Blister-like folliculitis

[DPM111]

I've been having trouble with a rash on my inner thigh near the groin. It appears along the crease of skin and as isolated round inflamed regions that might be starting at follicles and spread to be about 1/4 or 1/2 inch wide.  They do not have a ring-like edge as you see with fungus, and there is no white or black-head pustule or raised area, just red blister-like sore skin.  It has not responded to Lamisil ointment (antifungal) or an antibiotic ointment or to a week long course of oral Cephalexin.  It's mostly on one side, but starting to also appear on the other side.  Any ideas of what to try or what it might be?

[Bhupinder Kaur, MD]

Hello,

Thanks for posting the additional information.

From the symptoms that you have mentioned it is more likely to be due to chafing or friction rub. Follow the advice given above. Also do not use any cosmetic products at the sites. You can apply some calamine lotion at the rash as it will help in soothing the skin.Also wear cotton undergarments.Application of mild corticosteroid cream and oral antiinflammatories like ibuprofen/acetaminophen are also helpful but they should be used only under medical guidance because steroids should be used carefully because of their potential side effects on skin.

I sincerely hope that helps. Take care and regards.

[DPM111]

Thank-you.  There hasn't been a brown patch effect, the areas get red, and then after a while it fades to pink and slowly heals, but new spots appear, so it hasn't gone away.

[Bhupinder Kaur, MD]

Hello,

Thanks for posting your query.

I can understand your concern for the blister like sore patch on the groin and which has started appearing on the other groin also.

From your symptoms few possibilities are coming to my mind which need to be evlauted and ruled out one by one. These include:

1) Chafing skin:  Chafing occurs when the skin becomes irritated by the friction caused by rubbing – either against other skin or against a foreign material. Chafing can also be caused by improper or overly loose fitting clothing generating extra friction or due to obesity. It mostly occurs on thighs, groin, underarms, and nipples.

2) The second possibility is of intertrigo skin which is an inflammation (rash) of the body folds and very commonly effects the groins and thighs. Like chafing it can occur in obese, diabetics, bed ridden persons or due to frequent movement in hot and sweaty weather. An intertrigo usually appears red and raw-looking, and may also itch, ooze, and be sore.

3) The third possibility is of fungal infection or tinea cruris although its chances are less because it should have responded to the topical antifungal cream Lamisil.

4) The last possibility is of erythrasma that causes brown, scaly skin patches caused by proliferation of bacteria which is normally present on the skin. Like other above mentioned possibilities, it is also prevalent among diabetics and the obese, and in warm climates; it is worsened by wearing occlusive clothing. The patches of erythrasma are initially pink, but progress quickly to become brown and scaly.

My suggestion would be to get a KOH examination of the skin scrapings done to rule out any fungal infection. Other conditions can be diagnosed by physical examination but in some cases, to confirm the diagnosis the dermatologist may do a biopsy skin. Treatment can be started thereafter once the diagnosis is confirmed.

Till that time, keeping the area of the intertrigo dry and exposed to the air can help. Even diaper rash cream like Sudocream and Desitin may help. Wear cotton clothes and use baby powder or antiperspirant powder.  If it is erythrasma then it is treated with topical fusidic acid, or systemic macrolides like erythromycin.

Hope that this information helps and hope that you get better soon.

Wishing you good health.