Treatment alternatives encompass salicylic and lactic acid, together with topical 5-fluorouracil; oral retinoids are employed only in cases of greater severity (1-3). According to findings in reference (29), pulsed dye laser treatment and doxycycline have been observed to be effective. A laboratory investigation suggested that COX-2 inhibitors could potentially reinstate the dysregulated expression of the ATP2A2 gene (4). To put it concisely, DD is a rare keratinization condition which might have a widespread or focused presentation. Dermatoses that trace along Blaschko's lines require a differential diagnosis that considers segmental DD, even if this entity is uncommon. Treatment options span the spectrum of topical and oral medications, adjusted according to the severity of the condition.

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. 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. This report details a case involving a 28-year-old female patient who presented at our clinic with painful necrotic ulcers affecting both labia minora, exhibiting urinary retention and considerable discomfort (Figure 1). A few days before experiencing vulvar pain, burning, and swelling, the patient mentioned unprotected sexual intercourse. The urgent insertion of a urinary catheter became necessary due to intense burning and pain during the process of urination. Second generation glucose biosensor Crusts and ulcers, in abundance, afflicted the vagina and cervix. Multinucleated giant cells were evident on the Tzanck smear, and HSV infection was confirmed by PCR analysis, while syphilis, hepatitis, and HIV tests yielded negative results. FIIN-2 order The patient's labial necrosis progressed, and fever developed two days after admission. This prompted us to perform two debridements under systemic anesthesia, while also administering systemic antibiotics and acyclovir. The follow-up examination, conducted four weeks later, confirmed complete epithelialization of both labia. 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). Unusual genital disease manifestations are characterized by either atypical sites or shapes, exemplified by exophytic (verrucous or nodular), superficially ulcerated lesions commonly observed in HIV-positive patients, along with other atypical symptoms such as fissures, localized chronic redness, non-healing ulcers, and burning sensations in the vulva, especially in individuals with lichen sclerosus (1). Ulcerations in this patient prompted a discussion within our multidisciplinary team, given the possible connection to rare malignant vulvar conditions (3). To ensure accurate diagnosis, PCR from the lesion is used as the definitive method. Primary infection necessitates antiviral therapy initiated within 72 hours, subsequently continued for a period of seven to ten days. Debridement, the removal of nonviable tissue, is a fundamental procedure in wound healing. Debridement is only required for herpetic ulcerations that do not heal spontaneously, a condition that results in the accumulation of necrotic tissue, creating an ideal breeding ground for bacteria and the potential for more extensive infections. Necrotic tissue removal accelerates the healing process and minimizes the potential for secondary complications.

Dear Editor, Photoallergic skin reactions, a classic delayed-type hypersensitivity response mediated by T-cells, occur when a subject is previously sensitized to a photoallergen or a related chemical (1). Changes stemming from ultraviolet (UV) radiation exposure are identified by the immune system, which then initiates antibody production and skin inflammation in the impacted regions (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). 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. Preceding this by a few weeks, the patient endured a metatarsal bone fracture, requiring daily systemic NSAID administration to address the persistent 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. Essential hypertension was one of the conditions afflicting the patient, who was continuously prescribed ramipril. In order to remedy the skin lesions, it was recommended that she stop using ketoprofen, avoid sunlight, and apply betamethasone cream twice daily for seven days. This successfully resolved the lesions over a few weeks. Our patch and photopatch testing of baseline series and topical ketoprofen was conducted two months later. A positive ketoprofen reaction was observed solely on the irradiated side of the body where ketoprofen-containing gel had been applied. Skin lesions resulting from photoallergic reactions are described as eczematous and itchy; they may spread to involve areas not previously 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). Acute dermatitis, often photoallergic, resulting from ketoprofen use commonly shows up one week to one month later at the application site. This dermatitis is marked by swelling, redness, small bumps, vesicles, blisters, or skin lesions mimicking erythema exsudativum multiforme (7). Sun exposure's influence on ketoprofen-related photodermatitis can lead to its continuation or resurgence for a timeframe extending from one to fourteen years following discontinuation of the medication, as highlighted in reference 68. Moreover, ketoprofen is found to contaminate clothing, footwear, and bandages, and there are reported cases of photoallergic relapses triggered by re-using contaminated objects exposed to UV light (reference 56). Patients exhibiting ketoprofen photoallergy should, due to similar biochemical structures, avoid using medications like specific NSAIDs (suprofen, tiaprofenic acid), antilipidemic agents (fenofibrate), and sunscreens formulated with benzophenones (69). Physicians and pharmacists should explicitly communicate to patients the risks associated with topical NSAIDs applied to areas of skin exposed to light.

To the Editor, pilonidal cyst disease, an acquired inflammatory condition prevalent in the natal cleft of the buttocks, is discussed in reference 12. The disease's prevalence is significantly higher in men, demonstrating a male-to-female ratio of 3 to 41. The patients' ages are typically clustered around the tail end of their twenties. Asymptomatic lesions are the initial presentation, whereas the development of complications, such as abscess formation, is linked to pain and the release of pus (1). Individuals with pilonidal cyst disease, especially when their symptoms are minimal or nonexistent, may seek care at dermatology outpatient clinics. Our dermatology outpatient clinic has witnessed four cases of pilonidal cyst disease, the dermoscopic features of which are presented here. Upon presenting to our dermatology outpatient clinic with a solitary lesion on their buttocks, four patients were ultimately diagnosed with pilonidal cyst disease through combined clinical and histopathological evaluation. 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. Upon dermoscopic evaluation of the first patient's lesion, a red, featureless area was observed centrally, consistent with the presence of an ulcer. White reticular and glomerular vessels were present at the periphery of the pink homogeneous background, as seen in Figure 1, panel b. In the second patient's case, a structureless, central, ulcerated area of yellow hue was observed, with linearly arranged, multiple, dotted vessels forming a peripheral ring against a homogeneous 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. Following the pattern of the third case, dermoscopic analysis of the fourth patient displayed a pinkish uniform background with scattered, yellow and white, structureless areas, and peripherally located hairpin and glomerular vessels (Figure 2). Table 1 shows a concise overview of the patients' demographics and clinical features, encompassing all four patients. All cases' histopathology showed epidermal invaginations, sinus formation, free hair shafts, chronic inflammation marked by multinuclear giant cells. As shown in Figure 3 (a-b), the histopathological slides belong to the first case. A general surgery referral was issued for the treatment of each patient. Bipolar disorder genetics Dermoscopic knowledge of pilonidal cyst disease remains limited within dermatological publications, previously explored in just two documented instances. Our instances mirroring the authors' cases displayed a pink-colored background, radial white lines, central ulceration, and multiple peripherally situated dotted vessels (3). Dermoscopic examination reveals that pilonidal cysts possess unique features that distinguish them from other epithelial cysts and sinus tracts. In the case of epidermal cysts, a punctum and an ivory-white color are often observed in dermoscopic examinations (45).