Fig. 25.1
Upper panel represents a 20-year-old man with pemphigus vulgaris who was in remission on immunosuppressive therapy and presented with a “flare of his disease.” Histological evaluation confirmed the clinical diagnosis of candidiasis. Lower panel represents a middle-aged man with flexural psoriasis. Note the well-defined nature of the plaques
Case
A patient presents with a chronic rash of the groin with or without involvement of other skin folds.
Clinical differential diagnosis includes
intertrigo
candidiasis
erythrasma
tinea
gram-negative infection (especially in toe web maceration)
psoriasis
chronic dermatitis
Hailey–Hailey disease (HHD), and
granular parakeratosis.
Disorders which present with papules, such as condyloma, molluscum , skin tags, groin acantholytic dermatosis, or nodules, such as hidradenitis, are not considered here.
Clinical Clues
History
It is highly likely to elicit a positive family history in HHD and to a lesser degree in psoriasis. Patients with intertrigo and candidiasis are more likely to be overweight or obese. Patients with tinea and chronic dermatitis are more likely to report pruritus.
Examination
Upon examination, the lesions are:
More likely to be well defined in psoriasis, tinea, and erythrasma; and ill-defined in intertrigo, candidiasis, and chronic dermatitis
More likely to be crusted and/or vesicular in HHD and have active (pustular, vesicular, scaly) border in tinea
Generally brightly red in psoriasis, candidiasis, and HHD, and brown in erythrasma and granular parakeratosis
Usually raised in HHD, psoriasis, chronic dermatitis, and granular parakeratosis, and more flat in intertrigo , candidiasis, and erythrasma
Patients with psoriasis and HHD are more likely to have involvement of multiple skin folds.
Limitations in Clinical Diagnosis
In spite of the above clues, a clinical diagnosis is not always possible due to several reasons:
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