A 58-Year-Old Man With a Macerated Rash of the Neck and Axilla

Abstract

A 58-year-old overweight African American man presented with a 5-year history of a slightly pruritic and painful rash of the right lateral area of the neck and right axilla. It was worse during the summers, and blisters sometimes developed. Emollients were unhelpful. The patient was otherwise healthy. His sister had diabetes mellitus and a similar rash in her axillae. The patient performed indoor manual labor as a maintenance engineer and had no significant sun exposure. Physical examination revealed irregularly thickened skin of the right axilla (Figure 1, left) and right lateral area of the neck (Figure 1, right) containing hyperpigmentation, hypopigmentation, multiple acrochordons (skin tags), malodorous crust, and areas of maceration and erosion. Further examination of the skin revealed pseudofolliculitis barbae in the submental and mandibular regions bilaterally. The nails, oral cavity, and mucosal membranes appeared normal. A biopsy of right axillary skin was performed (Figure 2). Diagnosis Hailey-Hailey disease (benign familial pemphigus)What to Do Next C. Prescribe a topical corticosteroid and a topical antimicrobial

Generalized erythematous plaques with maceration and crusting

“…It often worsens in summer due to factors such as heat, sweating, and friction [9]. Disseminated lesions should be differentiated from various generalized entities, including common diseases such as seborrheic dermatitis, inverse psoriasis, and dermatophytoses, as well as uncommon diseases such as Darier disease, intertrigo erythrasma, and autoimmune pemphigus variants [9]. Typical clinical manifestations, laboratory tests, and histopathologic examination can help diagnose this disease.…”

“…Generalized HHD is an idiopathic entity that can atypically involve non-intertriginous areas, such as trunk, cubital fossa, and popliteal fossa, and usually lacks family history. It often worsens in summer due to factors such as heat, sweating, and friction [9]. Disseminated lesions should be differentiated from various generalized entities, including common diseases such as seborrheic dermatitis, inverse psoriasis, and dermatophytoses, as well as uncommon diseases such as Darier disease, intertrigo erythrasma, and autoimmune pemphigus variants [9].…”

Generalisierte erythematöse Plaques mit Mazeration und Krusten

“…Der Morbus Hailey-Hailey mit generalisierten Hautläsionen ist eine idiopathische Entität, die atypischerweise auch nicht-intertriginöse Bereiche wie den Rumpf, die Fossa cubitalis und die Fossa poplitea betreffen kann und für die in der Regel keine Familienanamnese vorliegt. Sie verschlimmert sich häufig im Sommer aufgrund von Faktoren wie Hitze, Schwitzen und Reibung [9]. Disseminierte Läsionen sollten von anderen generalisierten Dermatosen unterschieden werden, darunter häufige Erkrankungen wie seborrhoische Dermatitis, inverse Psoriasis und Dermatophytosen sowie seltene Erkrankungen wie Morbus Darier, Intertrigo, Erythrasma und autoimmune Pemphigusvarianten [9].…”

“…Sie verschlimmert sich häufig im Sommer aufgrund von Faktoren wie Hitze, Schwitzen und Reibung [9]. Disseminierte Läsionen sollten von anderen generalisierten Dermatosen unterschieden werden, darunter häufige Erkrankungen wie seborrhoische Dermatitis, inverse Psoriasis und Dermatophytosen sowie seltene Erkrankungen wie Morbus Darier, Intertrigo, Erythrasma und autoimmune Pemphigusvarianten [9]. Typische klinische Manifestationen, Labortests und histopathologische Untersuchungen können zur Diagnose dieser Krankheit beitragen.…”

Safety of Topical Calcineurin Inhibitors for Hailey-Hailey Disease

“…To the Editor Dr Haley and colleagues described a patient with Hailey-Hailey disease (HHD) in a JAMA Clinical Challenge article. The authors stated that long-term topical calcineurin inhibitors (TCIs) such as tacrolimus or pimecrolimus could be applied to control HHD because they lacked the adverse effects of topical corticosteroids.…”