In addition to salicylic and lactic acid and topical 5-fluorouracil, other treatment options exist. Oral retinoids are employed for more severe conditions (1-3). Reportedly effective are both doxycycline and pulsed dye laser therapy (29). A laboratory study indicated that COX-2 inhibitors might reactivate the improperly functioning ATP2A2 gene (4). In essence, a rare keratinization disorder, DD, manifests either as a generalized or localized condition. Although not frequent, segmental DD deserves inclusion in the differential diagnosis of skin conditions exhibiting Blaschko's lines. Treatment options span the spectrum of topical and oral medications, adjusted according to the severity of the condition.
Herpes simplex virus type 2 (HSV-2) is the leading cause of genital herpes, a widespread sexually transmitted infection, and is primarily transmitted via sexual contact. 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. Intense burning and pain while urinating necessitated the immediate insertion of a urinary catheter. psychopathological assessment The cervix and vagina suffered from the presence of ulcerated and crusted lesions. Polymerase chain reaction (PCR) analysis confirmed HSV infection, characterized by the presence of multinucleated giant cells on the Tzanck smear, and further tests for syphilis, hepatitis, and HIV were negative. medial elbow The progression of labial necrosis and the patient's fever, two days post-admission, prompted us to perform two debridement procedures under systemic anesthesia, administered concurrently with systemic antibiotics and acyclovir. At the four-week follow-up appointment, both labia had undergone full epithelialization. The clinical presentation of primary genital herpes includes multiple, bilaterally placed papules, vesicles, painful ulcers, and crusts appearing after a brief incubation period, with resolution within 15 to 21 days (2). Genital disease presentations that differ from the typical ones involve either unusual locations or unusual forms, including exophytic (verrucoid or nodular) superficially ulcerated lesions, often seen in HIV-positive patients; accompanying symptoms are also considered atypical, such as fissures, localized repetitive redness, non-healing ulcers, and burning sensations in the vulva, especially when lichen sclerosus is present (1). In our multidisciplinary team discussion, this patient's case was considered, as ulcerations may indicate an association with rare instances of malignant vulvar pathology (3). A PCR test performed on the lesion is the accepted gold standard for diagnosis. Treatment with antiviral medication for primary infection should commence within 72 hours of the initial exposure and be sustained for 7 to 10 days. A critical element in tissue regeneration is the removal of nonviable tissue, called debridement. Herpetic ulcerations requiring debridement are those that fail to heal spontaneously, leading to the formation of necrotic tissue, a breeding ground for bacteria that could trigger further infections. Surgical removal of necrotic tissue improves the healing time and reduces the risk of subsequent problems.
Dear Editor, a past sensitization to a photoallergen, or a substance with similar chemical properties, triggers a delayed-type hypersensitivity reaction in the skin, mediated by T-cells, creating a photoallergic response (1). Upon perceiving the transformations from ultraviolet (UV) radiation, the immune system activates antibody creation and skin inflammation at exposed locations (2). Certain drugs and components frequently associated with photoallergic reactions are found in some sunscreens, aftershave balms, antimicrobials (such as sulfonamides), non-steroidal anti-inflammatory medicines (NSAIDs), diuretics, anticonvulsants, chemotherapy agents, fragrances, and other personal care items (citations 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. A period of several weeks beforehand, the patient's metatarsal bones suffered a fracture, necessitating the daily systemic administration of NSAIDs to control the pain. The patient initiated a twice-daily regimen of 25% ketoprofen gel on her left foot, five days before being admitted to our department, and concurrently, she was frequently exposed to sunlight. For the past two decades, the individual endured persistent back discomfort, frequently resorting to various non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and diclofenac. Notwithstanding other conditions, essential hypertension was also present in the patient, who was on a regular regimen of ramipril. Following medical counsel, she was instructed to cease ketoprofen use, refrain from sun exposure, and apply betamethasone cream twice daily for seven days. This regimen effectively cleared the skin lesions within a few weeks. Following a two-month interval, we conducted patch and photopatch tests on baseline series and topical ketoprofen. The ketoprofen-containing gel application, specifically on the irradiated side of the body, led to a positive reaction to ketoprofen only there. Eczematous, pruritic skin lesions are a symptom of photoallergic reactions, and these lesions can spread to include additional, unexposed skin (4). Due to its analgesic and anti-inflammatory properties, as well as its low toxicity, ketoprofen, a benzoylphenyl propionic acid-based nonsteroidal anti-inflammatory drug, is applied topically and systemically for musculoskeletal disease management. Yet, it's a relatively frequent 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). Post-discontinuation of ketoprofen, photodermatitis, influenced by sun exposure frequency and intensity, may continue or reoccur within a range of one to fourteen years, as reported 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 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). Patients should be informed by their physicians and pharmacists about the potential risks of using topical NSAIDs on skin areas previously exposed to sunlight.
Dear Editor, the natal clefts of the buttocks are a frequent location for the acquired inflammatory condition, pilonidal cyst disease, as documented in reference 12. Men are afflicted with the disease at a rate 3 to 41 times higher than women, revealing a pronounced male-to-female ratio. Young patients, usually near the end of their second decade of life, constitute the majority of cases. While lesions initially do not produce any symptoms, the subsequent development of complications, like abscess formation, is accompanied by pain and the expulsion of fluid (1). Dermatology outpatient clinics often see patients suffering from pilonidal cyst disease, particularly when the condition remains unaccompanied by noticeable symptoms. We document, in this report, the dermoscopic findings in four pilonidal cyst disease cases seen at our dermatology outpatient clinic. 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. Figure 1, panels a, c, and e, demonstrates the presence of solitary, firm, pink, nodular lesions in the vicinity of the gluteal cleft in all young male patients. The dermoscopic examination of the initial patient displayed a central, red, structureless region within the lesion, 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. In the second patient, a yellow, structureless, central ulcerated area was encircled by multiple dotted vessels arranged linearly along its periphery, situated on a homogeneous pink backdrop (Figure 1, d). Dermoscopy of the third patient displayed a central, yellowish, structureless region, encircled by peripherally aligned hairpin and glomerular vessels (Figure 1, f). Finally, mirroring the third instance, a dermoscopic evaluation of the fourth patient revealed a uniform pinkish backdrop speckled with yellow and white amorphous regions, 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-b) displays the histopathological slides of the initial case. For the care of all patients, the general surgery service was designated. Fetuin The dermatological record offers limited dermoscopic insights into pilonidal cyst disease, previously studied in only two individual cases. Similar to our study, the authors' cases showed a pink-toned backdrop, radial white lines, a central ulceration, and multiple peripherally arranged dotted vascular structures (3). Pilonidal cysts display a distinctive dermoscopic presentation, contrasting with the dermoscopic characteristics of other epithelial cysts and sinus tracts. One of the reported dermoscopic characteristics of epidermal cysts is a punctum combined with an ivory-white background tone (45).