CASE
An 80-year-old man sought evaluation of a groin rash that had begun almost 2 years prior. Diagnosed variously as jock itch, yeast infection, and dermatitis, the condition had failed treatment with a number of OTC and prescription antiyeast, antifungal, and corticosteroid creams. Fortunately, the condition was relatively asymptomatic, being only slightly and occasionally pruritic, but it had become increasingly extensive and florid, ultimately warranting dermatologic evaluation.
The patient was otherwise healthy. He had never had any form of cancer and had no symptoms referable to the GI tract. Prostate-specific antigen levels and digital rectal examinations had been normal over the years. His only medications were for hypertension and mild dyslipidemia, and he had been taking them for years before the rash had appeared. He denied any history of eczema or atopy.
On examination, the rash was bright red and extensive—covering most of the intertriginous groin, spilling over onto the thigh, and coming up into the intergluteal fold. The arciform borders were well-defined, and there were multiple areas of focal erosion (Figure 1). Samples taken from the scale in several focal areas proved to be negative for fungal elements on potassium hydroxide examination.
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