Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2024;14(2):e2024134 1

Trichomycosis Axillaris: An Underdiagnosed Hair 
Shaft Condition

Juan Manuel Liñán Barroso1, Norberto Sánchez Rodríguez2

1 Dermatology Department. Trichology Unit. Virgen del Rocío University Hospital, Seville, Spain

2 Neurology Department. Virgen del Rocío University Hospital, Seville, Spain

Citation: Liñán Barroso JM, Sánchez Rodríguez N. Trichomycosis Axillaris: An Underdiagnosed Hair Shaft Condition. Dermatol Pract 
Concept. 2024;14(2):e2024134. DOI: https://doi.org/10.5826/dpc.1402a134

Accepted: December 12, 2023; Published: April 2024

Copyright: ©2024 Liñán Barroso et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing Interests: None.

Authorship: All authors have contributed significantly to this publication. 

Corresponding Author: Juan Manuel Liñán Barroso, MD, Dermatology Department, Virgen del Rocío University Hospital, Manuel Siurot 
Avenue s/n, Seville, Seville (Spain), 41013. ORCID: 0000-0002-6023-3151; Telephone number: +34/955013057  
E-mail: juanm.linan.sspa@juntadeandalucia.es

Figure 1. Trichoscopy showing white-yellowish lumpy sheath-like 

masses attached to the hair shaft.

Case Presentation

A 27-year-old male patient with a history of hidradenitis 

suppurativa and hyperhidrosis presented with an anomalous 

appearance and fragility of bilateral axillary hair for five 

years, without involvement of other regions, which did not 

respond to treatment with sertaconazole cream. On physical 

examination, there was axillary hair with devitalized appear-

ance and positive pull and tug tests. Dermoscopy revealed 

white-yellowish lumpy sheath-like masses attached to the 

hair shaft. Wood’s light showed intense white color in the 

affected hair. Microscopic analysis confirmed the presence 

of mucoid sheaths around the hair and colonization of the 

hair shafts by gram-positive cocobacilli. Fungal culture was 

negative. The definitive diagnosis was trichomycosis axillaris 

caused by Corynebacterium flavescens, which resolved after 

one week of treatment with clindamycin gel.



2 Image Letter | Dermatol Pract Concept. 2024;14(2):e2024134

Teaching Point

Trichomycosis axillaris is an underdiagnosed condition 

that commonly affects the axillary region [1]. It should be 

 considered in the differential diagnosis in cases of abnormal 

appearance of the hair shaft.

References

1. Rojas Mora E, Freites Martínez A, Hernández-Núñez A,  

Borbujo Martínez J. Tricomicosis axilar: diagnóstico en imá-

genes, clínica, luz de Wood y dermatoscopia. Actas Dermosifil-

iogr. 2016; 108(3):264–6. DOI: http://dx.doi.org/10.1016/j.ad 

.2016.09.018 0001-7310/