Hailey–Hailey disease

QUESTION 92

A 42-year-old woman presents to the dermatology clinic for the evaluation of a painful rash in her skinfolds. The rash has been present for about 1 year, but has progressively worsened and spread from involving the axillae to the groin folds and lower back. It is worse during the summer, especially with sweating and friction. She also notes malodorous drainage from these areas that require her to change her clothes twice a day. She has been evaluated by her primary care physician and treated with topical nystatin cream and powder for intertrigo, without improvement. On examination, there are arcuate and polycyclic well-demarcated plaques with central areas of erosion and an erythematous, scaly border (92a, b).