Four views of trichomycosis axillaris: Clinical, Wood's lamp, dermoscopy and microscopy

Vishal Gupta, Vinod Kumar Sharma

 Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Vinod Kumar Sharma
Department of Dermatology and Venereology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India

A 46-year-old man complained of axillary malodour for the last 2 years. Examination revealed waxy yellowish deposits adherent to several hair shafts [Figure - 1]a in both the axillae, which exhibited soft greenish fluorescence under Wood's lamp [Figure - 1]b. Dermoscopic examination with polarized light (×10 magnification) showed multiple hair shafts encased by golden-yellow concretions [Figure - 1]c. Microscopic examination of 10% KOH mount showed irregular concretions around the hair shafts [Figure - 1]d. The patient was diagnosed with trichomycosis axillaris. He was advised to shave off the axillary hair and was prescribed sodium fusidate 2% ointment twice daily, which resulted in complete improvement in 2 weeks.

Figure 1:

Trichomycosis axillaris is a superficial bacterial infection caused by bacteria belonging to Corynebacterium genus, particularly Corynebacterium flavescens, that forms masses around the hair shafts. The malodour is due to bacterial metabolism of sweat testosterone into malodorous compounds. Treatment includes topical antibiotics and general measures such as shaving the affected hair and control of hyperhidrosis. Dermoscopic examination can aid in its quick differential diagnosis, which includes hair casts, pediculosis and black and white piedra.

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