Josie is a 43-year-old teacher who presents with an abdominal and axillary rash present for several weeks.

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<p>Josie is a 43-year-old teacher who presents with an abdominal and axillary rash present for several weeks.</p><p>It is occasionally mildly itchy, but otherwise does not bother her.</p><p>Josie has obesity, with an otherwise unremarkable past medical history.</p><p>She has no known allergies and uses no regular medications.</p><p>About three months ago she started using a nightly emollient body cream.</p><p>The product is “low irritant and fragrance free” and contains water, glycerine, panthenol, petrolatum, oat kernel oil, benzalkonium chloride and sodium chloride.</p><p>She stopped using the product a few days ago but the rash hasn’t improved.</p><p>She has no systemic symptoms and examination reveals only the intertriginous rash involving the axillae, submammary region and abdominal fold (pictured).</p><p>Blood tests are normal, and skin biopsy shows parakeratosis with retention of keratohyalin granules within the stratum corneum.</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.