Not Every Chronic Intertrigo is Fungal: Hailey-Hailey Disease Revealed by Dermoscopy

Abstract

Aims: To report a case of Hailey-Hailey disease identified with the aid of dermoscopy in a woman with a darker skin phototype whose chronic flexural intertrigo had repeatedly been misdiagnosed and treated as a fungal infection, and to highlight dermoscopic features that may reduce diagnostic delay. Presentation of Case: A 50-year-old woman presented with a seven-year history of chronic, painful, relapsing-remitting lesions affecting the groin, axillae, and perineum, with exacerbations associated with heat, sweating, and friction. Repeated antifungal and antibacterial treatments had not produced sustained improvement, and there was no known family history of similar cutaneous manifestations. Examination showed erythematous-to-violaceous macerated plaques with fissuring, superficial erosions, and post-inflammatory hyperpigmentation. Dermoscopy demonstrated irregular whitish cloud-like areas separated by pink furrows and pink homogeneous structureless areas corresponding to superficial erosions. Histopathological examination of an inguinal plaque showed suprabasal acantholysis with the characteristic dilapidated brick wall pattern, confirming Hailey-Hailey disease. Topical corticosteroids produced limited improvement, whereas oral doxycycline resulted in partial symptomatic and inflammatory improvement. Discussion: The case illustrates how Hailey-Hailey disease may mimic common flexural dermatoses and remain unrecognised, particularly when inflammatory erythema is less apparent. Dermoscopy provided useful bedside clues that redirected the diagnostic approach and prompted confirmatory biopsy. Conclusion: Hailey-Hailey disease should be considered in chronic, recurrent intertrigo that does not respond to antifungal therapy. Dermoscopy may facilitate earlier recognition and appropriate histopathological confirmation, particularly in patients with darker skin phototypes.