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).
Forbes B, Petersen MJ. Violaceous Patches in the Axilla. JAMA Dermatol. 2018;154(12):1477–1478. doi:10.1001/jamadermatol.2018.1901
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