Bilateral axillary pustules
Our patient had no recent infections and was not immunocompromised. So what caused the sudden onset of lesions on her arms and thigh?
A healthy 29-year-old woman presented to the clinic with pustules and boil-like lesions in the axillary areas, on the left forearm, and on the right thigh (FIGURE). She indicated that she’d had the lesions for 4 weeks. She said that she had not had any recent infections, and there was no evidence of immune compromise in her history.
We incised a pustule in the right axilla and expressed the pus. We sent the sample out for bacterial culture and sensitivity testing.
We immediately considered bacterial folliculitis and hidradenitis suppurativa as part of the differential. The acute nature of the process led us to favor a diagnosis of bacterial folliculitis.
FIGURE
Papules and papulopustules on right axilla
Would you favor this diagnosis?
What would you choose for initial empiric antibiotic treatment?
