predisposition for men exists regarding this disease, with a male-to-female incidence ratio of 3:41. Commonly, the patient demographic encompasses individuals towards the close of their twenties. Lesions start without any noticeable symptoms, yet the appearance of complications like abscess formation is accompanied by pain and drainage (1). Dermatology outpatient clinics are the destination for patients with pilonidal cyst disease, especially if the initial symptoms remain concealed. This report elucidates the dermoscopic hallmarks of four pilonidal cyst disease cases encountered within our dermatology outpatient clinic. Four patients presenting with a single buttock lesion at our dermatology outpatient clinic received a pilonidal cyst disease diagnosis, substantiated through clinical and histopathological findings. 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. Dermoscopy of the first patient's lesion showed a central, red, and structureless region, suggestive of ulcerative involvement. White lines, signifying reticular and glomerular vessels, were present at the periphery of the pink, uniform background (Figure 1b). 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). In the case of the third patient, dermoscopy highlighted a central, featureless, yellowish area, with peripherally situated hairpin and glomerular vessels, as seen in 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. Epidermal invaginations, sinus formations, free hair follicles, and chronic inflammation with multinucleated giant cells were all observed in the histopathological examination of every case. Figure 3 (a-b) offers a visual representation of the histopathological slides related to the first case. For the care of all patients, the general surgery service was designated. FHD-609 purchase The dermatological literature offers limited insight into dermoscopy's application to pilonidal cyst disease, previously investigated only in two case studies. A pink background, radial white lines, central ulceration, and multiple peripherally arranged dotted vessels were reported by the authors, comparable to our findings (3). In dermoscopic evaluations, pilonidal cysts exhibit features differing significantly from those observed in other epithelial cysts and sinus tracts. Dermoscopic examinations of epidermal cysts have revealed a punctum and an ivory-white hue (45).