A 40-year-old black man came to the dermatology clinic for evaluation of painful, flocculent plaques under his arms and on his groin. The pruritic lesions had been present for several years. The patient also requested a rheumatologic examination because he had developed a disabling arthritis and was unable to work. Results of blood chemistries were normal. Knee and elbow x-rays showed erosive change consistent with an inflammatory arthritis.
The patient, a 50-year-old woman, had developed a painful skin rash on her left breast and surrounding tissue. The plaques were crusted and exhibited a slightly vegetative appearance. There was no bleeding or drainage. The lesions had been present for several months, and oral dapsone 50 mg daily had yielded some improvement. The patient reported having had multiple biopsies, including one using direct immunofluorescence. Her chest and back were also slightly affected.