ABSTRACT
A 56-year-old man presented with a 12-year history of erectile dysfunction, which caused him extreme distress with episodes of depression. Attempts with sildenafil did not improve his erections. We tried intracavernous injection of alprostadil which enabled the patient to achieve a moderate erection. Thus, we instructed the patient for self-injection, which led to sufficient erections over the following months. We then restarted with tadalafil as a monotherapy which then was successful.
Subject(s)
Alprostadil/administration & dosage , Carbolines/administration & dosage , Erectile Dysfunction/diagnosis , Erectile Dysfunction/drug therapy , Piperazines/administration & dosage , Sulfones/administration & dosage , Vasodilator Agents/administration & dosage , Humans , Injections/methods , Male , Middle Aged , Penis/drug effects , Purines/administration & dosage , Self Administration/methods , Sildenafil Citrate , Tadalafil , Treatment OutcomeABSTRACT
A 45-year old man presented with red-brown hyperkeratotic papules that were distributed in an unilateral segmental fashion on the right thorax. Histopathological examination revealed acanthosis and, in particular, acantholysis and dyskeratosis in the basal and suprabasal epidermal layers. Based on the clinical and histopathologic findings we diagnosed a type 1 segmental Darier disease. Darier disease is an autosomal dominant disorder that is caused by mutations in the ATP2A2 gene and is characterized by dysfunctional adhesion between neighboring keratinocytes. The type 1 segmental manifestation reflects a de novo postzygotic somatic mutation in the heterozygous state and as a rule can be found in all autosomal dominantly inherited genodermatoses.
