Trichomycosis Axillaris Clinical Presentation

Author: Zeina Nehme Ghorayeb, MD; Chief Editor: Dirk M Elston, MD more...

Updated: Jan 12, 2012

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History
Physical
Causes
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History

Trichomycosis axillaris typically is asymptomatic; however, patients may report malodorous sweat. Trichomycosis axillaris may be associated with similar findings of hair concretions in the pubic area (trichomycosis pubis).

Physical

Concretions encircle the hair shaft, making it appear beaded or thicker. Concretions are most common on the central portion of axillary hair.

Concretions consist of 1- to 2-mm red, black, or yellow nodules that adhere firmly to the hair shaft. The insoluble cement substance elaborated by the bacteria adheres to the hair shaft and, occasionally, invades and destroys cuticular and cortical keratin. The yellow color is observed most commonly (see the image below) and may stain clothes yellow. Black and red are seen most commonly in tropical climates.

Yellow concretions are seen over axillary hairs.

The hair shaft may become brittle and thus, more easily broken, but this is rare. Typically, since the hair shaft is not weakened, alopecia is not seen.

The underlying skin usually is normal, although hyperhidrosis of the affected regions is common.

Causes

Trichomycosis axillaris is caused by several species of the gram-positive diphtheroid Corynebacterium,^[4]not by a fungus as the name may imply.

Proceed to Differential Diagnoses

Contributor Information and Disclosures

Author

Zeina Nehme Ghorayeb, MD Lecturer, University of Balamand School of Medicine

Zeina Nehme Ghorayeb, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Coauthor(s)

Mona Matta-Muallem, MD Associate Professor, Department of Dermatology, American University of Beirut, Lebanon

Mona Matta-Muallem, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Susan M Swetter, MD Director, Pigmented Lesion and Melanoma Program, Professor, Department of Dermatology, Stanford University Medical Center and Cancer Institute, Veterans Affairs Palo Alto Health Care System

Susan M Swetter, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society of Clinical Oncology, Eastern Cooperative Oncology Group, Pacific Dermatologic Association, Society for Investigative Dermatology, Society for Melanoma Research, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

Freeman RG, McBride ME, Knox JM. Pathogenesis of trichomycosis axillaris. Arch Dermatol. Jul 1969;100(1):90-5. [Medline].
Shelley WB, Shelley ED. Coexistent erythrasma, trichomycosis axillaris, and pitted keratolysis: an overlooked corynebacterial triad?. J Am Acad Dermatol. Dec 1982;7(6):752-7. [Medline].
Rho NK, Kim BJ. A corynebacterial triad: Prevalence of erythrasma and trichomycosis axillaris in soldiers with pitted keratolysis. J Am Acad Dermatol. Feb 2008;58(2 Suppl):S57-8. [Medline].
Savin JA, Somerville A, Noble WC. The bacterial flora of trichomycosis axillaris. J Med Microbiol. May 1970;3(2):352-6. [Medline].
Shelley WB, Miller MA. Electron microscopy, histochemistry, and microbiology of bacterial adhesion in trichomycosis axillaris. J Am Acad Dermatol. Jun 1984;10(6):1005-14. [Medline].
Korting GW. Practical Dermatology of the Genital Region. Philadelphia, Pa: WB Saunders; 1980:59.
Levit F. Trichomycosis axillaris. J Am Acad Dermatol. May 1990;22(5 Pt 1):858-9. [Medline].
Levit F. Trichomycosis axillaris: a different view. J Am Acad Dermatol. Apr 1988;18(4 Pt 1):778-9. [Medline].
McBride ME, Duncan WC. Trichomycosis axillaris. Arch Dermatol. Mar 1972;105(3):459. [Medline].
Wilson C, Dawber R. Trichomycosis axillaris: a different view. J Am Acad Dermatol. Aug 1989;21(2 Pt 1):325-6. [Medline].

Yellow concretions are seen over axillary hairs.

Close-up view of axillary hairs.

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