Chemsex involves the use of psychoactive substances to facilitate or enhance sexual activity, particularly among gay, bisexual, and other men who have sex with men (GBMSM). Common substances used include methamphetamine, gamma-hydroxybutyric acid/gamma-butyrolactone (GHB/GBL), mephedrone, ketamine, inhaled nitrites ('poppers'), and cocaine, all of which are linked to various dermatological complications. Dermatologists are often the first to recognize skin and mucosal manifestations in chemsex users, providing an opportunity for timely intervention and risk reduction. A targeted literature search until January 2026 was conducted using PubMed/MEDLINE to identify relevant publications on chemsex-associated dermatological manifestations. The studies included were observational, case series, case reports and clinical guidelines, focusing on the clinical presentation, substances involved and routes of administration. Cutaneous and mucosal lesions vary depending on the substance and route of administration. Poppers dermatitis, commonly seen in GBMSM, is a well-defined manifestation and often misdiagnosed as impetigo. 3,4-Methylenedioxymethamphetamine (MDMA), often used in chemsex, leads to oral mucositis and painful aphthous-like ulcers due to its acute effects, such as bruxism and xerostomia. Injection-related lesions from substances like mephedrone and ketamine are particularly concerning, often resembling infectious or vasculitic processes and frequently leading to delayed diagnoses. Cocaine use, especially when combined with levamisole, can cause cutaneous necrosis, vasculitis and soft tissue infections. GHB/GBL use may cause traumatic genital and perianal injuries due to reduced pain sensitivity, while alprostadil injections can result in localized oedema, haematomas or fibrosis. Lastly, constricting devices used in chemsex settings can lead to mechanical trauma, ischaemic injury and chronic complications like fibrosis and penile deformities. Chemsex is a significant public health concern with dermatological implications. Improved awareness of characteristic cutaneous and mucosal lesions can support earlier recognition, targeted investigation and non-stigmatizing risk-reduction advice and referral. More prospective studies and standardized diagnostic criteria are needed to enhance the management of chemsex-related dermatological and systemic complications.

Pyoderma gangrenosum is a non-bacterial inflammatory disease that forms ulcers and abscesses and can be exacerbated by mechanical stimulation. Surgical intervention for abscesses in the corpora cavernosa may exacerbate penile pyoderma gangrenosum. We report a case of penile pyoderma gangrenosum that was diagnosed minimally invasively by biopsy alone and treated with steroids. A 77-year-old man with penile swelling and pain was referred to our institution by his primary care physician for suspected penile cancer. Both infectious diseases and penile cancer were ruled out based on physical examination and laboratory test results. Magnetic resonance imaging revealed fluid accumulation in the corpora cavernosa, leading to the decision to perform a penile biopsy. The biopsy revealed no malignancy, but an abscess was identified. Based on the clinical presentation, penile pyoderma gangrenosum was suspected and steroid therapy was initiated, resulting in rapid symptomatic improvement. The steroid dose was gradually tapered, and after 18 months of treatment, the steroids were discontinued. The patient has remained asymptomatic with no recurrence of the abscess or other subjective complaints.

Disorders of sex development (DSD) are rare congenital conditions characterized by discordance among chromosomal, gonadal, and phenotypic sex. Adult presentation of ambiguous genitalia is not uncommon, particularly in low-resource settings where delayed diagnosis, limited access to specialized care, sociocultural stigma, and financial barriers constrain evaluation and management. We present two adults with remarkably comparable external genital appearances but profoundly different gender identities, social roles, treatment interests, and therapeutic goals. The two patients, both aged 25 years, presented to our institution with comparable ambiguous external genitalia but different gender roles and concerns. Case one is a phenotypic female presenting with an enlarged clitoris and partially obstructed vaginal introitus, causing her severe psychosocial distress and inability to engage in sexual intercourse. She had normal female secondary sexual characteristics and regular menstruation. Imaging demonstrated normal internal female reproductive organs. Due to financial limitations, karyotyping was not performed. She desired vaginal opening and removal of the penile-like structure. She underwent examination under anesthesia, introital reconstruction, and clitoral reduction surgery, with good postoperative functional and psychological outcomes. Case two is an individual raised and socially recognized as male who presented with progressive abdominal distension and chronic pelvic pain. Despite a masculine gender identity and virilized phenotype, the patient reported menstruation since adolescence. Imaging demonstrated multiple abdominal masses suspicious for malignancy. He was desirous of the removal of the uterus to eliminate menstruation, which was a major source of his distress, irrespective of whether he would sexually perform as a male or not. Exploratory laparotomy revealed large intra-abdominal tumors, and histopathology confirmed dysgerminoma. The patient is currently undergoing chemotherapy. These cases highlight the complexity of adult DSD presentation in resource-constrained settings and underscore the importance of individualized, patient-centered management that prioritizes gender identity, psychosocial well-being, reproductive goals, and informed consent. The report further emphasizes the ethical and clinical challenges posed by limited diagnostic capacity and delayed presentation.