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JAMA Dermatology Clinicopathological Challenge
December 2018

Violaceous Patches in the Axilla

Author Affiliations
  • 1Department of Dermatology, University of Utah School of Medicine, Salt Lake City
JAMA Dermatol. 2018;154(12):1477-1478. doi:10.1001/jamadermatol.2018.1901

A man in his 40s presented with a 3-month history of discrete, dark red, circular lesions in his right axilla. He endorsed severe pruritus at these sites that would wake him up at night. He denied any recent trauma or history of similar lesions. He denied associated pain, blisters, or systemic symptoms (eg, fever, chills). His medical history was unremarkable, and he noted no environmental triggers or new medications. Treatment with over-the-counter hydrocortisone cream, ketoconazole cream, and discontinuation of underarm deodorant yielded no improvement. Physical examination revealed 3 well-circumscribed, violaceous, annular patches without scale or erosion that are limited to his right axilla (Figure, A). No other lesions were noted on his skin or mucous membranes. A Wood lamp examination was negative. A punch biopsy specimen from a lesion was obtained (Figure, B and C).

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