Irritating skin problems affecting the axilla – 10 cases

Severe atopic dermatitis

Atopic dermatitis most often affects the antecubital and popliteal fossae. It also very commonly involves the axillae, but generally spares the vault, tending to affect the posterior aspect where clothing rubs. The patient illustrated has lichenified plaques in the axillae, which are ill-defined and hyperpigmented. She complained of severe pruritus and was almost erythrodermic from chronic, severe, generalised atopic dermatitis.
Topical steroids and emollients are the main treatments for atopic dermatitis. Moderate potency steroid creams may be prescribed for a few days for axillary involvement, with emollients and/or hydrocortisone cream as maintenance if required. The calcineurin inhibitor, pimecrolimus cream, can be used if hydrocortisone is insufficient or its use is prolonged.
This patient was treated with oral corticosteroids for several months; an immunosuppressive agent such as azathioprine or ciclosporin is often required for severe atopic dermatitis in adults.