A 52-year-old man presented with skin lesions that had developed on the skin of both axillae 3 months earlier and had steadily increased in size. There was no pain or itching. A skin examination revealed densely aggregated and partly confluent, brownish red, focally macerated papules that were covered by an adherent shiny keratotic scale (Figure 1 and Figure 2). The patient was asked to discontinue the use of deodorants and was treated with topical antibiotics, corticosteroids, and zinc oxide paste, without resolution of his lesions. A short course of fluconazole did not improve the eruption. Potassium hydroxide preparations and microbial cultures were negative for fungi and bacteria. The results of laboratory tests, including a complete blood cell count and a basic biochemical profile, were within normal limits.
Martínez MB, Ramírez JCP, Betlloch Mas I, Salvador JFS, Tendero PA. Scaling Lesions on the Axillary Skin of a 52-Year-Old Man—Quiz Case. Arch Dermatol. 2004;140(9):1161–1166. doi:10.1001/archderm.140.9.1161-e