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). The combination of doxycycline and pulsed dye laser has also yielded positive outcomes, as documented in reference (29). Within a laboratory setting, one study indicated a possibility that COX-2 inhibitors may reactivate the dysregulated ATP2A2 gene (4). In short, DD, a rare keratinization disorder, can be either generalized or localized in its presentation. Segmental DD, while infrequent, warrants consideration in the differential diagnosis of dermatoses displaying Blaschko's linear patterns. Treatment alternatives, including topical and oral medications, are tailored to the intensity of the disease.
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 presented an atypical case of HSV infection, rapidly progressing to labial necrosis and rupture within 48 hours of initial symptoms. A female patient, 28 years of age, sought treatment at our clinic for painful necrotic ulcers affecting both labia minora, resulting in urinary retention and extreme discomfort (Figure 1). Unprotected sexual activity, as detailed by the patient, preceded the appearance of pain, burning, and swelling of the vulva by a few days. The intense burning and pain associated with urination prompted the immediate insertion of a urinary catheter. CNS-active medications Ulcers and crusts covered the surface of the cervix and vagina. 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. Preclinical pathology Since labial necrosis worsened and the patient experienced fever two days after being admitted, debridement was performed twice under systemic anesthesia, and the patient was given systemic antibiotics and acyclovir simultaneously. The follow-up examination, conducted four weeks later, confirmed complete epithelialization of both labia. Following a short incubation period in primary genital herpes, bilaterally distributed papules, vesicles, painful ulcers, and crusts develop, ultimately resolving over a period of 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). Our multidisciplinary team reviewed this patient, recognizing the potential link between ulcerations and uncommon malignant vulvar conditions (3). PCR of the lesion is the definitive diagnostic method. 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. Wound healing hinges on the removal of nonviable tissue, a procedure known as debridement. Only when a herpetic ulceration fails to heal naturally does debridement become necessary, as this condition promotes the formation of necrotic tissue, a reservoir for bacteria that can initiate more severe infections. Disposing of necrotic tissue hastens the recovery process and minimizes the risk of additional 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). The immune system's response to ultraviolet (UV) radiation involves the generation of antibodies and consequent inflammatory reactions in exposed skin (2). A range of common photoallergic drugs and constituents, including those present in some sunscreens, aftershave lotions, antimicrobials (especially sulfonamides), non-steroidal anti-inflammatory drugs (NSAIDs), diuretics, anticonvulsants, chemotherapy medications, fragrances, and other personal care items, should be noted (from references 13 and 4). A 64-year-old female patient, whose left foot displayed erythema and underlying edema (Figure 1), was admitted to the Department of Dermatology and Venereology. 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. Five days prior to their admission, the patient was actively applying 25% ketoprofen gel twice daily to her left foot while undergoing 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. The patient's medical history encompassed essential hypertension, and ramipril was a component of their regular treatment plan. She was instructed to cease using ketoprofen, to avoid sun exposure, and to apply betamethasone cream twice a day for seven days. This led to a complete recovery of the skin lesions in just 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. Photoallergic responses present as eczematous, itchy spots, potentially spreading to unexposed skin areas (4). Topical and systemic applications of ketoprofen, a benzoylphenyl propionic acid-based nonsteroidal anti-inflammatory drug, are common in the treatment of musculoskeletal diseases, due to its analgesic and anti-inflammatory action, and low toxicity. However, it is a frequently recognized photoallergen (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). The frequency and intensity of sun exposure will dictate the duration of ketoprofen photodermatitis, which may continue or recur for up to 14 years after the medication is stopped, based on reference 68. In addition, contamination of clothing, shoes, and bandages with ketoprofen has been observed, and there have been reports of photoallergic reactions relapsing due to the subsequent use of contaminated items exposed to UV radiation (reference 56). Due to the comparable biochemical structures of these substances, patients sensitive to ketoprofen's photoallergic effects should steer clear of medications such as some nonsteroidal anti-inflammatory drugs (NSAIDs) like suprofen and tiaprofenic acid, antilipidemic agents such as fenofibrate, and sunscreens containing benzophenones (reference 69). To ensure patient safety, physicians and pharmacists must fully explain the potential risks when patients utilize topical NSAIDs on sunlight-exposed 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. The disease's prevalence is significantly higher in men, demonstrating a male-to-female ratio of 3 to 41. Patients tend to be young, approaching the concluding phase 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). Patients experiencing pilonidal cyst disease frequently find their way to dermatology outpatient clinics, particularly when no symptoms are apparent. In this report, we detail the dermoscopic characteristics of four cases of pilonidal cyst disease observed 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. The dermoscopic examination of the initial patient displayed a central, red, structureless region within the lesion, indicative of ulceration. In addition, white lines defining reticular and glomerular vessels were visible at the edges of the uniform pink backdrop (Figure 1, panel b). On a homogenous pink background (Figure 1, d), the second patient's central ulcerated area, yellow and structureless, was surrounded by multiple dotted vessels arranged in a linear pattern at the periphery. 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). As the third case illustrates, the dermoscopic evaluation of the fourth patient exhibited a pink, homogeneous backdrop containing yellow and white amorphous regions, and displayed a peripheral arrangement of hairpin and glomerular vessels (Figure 2). Table 1 presents a summary of the four patients' demographics and clinical features. Our histopathological analyses of all cases exhibited epidermal invaginations and sinus formation, along with free hair shafts and chronic inflammation with prominent multinuclear giant cells. Figure 3 (a-b) contains the histopathological slides pertinent to the first case study. All patients, upon assessment, were directed to the general surgery department for treatment. NST-628 cell line Currently, the dermatologic literature lacks extensive dermoscopic information on pilonidal cyst disease, with only two previous case evaluations. The authors, in cases mirroring ours, observed a pink backdrop, radiating white lines, a central ulceration, and multiple, peripherally clustered, dotted vessels (3). Through dermoscopic evaluation, the features of pilonidal cysts are distinguishable from those of other epithelial cysts and sinus tracts. Characteristic dermoscopic signs of epidermal cysts include a punctum and an ivory-white background (45).