CASE
A 34-year-old woman presented with a 1-month history of a slightly pruritic rash on her left axilla. She first noticed the small bumps 4 weeks earlier. Believing she may have irritated the skin, the patient did not initially treat the rash. Approximately 1 week later, a mild pruritus developed and the rash appeared to have spread. She tried an OTC cortisone cream, but it caused a burning sensation.
The patient said she had been using the same deodorant for the past 3 years, does not apply cream or powder to her axilla, and washes her clothes with only a gentle detergent. The patient is otherwise healthy.
Physical examination revealed a 3×2-cm hyperpigmented area of multiple hyperkeratotic papules, and some had coalesced into plaques (Figure 1). In addition, small scales that peeled off easily with manipulation were noted. The rash was limited to the outer quadrant of the axilla with no palpable axillary lymph node involvement. The right axilla did not have a similar rash.
Tinea infection was the presumed diagnosis, and a course of a topical antifungal ointment was given. The patient returned 2 weeks later with no improvement in the rash. At this time, a punch biopsy was performed for definitive diagnosis.
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