A 68-year-old woman was referred to the dermatology service of Stanford (Calif) University Medical Center with a three-month history of a progressive skin disease. According to the patient, her problem began with a persistent "sore throat" that had been diagnosed clinically by her internist as a streptococcal infection and treated with a course of oral phenoxymethyl penicillin. The sore throat persisted and was later accompanied by a slowly extending intertriginous eruption consisting of malodorous plaques and pustules. When direct wet-mount skin preparations demonstrated pseudohyphae, the patient was presumed to have chronic mucocutaneous candidiasis; however, treatment with systemic antifungal agents was without benefit. With the exception of obesity, the patient was otherwise in excellent health.Physical examination revealed a moderately obese female whose skin emanated a musky odor. Large vegetating plaques with a moist denuded surface were symmetrically localized to the axillary, inguinal, abdominal, and inframammary folds (Figs 1 and 2). The plaques were surrounded by discrete 3-to 6-mm pustules. Superficial erosions were present in the oral buccal mucosa and inner surface of the labia majora. A biopsy specimen was obtained, and repre¬ sentative sections are shown in Figs 3 and 4.
A 40-year-old man with a generalized skin eruption was referred to the dermatology service at the Palo Alto (Calif) Veterans Administration Hospital. Seven months prior to admission, during an emotionally stressful period, the patient noticed a nonhealing tender red patch on the preauricular region of the left side of his face. In the following five months, similar lesions appeared, remaining localized to the head and neck, and later becoming generalized to all areas but the mucous membranes.According to the patient, disease exacerbation was precipitated by sun and heat exposure. Burning, pain, and skin tightness were his primary symptoms. He was otherwise in excellent health and was taking no medications prior to the onset of his skin disease.Skin examination revealed rare flaccid bullae, large areas of superficial denudation, and serpiginous, erythematous patches with an overlying loosely adherent yellowish thin crust (Fig 1). Nikolsky's sign was positive. No oral or genital lesions were found. A biopsy specimen was obtained, and repre¬ sentative sections are shown in Figs 2 and 3.What is your diagnosis?
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.