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A 76-year-old woman presented with a venous leg ulcer 7. Incidentally hemorrhagic macules on hands and fingers and dystrophy of toe and fingernails were noticed. Except for submammary erythema, no further dermatologic signs were shown. Histology of palmar lesions fit with a hemorrhagic lesion of dyskeratosis follicularis in acral skin. During following months actinic induced reddish-brown hyperkeratotic papules appeared on the forehead and in seborrheic and intertriginous areas of the trunk. Papules were most prominent during summer and almost completely resolved in winter. The hemorrhagic variant of dyskeratosis follicularis represents a rare clinical variant which has to be separated from other purpuric macules on acral sites.

History and Clinical Findings: A 57-year-old man with diabetes and hypertension was treated with amoxycillin, clarithromycin and pantoprazole for a gastric ulcer positive for Helicobacter pylori. On the second treatment day he developed inguinal pruritus with erythema. He presented at out-patient clinic on the 5th day suspected of having Candida intertrigo. He had bright red, relatively well-circumscribed erythema, most marked at the edges, mainly over the inguinal region and the inside of the thigh. There were no other symptoms., Investigations and Diagnosis: Bacteriological and mycological tests of the affected skin were unremarkable. Immunological tests showed a normal total IgE but were negative in the CAP-FEIA test for penicilloyl G, penicilloyl V, amoxycilloyl and ampicilloyl. An epifocal epicutaneous test with amoxycillin and ampicillin (5% each in vaseline and doritin) gave a +2 positive reaction and confirmed a suspected fixed drug reaction., Treatment and Course: After amoxycillin had been discontinued and local class III steroids had been administered (mometasone furoate, Ecural) for one week the cutaneous changes disappeared without complication, except for slight hyperpigmentation. H. pylori eradication was continued without further complications using clarithromycin, metronidazole and pantoprazole. The patient was issued with an "allergic to penicillin" card., Conclusion: Intertriginous changes during antibiotic treatment may not be due to Candida intertrigo, which is fairly common, but to a prognostically much more important drug reaction.

A 69-year-old woman presented with widespread symmetrical papular lesions in submammary and inguinal areas. History revealed that the disease had only been present for a few years. A skin biopsy showed focal suprabasal acantholysis, dyskeratosis up to the horny layer and in part parakeratotic hyperkeratosis. The patient had no further evidence for Darier disease, Hailey-Hailey disease or pemphigus vegetans. In particular, characteristic lesions of Darier disease of hands and nails were absent. We found several reports in the literature describing similar skin lesions in intertriginous and genital areas with histological evidence of acantholytic dyskeratosis under various terms. This report discusses the difference between these cases and the differential diagnoses, in particular Darier disease. We propose to designate cases of intertriginous papulosis with histological proof of acantholytic dyskeratosis but without further evidence of Darier disease as intertriginous acantholytic dyskeratosis.

During the last decade an unusual amicrobial intertriginous pustulosis has been described in association with autoimmune disease in sixteen female patients. The clinical hallmark is a sterile pustular dermatosis preferentially located in intertriginous regions that responds to local or systemic corticosteroids. Histologic features are subcorneal sometimes spongiform neutrophilic pustules. We report an additional patient suffering from this unusual dermatosis. An overview of the patients described to date and a review of the literature are given in an attempt to delineate this amicrobial intertriginous pustulosis from the known pustular dermatoses.

Intertrigo is an inflammatory dermatosis involving the body folds. Predisposing factors include constant friction opposing skin surfaces, obesity, sweating and occlusion. Colonization with bacteria, yeast and dermatophytes may exacerbate the dermatosis. Irritant antiseptics may aggravate intertrigo and provoke an allergic contact dermatitis. Treatment consists in careful drying the skin. Antimicrobial agents topically applied may be helpful. Predisposing factors should be corrected carefully.