CASE
A 50-year-old woman presented with a 3-month history of a pruritic eruption in bilateral axillary locations. The condition had persisted despite changing underarm antiperspirants, soap, laundry detergent, razors, and shaving cream as well as eliminating the use of powders and perfumes. The use of several OTC topical treatments, including clotrimazole and hydrocortisone creams, had had no effect.
The patient was worried about comments from friends and relatives who suggested she might have a yeast infection. She denied having a history of other skin diseases, such as those involving the scalp, elbows, or knees, or any serious medical problems. On inspection, papular follicular eruption was present that was modestly hyperpigmented (brown) and palpably hyperkeratotic with only faint erythema underneath (Figure 1). No edema was present, and there was no tenderness on palpation. The right side was slightly worse than the left. Her skin elsewhere was normal.
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