Pruritic plaques in the axillae

Presenter: Nicole Bright, DO (resident), Sharon Zellis, DO, Tanya Ermolovich, DO
Dermatology Program: Philadelphia College of Osteopathic Medicine/Frankford Hospital
Program Director: Tanya Ermolovich, DO
Submitted on: Feb 1, 2008

CHIEF COMPLAINT:  A patient presents with a pruritic rash in the axillae.

CLINICAL HISTORY:

Signs and symptoms:  A 70 year old female presents with a several month history of hyperpigmented pruritic lesions in bilateral axillae.

Previous Treatment:  None.

Other information:  Her past medical history is significant for arthritis, thyroid disease, diabetes, and hypertension. Her medications include pioglitazone, calcium, valsartan and a thyroid medication. She denies any changes in her soap or laundry detergent. The patient’s lesions persist despite switching brand of deodorant. She denies dryer sheet usage but uses a scented fabric softener. She also has no known drug allergies.

PHYSICAL EXAM:

A well appearing female with dark brown flat topped papules coalescing into plaques in bilateral axillae. Moderate scale is present and the lesions are more prominent in the left axilla than the right. No fissures or erosions are apparent.

Right axilla. Demonstrating hyperpigmented papules coalescing into plaques.
Magnified view of left axilla.

LABORATORY TESTS:

None.

DERMATOHISTOPATHOLOGY:

A shave biopsy from the left axilla reveals a compact stratum corneum with extensive parakeratosis. Nummerous fine keratohyalin granules are interspersed in the stratum corneum. Perivascular lymphocytic infiltrate is present in the superficial dermis. PAS staining is negative for hyphae.

H&E
H&E

DIFFERENTIAL DIAGNOSIS:

1.   Hailey-Hailey
2.   Acanthosis Nigricans
3.   Contact Dermatitis
4.   Granular Parakeratosis
5.   Inverse Psoriasis


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