The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Stephanie V. Sherman, M.D., Editor

Trichomycosis Axillaris
A B C

A
35-year-old man presented to the dermatology clinic with a Emily Murphy, M.D.
9-month history of white clumps on the hairs of his axillae. He had ini- George Washington University School
tially noticed the deposits on the hair of his axillae and groin. The pubic- of Medicine and Health Sciences
hair involvement resolved after an episode of shaving, but the abnormalities with Washington, DC
regard to the axillary hair persisted despite regular washing with coconut-oil– Mary Maiberger, M.D.
based and antibacterial soaps and one episode of shaving. He reported no mal-
Washington VA Medical Center
odor, pain, or pruritus. On examination, white concretions encircling the hairs in Washington, D.C.
both axillae (Panel A) were observed. A Wood’s lamp examination showed yellow- mary.maiberger@va.gov
green fluorescence of the concretions (Panel B), and dermoscopy revealed cotton- This article was published on November
like structures on the hair shafts (Panel C). A diagnosis of trichomycosis axillaris 26, 2022, at NEJM.org.
was made. Trichomycosis axillaris is a superficial bacterial infection of the hair of
the axillae; the name is a misnomer, given that it is caused by corynebacterium
species as opposed to fungi. Visible deposits form on hair shafts when bacteria
mix with dried apocrine sweat, especially in the presence of hyperhidrosis or im-
paired hygiene. After 1 week of treatment with topical clindamycin and a daily
benzoyl peroxide wash, the patient’s symptoms abated and did not recur.
DOI: 10.1056/NEJMicm2206453
Copyright © 2022 Massachusetts Medical Society.

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