What is the best course of treatment for a patient with multiple localized axillary and groin dermatitis (LAD) in the armpits and groin area?

Treatment of Multiple Lymphadenopathy in Axillae and Groin

Critical First Step: Confirm the Diagnosis

The term "LAD" in this context most likely refers to lymphadenopathy (swollen lymph nodes), NOT a dermatological condition, and requires immediate evaluation to exclude serious systemic disease before any treatment is initiated. Multiple enlarged lymph nodes in both axillae and groin regions demand urgent assessment for:

• Lymphoma or other malignancies - bilateral axillary and inguinal lymphadenopathy is a red flag for systemic disease 1
• Infectious causes - including HIV, tuberculosis, or other systemic infections
• Hidradenitis suppurativa - if these are actually inflammatory nodules rather than true lymph nodes, as this condition characteristically affects axillae and groin 1, 2

If This is Actually Inflammatory Skin Disease (Hidradenitis Suppurativa or Dermatitis)

For Axillary and Groin Dermatitis/Inflammation

Use only low-to-medium potency topical corticosteroids in these intertriginous areas, never high-potency agents, due to dramatically increased absorption risk and potential for skin atrophy. 3

Specific Treatment Protocol:

• Apply hydrocortisone 1% cream or clobetasone butyrate 0.05% (Eumovate) to affected areas 3-4 times daily 1, 4
• Never use betamethasone, mometasone, or clobetasol in axillae or groin - these potent/very potent steroids cause rapid skin atrophy in occluded areas 1, 3

Essential Adjunctive Measures:

• Apply emollients liberally and frequently - use 15-30g per 2 weeks for groin/genital area and similar amounts for axillae 1
• Apply moisturizers within 3 minutes of bathing to lock in moisture 3
• Use lukewarm water for bathing, limit to 5-10 minutes, pat dry gently 3

If Secondary Infection is Present:

• Look for crusting, weeping, honey-colored discharge, or pustules as signs of bacterial superinfection 3
• Apply topical antibiotics in alcohol-free formulations for at least 14 days if infection is suspected 1, 3
• Obtain bacterial culture before starting antibiotics 3

For Hidradenitis Suppurativa (if nodules/abscesses present):

Hidradenitis suppurativa characteristically presents with painful nodules, abscesses, and sinus tracts in axillae and groin regions - this is a distinct entity requiring different management than simple dermatitis. 1

• Hurley Stage I-II disease: Topical clindamycin, oral tetracyclines, or intralesional corticosteroids 1
• Hurley Stage III or refractory disease: Requires systemic therapy including adalimumab, which is approved for moderate-to-severe HS 1

Critical Pitfalls to Avoid:

• Do not treat bilateral axillary and inguinal lymphadenopathy empirically without proper workup - this pattern demands exclusion of lymphoma and systemic disease 1
• Never use potent corticosteroids (betamethasone, mometasone, clobetasol) in axillary or inguinal folds - absorption is dramatically increased in these occluded areas 1, 3
• Avoid topical antihistamines - they increase contact dermatitis risk without proven efficacy 3
• Do not overlook signs of infection which can worsen despite appropriate anti-inflammatory treatment 3

Maintenance Strategy:

• Once controlled, use intermittent low-potency corticosteroids (twice weekly) plus daily emollients to prevent flares - this reduces recurrence by 7-fold 1, 3
• Continue barrier repair with regular moisturization even after inflammation resolves 1, 3