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Apocrine chromhidrosis is a rare diagnosis that occurs due to colored sweat being secreted from the apocrine glands, which are located in the axillae, anogenital skin, and areolae and over the skin of the trunk, face, and scalp. We present the case of a 65-year-old woman who presented with a sudden onset of pink sweating affecting mainly her axillae but also her pelvis, causing staining of clothing and bed sheets. There was nil to note on examination and histology with immunostaining demonstrated focally prominent yellow-brown lipofuscin granules in the cytoplasm of the apocrine secretory cells confirming the diagnosis. The disease can have a significant psychosocial impact, and treatment remains challenging. Our case is unique because the red and pink coloring of sweat is less common in cases of apocrine chromhidrosis, which is often in favor of darker colored sweat, and the distribution involved the inguinal canal, which is also less often seen.

Summary Aim Johnson et al. aimed to assess caregivers’ willingness to treat childhood atopic dermatitis (AD) with a corticosteroid when presented with clinical trial evidence, anecdote, or both. Setting and design This prospective parallel group (1: 1; eight groups) randomized control trial (RCT) was carried out with caregivers recruited from a tertiary care dermatology clinic in the USA and an online crowdsourcing platform using caregivers who may not have had a child with AD. Study exposure Caregivers were randomized to eight groups. The three main groups were given clinical trial evidence, anecdote, or a combination of both. Each of these three groups was further divided and presented with either the term ‘medication’ or ‘topical steroid’. These were compared with the two remaining groups, which included a group told that they would not be informed of a medication's efficacy or safety profile, and a group informed that the medication was recommended by the doctor. Outcome Caregivers were asked about their willingness to treat based on the information they had received using a 10‐point Likert scale where 1 was ‘not willing’ and 10 ‘completely willing’. Results A total of 476 caregivers were recruited (80 clinic, 396 online), 48% of whom had a history of a child with AD. Caregivers’ willingness to treat was higher in all information assignment groups compared with those not provided with safety information: clinical trial evidence of a ‘medication’ (P = 0·003; Cohen's d = 0·83) or ‘topical steroid’ (P = 0·030; d = 0·55), anecdote of a ‘medication’ (P < 0·0001; d = 1·37) or ‘topical steroid’ (P < 0·0001; d = 0·85), both clinical trial evidence and anecdote of a ‘medication’ (P < 0·0001; d = 1·00) or ‘topical steroid’ (P = 0·000; d = 0·89), and simply the doctor's recommendation (P < 0·0001; d = 0·92). Conclusion Johnson et al. conclude that the provision of anecdotal reassurance may be an effective strategy to improve caregivers’ willingness to use topical steroids. Comment Exploring factors that affect caregivers’ willingness to adhere to topical corticosteroids is an important area of research. This study was a potentially efficient way of conducting a rapid RCT to explore such factors. The study conclusions are significantly undermined by lack of a registered trial protocol, poor trial reporting, the use of caregivers who did not have experience of AD, the multiplicity and complexity of treatment arms, and the use of an unvalidated primary outcome.

A 66-year-old man presented with a 10-month history of erythematous blistering lesions in his axillae and groin. This eruption had begun when he was on holiday in the Caribbean, where he developed purpuric patches in the intertriginous areas. These then blistered within hours, leaving 'tissue paper-like' skin. The lesions were otherwise asymptomatic. His only longterm medication was co-tenidone for hypertension. He had no prior history of photosensitivity, excess alcohol intake, liver or autoimmune disease, or any relevant family history.On physical examination, macerated erythematous blistered areas were seen in the groin and axillae, with signs of atrophic wrinkled skin in the perinatal cleft, back and posterior legs. Nikolsky sign was negative ( Fig. 1a-d). There were no clinical changes noted on the oral and genital mucosae. The hair and nails were normal. Swabs, fungal cultures and Borrelia serology were negative. Figure 2 (a) Skin biopsy from affected skin of the patient showing hyperkeratosis, focal interface change and a subepidermal split. (b,c) Dermal hyalinization with subjacent perivascular lymphoid infiltrate. Haematoxylin and eosin; original magnification (a) 9 20; (b) 9 200; (c) 9 400. Clinicopathological case ª