Malodorous Intertriginous Pustules and Plaques

Abstract

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.

Efficacy of Dapsone in the Treatment of Pemphigus and Pemphigoid

“…[39] It is recommended that in widespread, recurrent, recalcitrant bullous pemphigoid, when adequate control is not achieved with prednisone and azathioprine, before increasing the prednisone dose, a brief course of dapsone be included in the overall treatment strategy. [40] The analysis of the data demonstrated that 32 of 37 (86%) patients with pemphigus vulgaris [7][8][9][10][11][12][13][14][15][16][17][18][19] and 14 of 18 (78%) patients with pemphigus foliaceus [8,[20][21][22][23][24][25][26][27][28] responded to dapsone. [38] In a more recent study of 62 patients, the combination of dapsone and oral methylprednisolone achieved control of disease in 100% of patients.…”

“…[38] The effectiveness of dapsone when combined with oral prednisone alone or with azathioprine was 92% in one study. [8,9,[11][12][13][14][15][16][17][18][23][24][25][26][27][28] It has been demonstrated that the addition of dapsone decreases the dose of corticosteroid required to control the disease. [41] Patients who respond to a sulfone will also respond to sulfonamides.…”

“…[7][8][9][10][11][12][13][14][15][16][17][18][19] Dapsone was used as monotherapy in six (16%) patients. There were 37 patients in 13 reports who were treated with dapsone.…”

“…[13,17,19] Of these, 11 patients had a clinical response. [7][8][9][10][11][12][13][14][15][16][17][18] Three of these 11 patients did not meet the criteria for response to dapsone specified in the randomized controlled trial.…”

An unusual case of pemphigus vulgaris presenting as bilateral foot ulcers

“… 4 Two types of pemphigus vegetans, the Neumann and Hallopeau types, are recognized, and show a histology characterized by marked acanthosis, extensive papillomatosis and prominent tissue eosinophilia. 5 A case of pemphigus vegetans presenting as verrucous vegetative plaques on the soles of the feet in a 40‐year‐old Indian woman has been reported. 6 Other uncommon manifestations of pemphigus vulgaris include paronychia, 7 trachyonychia, 8 and nail bed erosion.…”