I have a rash in my axillae

 The commonest conditions the Pharmacist would see in the axillae would be intertrigo, contact irritant or allergic dermatitis, psoriasis and candida infection. Erythrasma would be more common than tinea. Rarely a patient with hidradenitis suppurativa could present fo advice.

 

In obese individuals skin tags are found. There also may be features of intertrigo from sweating or mild irritant or seborrhoeic dermatitis. The axilla is also a common site for contact dermatitis from a deodorant, and also for flexural psoriasis and occasionally rarer diseases such as Darier’s or Hailey-Hailey disease which will show a characteristic splitting of the skin, but these aren’t things you are going to commonly see in a skin cancer practice though clinically they are quite distinctive.

We are also seeing recently a lot of superficial peeling of the skin in the axillae and groin in patients with axillary granular parakeratosis, a contact irritant reaction to Canesten washes. (Dermnet)

Hailey Hailey but Dariers would look similar Rx Strong topical steroid, mupirocin and antifungal cream such as Lamasil

Mild axillary granular parakeratosis  Stop any additives to washing clothes.

The axilla can also be a common area to get a condition called erythrasma. (GSA) It is a Corynebacterial infection and it will give rise to a spreading annular lesion coming out of the axilla that is red or  brown in colour.  There is no real clearing behind it and there is no real scale at the advancing edge that you would see in a tinea infection.

Rx  It is best treated just with 1% topical Clindamycin Lotion twice daily.  You can do some scrapings to show the Corynebacteria there.  It will also fluoresce pink with a Woods light. 

Groin rather than axilla but same appearance

Trichomycosis axillaris is another corynebacterial infection presenting with small orange concretions attached to the axillary hairs. See the description in the image details below.

The other condition that you should know about is hidradenitis suppurativa.  (GSA) This commonly presents in the axilla as a series of sinuses or abscesses.  They may look like tumours when you are examining the patient.  Unfortunately this disorder is difficult to manage.  In an early stage surgical therapy is often best to just cut out the damaged areas, but later on three monthly courses of antibiotics are required, or some of the new TNF alpha inhibitors such as Humira are used. They are given as 2 weekly injections of 80mgs per injection and will reduce the level of inflammation and abscess formation if continued for some months. Antiandrogens such as Aldactone 100 mgs daily are also of value in perimenopausal women. Hidradenitis is particularly common in people who are overweight, and it can come on suddenly.

Well established HS Needs biologic to settle 

Long standing HS with sinuses and scarring