Unilateral hyperpigmented axillary eruption

Presenter: Risa Gorin, D.O.
Dermatology Program: St. Barnabas Hospital Dermatology Department, Bronx, New York
Program Director: Cindy Hoffman, DO, FAOCD
Submitted on: May 29, 2007

CHIEF COMPLAINT:  Unilateral Hyperpigmented Axillary Eruption

CLINICAL HISTORY:

Signs and symptoms:  A 71 year old Hispanic female with a past medical history of insulin dependent diabetes, and left cerebral vascular accident was referred by her primary care physician for evaluation of a unilateral, hyperpigmented rash located in the right axilla. According to the patient the rash had been present for three weeks. She admitted to using copious amounts of deodorants in the area. The patient denied any symptoms of pruitus or burning.

Previous Treatment:  Prior to presentation, she did not receive any treatment for her rash.

Other information:

PHYSICAL EXAM:

Cutaneous examination revealed multiple hyperpigmented papules coalescing into a velvety plaque in a linear distribution in the right axilla. No active lesions were noted in the left axilla. Due to her past history of a left sided stroke, the patient was noted to have difficulty raising her right axilla.

 

LABORATORY TESTS:

A 3-mm punch biopsy of a right axillary lesion was performed. The patient was asked to discontinue deodorant use and replaced it with bacitracin ointment bid to the biopsy site.

DERMATOHISTOPATHOLOGY:

Microscopic evaluation revealed severe compact parakeratosis with retention of keratohyalin granules throughout the stratum corneum.

DIFFERENTIAL DIAGNOSIS:

1.   unilateral acanthosis nigricans
2.   axillary granular parakeratosis
3.   post-inflammatory hyperpigmentation
4.   linear epidermal nevi
5.   contact dermatitis


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