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Dermatophytosis. Presented by Dr. Ochs.
A girl, aged 16, presented a lesion about 2I/2 by 3/4 inches (6.3 by 1.8 cm.) in each axilla, with raised edges and hypertrophied papillae, sharply marginated and showing exaggerated skin clefts (striae). The lesions were brownish red and showed a slight exudation. The duration of the disease was two weeks. The patient also presented small foci of psoriasis (?) on the arms, which she said had developed later than the lesions in the axillae.
Dr. MacKee: I find it difficult to differentiate between psoriasis and dermatophytosis. The axillae cannot be accepted as a common site for psoriasis, for it often occurs under pendulous breasts, in the gluteal fold and in other locations where there is heat, moisture and friction. In such locations the lesions may be inflamed, exudative and occasionally vegetating. In such locations it is difficult to differentiate between psoriasis and seborrheic dermatitis. When located in the axillae, dermatophytosis is likely to be sharply marginated, exudative and vegetating (eczema marginatum), and has the exact appearance of the lesions exhibited by this patient. The lesions on the arms do not show typical micaceous scales, and they are not particularly well marginated. I think that the case is one of dermatophytosis and probably also of dermatophytid. Incidentally, the term dermatophytosis includes any eruption in this group regardless of the organism. Such a case should not be called epidermophytosis until the epidermophyton has been demonstrated.
Eller J. MANHATTAN DERMATOLOGICAL SOCIETY. Arch Derm Syphilol. 1927;16(2):207–210. doi:10.1001/archderm.1927.02380020079013