Hailey-Hailey

An 18-year-old white man with a "rash" on his forehead, neck, and upper part of the back for more than 5 years presented to the dermatology clinic complaining of chronic irritation and burning in these locations. He first became aware of the problem while playing football when he noticed that areas where his shoulder pads and helmet contacted his skin were red and irritated. He was treated by his primary care physician for contact dermatitis, and the areas partially responded to mild topical corticosteroids and emollients. Symptomatic worsening of the lesions, including increasing burning pain and a clear discharge, subsequently led to a primary care diagnosis of impetigo, which was treated with oral antibiotics. Again, there was partial improvement while taking the antibiotics but no resolution, and the areas of involvement continued to expand. Exacerbations over the next few years were diagnosed as tinea, psoriasis, and seborrheic dermatitis, with the patient reporting temporary and incomplete relief following treatment for all of the above diagnoses.