2.1 History and examination:-
A 47- year-old male presented to the dermatology outpatient department
with a 3 year history of pruritic skin lesions affecting bilateral groin
areas, scrotum and axilla. The lesion was first noticed by the patient
as a black scab accompanied by intense pruritus. The lesions followed a
relapsing-remitting course over the period of 3 years, and were found to
be aggravated by sweating. No history of similar lesions in the family
was noted. Patient was initially misdiagnosed to have an allergic
reaction and Levocetrizine was started, which did not resolve his
symptoms. Subsequently, he sought advice from another medical center
where he was diagnosed to have Tinea with secondary infection and was
started on medication. After initiation of medication, slight remission
was observed, however he relapsed again after a period of 3 months.
Subsequently, a KOH mounted microscopy was done, which revealed no
hyphae or spores under the light microscope.
Physical examination revealed excoriated bright red papules on bilateral
groin areas, scrotum and perineum (Figure 1), as well as few
excoriations around the axilla. There was no scalp, palm, soles or nail
involvement. There is no evidence of systemic or mucosal involvement.