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: February 1, 2008

CHIEF COMPLAINT: Pruritic rash in the axillae

CLINICAL HISTORY: A 70-year-old female presents with several month histories of hyperpigmented pruritic lesions in bilateral axillae. No previous treatment history. Her past medical history is significant for arthritis, thyroid disease, diabetes, and hypertension. Her medications include pioglitazone, calcium, valsartan, and thyroid medication. She denies any changes in her soap or laundry detergent. The patient’s lesions persist despite the 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. The moderate scale is present and the lesions are more prominent in the left axilla than the right. No fissures or erosions are apparent.

LABORATORY TESTS: N/A

DERMATOHISTOPATHOLOGY:

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