A Recurrent Intertriginous Rash Responsive to Topical as Well as Surgical Therapy

REPORT OF A CASE  A 31-year-old woman, treated six years previously with ileojejunal bypass for morbid obesity (weight, 145 kg; height, 162 cm), developed a rash in her groin and intergluteal area (Fig 1) and under her breasts shortly after reanastomosis of her bowel. Zinc levels at that time were reportedly normal. The rash recurred intermittently for the next five years, during which time she regained 52 kg. Treatment of the potassium hydroxide-positive skin lesion included various topical steroid and antifungal preparations. However, even with the systemic antifungal agent ketoconazole, the rash failed to completely resolve and continued to recur.Topical application of combined 1% iodoquinol and 1% hydrocortisone cream (Vytone) markedly improved the rash. However, traces of erythema remained in spite of treatment. Laboratory studies included a skin punch biopsy (Fig 2), which showed hyperkeratosis and parakeratosis with mild psoriasiform hyperplasia of the epidermis. Only slight focal