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 © 2001-2009, DermAtlas | Image Name: | Hidradenitis_Suppurativa_1_060721 | File Type: | jpg | |
| Diagnosis: | HIDRADENITIS SUPPURATIVA | Category: | intertriginous rashes | ||
| Body Site: | groin | Age: | 27 years | ||
| Contributor: | Patricia Greene | ||||
| Description: | draining cyst | ||||
| Comments: | This 26-year-old woman complained of chronic and recurrent boils, cysts and draining sinus tracts in the groin billaterally. | ||||
 © 2001-2009, DermAtlas | Image Name: | granular_parakeratosis_2_060206 | File Type: | jpg | |
| Diagnosis: | GRANULAR PARAKERATOSIS | Category: | intertriginous rashes / hyperpigmentation / histologic finding | ||
| Body Site: | axilla (armpit) | Age: | 50 years | ||
| Contributor: | Greg Hosler, MD, PhD | ||||
| Description: | At high power of the same lesion, there is conspicuous retention of keratohyaline granules within the parakeratotic scale. These granules are large, coarse, and basophilic. No cytologic atypia is noted. | ||||
| Comments: | This 50-year-old African-American female developed a warty, hyperpigmented plaque in her axilla. It was submitted as a possible seborrheic keratosis. Granular parakeratosis is largely idiopathic but some authors feel it is due to external injury, such as antiperspirant use. Defects in profilaggrin-filaggrin processing have been suggested. The histology is characteristic in this case, showing retention of keratohyaline granules within the parakeratotic scale. | ||||
| Related Images: | granular_parakeratosis_1_060206 | ||||
 © 2001-2009, DermAtlas | Image Name: | granular_parakeratosis_1_060206 | File Type: | jpg | |
| Diagnosis: | HYPERPIGMENTATION | Category: | intertriginous rashes / hyperpigmentation / histologic finding | ||
| Body Site: | axilla (armpit) | Age: | 50 years | ||
| Contributor: | Greg Hosler, MD, PhD | ||||
| Description: | Histologic sections of skin show epidermal acanthosis with overlying mounds of hyperparakeratosis. The lesion has a flat bottom and is not infiltrative. | ||||
| Comments: | This 50-year-old African-American female developed a warty, hyperpigmented plaque in her axilla. It was submitted as a possible seborrheic keratosis. Granular parakeratosis is largely idiopathic but some authors feel it is due to external injury, such as antiperspirant use. Defects in profilaggrin-filaggrin processing have been suggested. The histology is characteristic in this case, showing retention of keratohyaline granules within the parakeratotic scale. The differential diagnosis would include other benign keratoses when the retention of granules is less prominent. | ||||
| Related Images: | granular_parakeratosis_2_060206 | ||||
 © 2001-2009, DermAtlas | Image Name: | streptococcal_intertrigo_1_050114 | File Type: | jpg | |
| Diagnosis: | STREPTOCOCCAL INFECTION / INTERTRIGO / INTERTRIGO, STREPTOCOCCAL | Category: | infections and infestations / intertriginous rashes | ||
| Body Site: | groin / diaper area | Age: | 0 | ||
| Contributor: | Paul Honig, MD | ||||
| Description: | symmetric sharply demarcated, beefy-red scaly macerated plaques | ||||
| Comments: | A 5-month-old girl had an 8-week history of a persistent foul smelling intertriginous eruption involving the neck, axillae, groin, and flexural creases of the arms and legs. Lesions were unresponsive to topical and oral nystatin for presumed candidal intertrigo. Culture yielded heavy growth of a single organism (Group A beta-hemolytic Streptoccus). Group A beta-hemolytic streptococci (GABHS) produce a variety of skin infections, including cellulitis, ecthyma, erysipelas and perianal cellulitis in young children. Another streptococcal skin infection – GABHS intertrigo – represents an under-recognized cause of intertriginous eruptions in children. Simple intertrigo results from the friction created by opposing skin surfaces and is exacerbated by moisture trapped in deep skin folds. Young infants are especially susceptible due to their relative chubbiness, short necks, and flexed posture, all of which lead to deep skin folds. Secondary infection by Candida albicans is not uncommon; however, other secondary pathogens, such as GABHS, should also be considered. Other bacteria reported to occur in mixed infections include Pseudomonas aeruginosa and Proteus vulgaris or P. mirabilis. Certain clinical features may help to differentiate monilial intertrigo from GABHS intertrigo. Although present in both settings, satellite lesions favor Candida infection, whereas the presence of a distinct, foul smell on examination suggests GABHS intertrigo. GABHS skin infections may also induce psoriasiform skin lesions or may be associated with psoriasis, which present as scaly, erythematous islands that can resemble satellite lesions. Culture of the affected skin areas provides the most definitive tool to differentiate these two conditions. Some suggest the use of a rapid strep test to help with prompt diagnosis; however, the specificity and sensitivity of the technique for this anatomic site remains to be determined. Simple intertrigo responds to measures that minimize moisture and reduce friction, such as barrier creams or absorptive powders such as cornstarch. Candidal intertrigo responds to anti-yeast preparations such as econazole, ketoconazole, or nystatin creams or ointments. A 10-day course of properly dosed penicillin successfully treats GABHS in most instances. For less-severe cases, a trial of topical mupirocin ointment can be utilized. Frequently, use of a low-potency topical steroid is helpful for decreasing inflammation and its associated symptoms. References: 1. Amren DP, Anderson AS, Wanamaker LW. Perianal cellulitis associated with group A streptococci. Am J Dis Child. 1996;112:546-552. 2. Esterly NB, Markowitz M. The treatment of pyoderma in children. JAMA. 1970;212:1667-1670. 3. Honig PJ. Gutt ate psoriasis associated with perianal streptococcal disease. Arch Dermatol. 1998;124:702-704. 4. Honig PJ, Frieden IJ, Kim HJ, Yan AC. Streptococcal Intertrigo: An Underrecognized Condition in Children. Pediatrics 2003;112:1427-29. 5. Koky NP, Cornstock JA, Facklam RR. Streptococcal perianal disease in children. Pediatrics. 1987;80:659-663. 6. Leyden J, Kligman AM. The role of microorganisms in diaper dermatitis. Arch Dermatol. 1978;114:56-59. | ||||
 © 2001-2009, DermAtlas | Image Name: | Tinea_cruris_1_040522 | File Type: | jpg | |
| Diagnosis: | TINEA CRURIS / TINEA CORPORIS / DERMATOPHYTOSIS | Category: | infections and infestations / intertriginous rashes | ||
| Body Site: | groin / diaper area | Age: | 29 years | ||
| Contributor: | Kosman Sadek Zikry, MD | ||||
| Description: | red crusted weepy symmetric intertriginous plaques | ||||
| Comments: | This 29-year-old man complained of a chronic itchy and painful eruption in the groin creases for several years. He was treated with an oral antifungal medication followed by prophylactic topical antifungal cream. | ||||
| Related Images: | Tinea_cruris_2_040522 | ||||
 © 2001-2009, DermAtlas | Image Name: | Psoriasis_Inversa_1_040215 | File Type: | jpg | |
| Diagnosis: | PSORIASIS / PSORIASIS, INVERSE | Category: | papulosquamous eruptions / intertriginous rashes | ||
| Body Site: | trunk / buttock | Age: | 36 years | ||
| Contributor: | Shahbaz A. Janjua, MD | ||||
| Description: | symmetric red scaly polycyclic plaques in creases; silvery scaly plaqes on trunk | ||||
| Comments: | This 36-year-old woman presented with symmetric red scaly plaques affecting the submammary folds, axillae and trunk Please note that the scaling was not pronounced in the folds as compared to the plaques elsewhere on the body. Psoriasis inversa is a variant of psoriasis involving the groins, vulva, axillae, gluteal cleft and other body folds. Scaling is greatly reduced or absent. | ||||
| Related Images: | Psoriasis_Inversa_2_040215 | ||||
 © 2001-2009, DermAtlas | Image Name: | Psoriasis_Inversa_2_040215 | File Type: | jpg | |
| Diagnosis: | PSORIASIS / PSORIASIS, INVERSE | Category: | papulosquamous eruptions / intertriginous rashes | ||
| Body Site: | trunk / buttock | Age: | 36 years | ||
| Contributor: | Shahbaz A. Janjua, MD | ||||
| Description: | symmetric confluent red scaly polycyclic plaques with maceration | ||||
| Comments: | This 36-year-old woman presented with symmetric red scaly plaques affecting the submammary folds, axillae and trunk Please note that the scaling was not pronounced in the folds as compared to the plaques elsewhere on the body. Psoriasis inversa is a variant of psoriasis involving the groins, vulva, axillae, gluteal cleft and other body folds. Scaling is greatly reduced or absent. | ||||
| Related Images: | Psoriasis_Inversa_1_040215 | ||||
 © 2001-2009, DermAtlas | Image Name: | Tinea_cruris_1_031007 | File Type: | jpg | |
| Diagnosis: | TINEA CRURIS / TINEA CORPORIS / DERMATOPHYTOSIS | Category: | infections and infestations / papulosquamous eruptions / hyperpigmentation / intertriginous rashes | ||
| Body Site: | groin | Age: | 25 years | ||
| Contributor: | Jayakar Thomas, MD. PhD | ||||
| Description: | symmetric, scaly hyperpigmented plaques | ||||
| Comments: | This young man complained of an itchy scaly groin rash. The plaques and symptoms cleared with topical antifungal cream therapy. | ||||
 © 2001-2009, DermAtlas | Image Name: | Candidal_Diaper_Rash_1_030828 | File Type: | jpg | |
| Diagnosis: | CANDIDIASIS | Category: | infections and infestations / intertriginous rashes | ||
| Body Site: | perineum | Age: | 5 months | ||
| Contributor: | Douglas Hoffman, MD | ||||
| Description: | Symmetric red perineal papules worsened after a week of topical barrier paste. Potassium hydroxide microscopic prep revealed hyphae. Rash cleared with Nystatin cream. | ||||
| Comments: | This diaper dermatitis worsened over a week until treatment with topical mycostatin cream was started. A potassium hydroxide preparation revealed hyphae. The eruption cleared in 3 days. | ||||
 © 2001-2009, DermAtlas | Image Name: | Tinea_Cruris_1_030326 | File Type: | jpg | |
| Diagnosis: | TINEA CRURIS / TINEA CORPORIS / DERMATOPHYTOSIS | Category: | intertriginous rashes / papulosquamous eruptions | ||
| Body Site: | groin / genital diaper area / suprapubic area | Age: | 18 months | ||
| Contributor: | Douglas Hoffman, MD | ||||
| Description: | 18 year old baseball player with a pruritic, progressive rash which spread from groin to lower abdomen over the course of a month. There are scattered excoriations from itching. There was extensive involvement of proximal inner thighs (not shown). The lesion began to regress after two days of 1% clotrimazole cream. Management also included prevention teaching and recommendation that he trim his finger nails! | ||||
| Comments: | This 18-year-old baseball player complained of a pruritic dermatitis which spread from the groin to the lower abdomen over a month. He also had extensive excoriations on his inner thighs. The lesion began to heal after 2 days of 1 percent clotrimazole cream. | ||||
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