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Pruritic axillary papules

A 46-year-old man presented with a 7-year history of bilateral axillary pruritus exacerbated by warm, humid environments and associated perspiration. The patient worked as a vehicle security manager. There was no other relevant history. On physical examination, well-defined, nonfollicular, red-brown papules and plaques with surface bran-like scale were seen in both axillae (Fig. 1). Thorough investigations including patch tests, skin scrapings for mycology, and skin-biopsy examination were performed to ascertain the cause, as the differential diagnosis included an atypical presentation of allergic and irritant contact dermatitis, tinea corporis, erythrasma, and Hailey–Hailey and Fox–Fordyce diseases. Topical formulations including mild to moderate potency corticosteroids, antibiotics, antifungals, immunomodulators, vitamin D preparations and retinoids were of little benefit.