Salicylic and lactic acids, along with topical 5-fluorouracil, represent alternative treatment options, with oral retinoids reserved for more advanced cases (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. Segmental DD, although less common, must be considered in the differential diagnosis of dermatoses exhibiting Blaschko's linear distribution. Various topical and oral treatments are available, the selection contingent on the severity of the illness.

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 case study reports a 28-year-old female with a novel HSV presentation, leading to the rapid development of labial necrosis and rupture within a 48-hour timeframe following the initial appearance of symptoms. A 28-year-old female patient presented to our clinic with the distressing presentation of necrotic and painful ulcers on both labia minora, accompanied by urinary retention and profound discomfort (Figure 1). The patient recounted unprotected sexual intercourse a few days prior to experiencing pain, burning, and swelling of the vulva. In response to the acute burning and pain accompanying urination, a urinary catheter was inserted without delay. multiple infections Crusts and ulcers, in abundance, afflicted 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. Nucleic Acid Detection 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. A follow-up visit, conducted four weeks post-procedure, showed full epithelialization of both labia. In primary genital herpes, bilaterally located papules, vesicles, painful ulcers, and crusts develop following a brief incubation period, disappearing after 15 to 21 days (2). Presentations of genital disease that deviate from typical forms include unusual sites or atypical shapes such as exophytic (verrucous or nodular) outwardly ulcerated lesions, frequently observed in HIV-positive individuals, as well as fissures, persistent redness in a specific area, non-healing sores, and a burning feeling in the vulva, often associated with lichen sclerosus (1). This patient's presentation, including ulcerations, triggered a multidisciplinary team discussion on potential connections to rare malignant vulvar pathologies (3). A PCR test performed on the lesion is the accepted gold standard for diagnosis. To effectively combat primary infection, antiviral therapy must be initiated within 72 hours and administered for a period of 7 to 10 days. A critical element in tissue regeneration is the removal of nonviable tissue, called 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. Necrotic tissue removal enhances the rate of healing and decreases the probability of future complications.

Dear Editor, a subject's prior sensitization to a photoallergen or chemically related compound can induce a classic T-cell-mediated, delayed-type hypersensitivity skin reaction, as seen in photoallergic responses (1). The immune system's response to ultraviolet (UV) radiation involves the generation of antibodies and consequent inflammatory reactions in exposed skin (2). Certain photoallergic medications and substances are present in some sunscreens, aftershave lotions, antimicrobials (specifically sulfonamides), non-steroidal anti-inflammatory drugs (NSAIDs), diuretics, anticonvulsants, chemotherapy agents, fragrances, and other personal care items (reference 13,4). Due to erythema and underlying edema on her left foot (Figure 1), a 64-year-old female patient was admitted to the Department of Dermatology and Venereology. A couple of weeks before this incident, the patient experienced a fracture in their metatarsal bones, prompting a daily regimen of systemic NSAIDs to alleviate 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 twenty years, the individual grappled with chronic back pain, which prompted the regular intake of different NSAIDs, including ibuprofen and diclofenac. The patient, additionally, experienced essential hypertension, and was regularly administered ramipril. She was recommended to stop using ketoprofen, stay out of direct sunlight, and apply betamethasone cream twice a day for a period of seven days, resulting in the complete healing of the skin lesions over several weeks. Following a two-month interval, we conducted patch and photopatch tests on baseline series and topical ketoprofen. Only the irradiated body area to which ketoprofen-containing gel was applied demonstrated a positive reaction to ketoprofen. Photoallergic reactions, marked by eczematous, itchy eruptions, sometimes extend to areas of skin not directly 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). The onset of ketoprofen-induced photosensitivity reactions typically occurs one week to one month after initiating use. These reactions typically manifest as photoallergic dermatitis, exhibiting acute symptoms such as swelling, redness, small bumps, blisters, or skin lesions resembling erythema exsudativum multiforme at the application site (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 the matter of ketoprofen, it is a contaminant on apparel, footwear, and bandages, and some recorded cases of photoallergy relapses were seen after reusing contaminated items exposed to UV light (reference 56). The comparable biochemical structures of certain drugs, including some NSAIDs (suprofen, tiaprofenic acid), antilipidemic agents (fenofibrate), and benzophenone-based sunscreens, necessitate avoidance by patients with ketoprofen photoallergy (reference 69). For patients using topical NSAIDs on photoexposed skin, physicians and pharmacists have a duty to explain the possible risks.

Editor, the acquired inflammatory condition known as pilonidal cyst disease commonly affects the natal clefts of the buttocks, according to reference 12. The disease demonstrates a markedly higher prevalence in men, with the ratio of male to female cases being 3 to 41. The patients' age range is concentrated near the latter part of their twenties. Initially, lesions exhibit no symptoms, but the emergence of complications, including abscess formation, brings about pain and discharge (1). Pilonidal cyst sufferers frequently seek care at dermatology outpatient facilities, especially if the affliction lacks initial outward indications. Our dermatology outpatient clinic observed four pilonidal cyst disease cases, and this report outlines their dermoscopic presentations. 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. Young male patients exhibited solitary, firm, pink, nodular lesions near the gluteal cleft, as depicted in Figure 1, panels a, c, and e. In the dermoscopic image of the first patient's lesion, a centrally situated, red, and amorphous area was noted, indicative of ulceration. White reticular and glomerular vessels were present at the periphery of the pink homogeneous background, as seen in Figure 1, panel b. 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). Hairpin and glomerular vessels, peripherally arranged, framed a central, structureless, yellowish area visible in the dermoscopic image of the third patient (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). A concise description of the demographics and clinical features of the four patients is displayed in Table 1. 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 and b) showcases the histopathological slides from the first patient's case. For the care of all patients, the general surgery service was designated. LAQ824 mouse The dermatological literature offers limited insight into dermoscopy's application to pilonidal cyst disease, previously investigated only in two case studies. The authors' cases, similar to ours, exhibited a pink-hued background, white lines extending radially, a central ulceration, and multiple dotted vessels situated peripherally (3). Dermoscopic analysis distinguishes pilonidal cysts from other epithelial cysts and sinus tracts through their specific features. In the case of epidermal cysts, a punctum and an ivory-white color are often observed in dermoscopic examinations (45).