In previously healthy subjects, vulvar ulcers are mostly caused by sexually transmitted microorganisms. Lipschütz's acute vulvar ulceration, first reported in 1912, is a non-sexually acquired condition characterized by sudden onset of a few genital ulcers. We systematically review presentation, underlying causes and disease duration of Lipschütz's ulceration.Comprehensive source of Excerpta Medica, National Library of Medicine and Web of Science databases was performed. Reports including cases of apparently previously healthy females affected by Lipschütz's ulceration were selected a predefined database was used to extract data on demographics, history, clinical and microbiological findings, and treatment.The search disclosed 158 cases. Almost 90% of cases were ≤20 years of age and sexually inactive. Lesions were usually one to about three, painful, ≥10 mm large, well-delimited, with a fibrinous and necrotic center and a symmetric distribution. Voiding disorders and enlarged inguinal lymph nodes were observed in a large subset of cases. Canker sores were noted in 10% of patients. Lipschütz's vulvar ulceration occurred concomitantly with an infectious disease in 139 cases. Infectious mononucleosis syndrome (N=40) was the most frequently detected well-defined infection, followed by mycoplasma species infections (N=11). The disease resolved after ≤3 weeks. CONCLUSIONS: Lipschütz's ulceration mainly affects both sexually inactive and, less frequently, sexually active subjects ≤20 years of age, presents with ≤3 vulvar ulcers, resolves without recurrences within 3 weeks and is temporarily associated with an infection, most frequently a flu-like illness or an infectious mononucleosis syndrome.

Background: Maculopapular or urticarial eruptions and erythema multiforme sometimes occur in patients affected with Mycoplasma pneumoniae respiratory infections. Further eruptions have also been reported. Objective: To review the literature addressing M. pneumoniae respiratory infection and rather unusual eruptions. Methods: Computer-based search in the US National Library of Medicine database as well as in the search engine Google. Results: We found a possible relationship between M. pneumoniae infection and Fuchs' syndrome (n = 37), varicella-like eruptions (n = 8), Henoch-Schönlein syndrome and further leukocytoclastic vasculitides (n = 21) and erythema nodosum (n = 11). A temporal relationship was also observed with 2 cases of Gianotti-Crosti syndrome. Finally, there exists reasonable evidence that pityriasis rosea Gibert and pityriasis lichenoides et varioliformis acuta Mucha-Habermann are not associated with Mycoplasma infections. Conclusion: This review implies that M. pneumoniae may cause, in addition to erythematous maculopapular (or urticarial) eruptions and erythema multiforme, Fuchs' syndrome and varicella-like eruptions. Furthermore, there is an intriguing link with leukocytoclastic vasculitides or erythema nodosum that deserves further investigation.

Aim Intramuscular or, more rarely, local drug injection is occasionally followed by immediate local pain, livedoid skin lesions and, some days later, the development of ischemic lesions. This very uncommon but potentially severe reaction, termed Nicolau syndrome, is traditionally associated with bismuth and β‐lactam antimicrobials. The aim of this report was to review the literature associating Nicolau syndrome with the administration of non‐steroidal anti‐inflammatory drugs. Methods The National Library, Excerpta Medica, Web of Science and Cochrane library databases were used. Results Sixty‐two cases (40 females and 22 males aged from 13 to 81, median 57 years) of Nicolau syndrome were published after 1992. Fifty‐three cases occurred after diclofenac. The remaining nine cases were associated with ketoprofen (N = 2), ketorolac (N = 2), phenylbutazone (N = 2), etofenamate (N = 1), ibuprofen (N = 1) and piroxicam (N = 1). Conclusion Although Nicolau syndrome is extremely uncommon, physicians must be aware of this complication after intramuscular administration of non‐steroidal anti‐inflammatory drugs and should avoid unnecessary injections.

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