A female patient in her late 40s presented with a 3-year history of nonhealing ulcers in her groin and axillae. These lesions started as itchy, weepy, reddish papules and plaques, which gradually progressed to form ulcers and were associated with pain and pus discharge. They did not heal completely after multiple courses of topical as well as systemic antibiotics, antifungals, and steroids. She frequently experienced scaling and greasiness on her scalp, which was treated with shampoos and topical steroids. She also complained of polyuria and polydipsia for the past 4 years.
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General examination revealed multiple mobile, firm, nonmatted, and nontender lymph nodes in cervical and inguinal region. On systemic examination, hepatomegaly (2 cm below the right costal margin) was seen. There was also bilateral enlargement of the parotid area, which was tender on palpation. Cutaneous examination revealed yellowish greasy scales on the scalp, suggestive of seborrheic dermatitis. Erythematous edematous papules were present over the retroauricular areas and the inframammary folds (Figure, A). On examination of external genitalia, deep ulcers were observed in the bilateral inguinal folds, resembling knife-cut ulcers (Figure, B). Similar lesions were present over the junction of labia majora and labia minora and were associated with yellowish pus discharge. A 3.5-mm punch biopsy specimen was obtained for histopathological examination from the edge of an ulcer on one of the groin folds (Figure, C and D).
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Corresponding Author: Keshavamurthy Vinay, MD, DNB, Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India (firstname.lastname@example.org).
Published Online: January 11, 2023. doi:10.1001/jamadermatol.2022.5863
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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