M. Zureigat1, 2
Amicrobial pustulosis of the folds is a recently described entity characterized by relapsing painful pustular eruptions predominantly involving the skin folds. It primarily affects women of child bearing age. So far, there have been 63 reported cases in the medical literature.
APF is a diagnosis of exclusion after ruling out infections and other pustular eruptions. A biopsy is essential for diagnosis. The association of this condition with autoimmune diseases has been highlighted in the literature with the majority of cases associated with autoimmune conditions mainly SLE. Various treatments have been proven successful including oral steroids, a combination of cimetidine and ascorbic acid, tetracyclines, dapsone, immunosuppresants, and ustekinumab.
We present a case of a 45 year old Caucasian female patient who presented to the emergency department at Canberra hospital with 4 year history of recurrent painful pustular rash in the axillae and the groin. Blood and microbiological testing failed to identify a cause. A biopsy suggested the diagnosis of amicrobial pustulosis of the folds. She was not found to have an associated autoimmune disease and failed to respond to potent topical steroids. She was subsequently treated successfully with colchicine with complete resolution of symptoms within 4 weeks of starting the treatment.