Intractable pruritic dermatosis of the perineum in a female with highly unusual pathological features.

We present a case of an atypical pruritic dermatosis of the perineum in a woman with highly unusual pathologic features. Initially unresponsive to multiple therapies, the patient responded remarkably quickly to doxepin. However, a gradual loss of efficacy was noted after only 1 month of treatment. Although the histopathologic features of the eruption overlapped somewhat with those of pagetoid dyskeratosis and papular acantholytic dyskeratosis, the absence of either epidermal acantholysis or dyskeratosis and a distinct clinical presentation differentiate this case from other described cases of dermatoses.