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What Is Causing These Painful “Boils”?

What Is Causing These Painful “Boils”?

A 42-year-old African American man presented to our dermatology clinic for draining “boils” in his underarms and groin area for the past 2 years. He had undergone various treatments by his primary care physician, including repeated rounds of oral antibiotics and incision and drainage of the most bothersome lesions. He was a smoker and had a history of hypertension and hypercholesterolemia. He denied any family history of any skin conditions. He was currently unemployed. Given excessive drainage and pain from his skin condition, the patient was depressed and infrequently left the house, due to concerns over the odor and difficulty in sitting or walking for long periods with his groin involvement.

Physical examination and diagnostic tests. On physical examination, the patient appeared slightly overweight. He demonstrated several erythematous, tender, draining abscesses in his bilateral axillae and inguinal creases in a linear fashion with some scarring and tethering of the axillary skin (Figure). Blood-tinged, purulent discharge was noted on the bandage covering his wounds. 

Laboratory work was notable for an elevated erythrocyte sedimentation rate and mild microcytic anemia. Other laboratory work-up was within normal limits.

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